Total prevalence of diabetes in the United States, 2002, all ages: [2003

National Diabetes Fact Sheet - CDC ]

18.2 million people
Diagnosed: 13.0 million
Undiagnosed: 5.2 million

Prevalence of diagnosed diabetes among Florida adults (18+ years), [2003

BRFSS data]
Over 1 million adults - 8.5% of Florida’s adult population have
been diagnosed with having diabetes.
An additional 300,000 – 400,000 persons are undiagnosed.
Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR)
Macular edema can be present at this stage and is defined as retinal thickening
within 3,000 m of the fovea (center of vision). Clinically significant macular
edema (CSME) occurs when edema threatens the center of vision or is within
500 m of the fovea. If photocoagulation is not performed the patient should
be carefully monitored and examined approximately every three months for
progression.
•Maintain good blood pressure control (< 130/80 mm Hg)
•Maintain normal blood cholesterol levels
•No smoking
The most common association is atherosclerosis followed by arterial hypertension.
Carotid artery disease occurs in 45%. The difference in etiology depends on age; if 
presentation is at less than 30 years, it is more associated with migraine, trauma and
coagulation disorders.
Presentation is usually with a sudden painless loss of vision. The onset of obstruction
is most often between midnight and 6 am and second most often from 6am to noon.
Vision at presentation is usually counting fingers to light perception and often remains
so regardless of treatmant. Studies have shown that about 35% get a VA of 20/200 or
better and 20% have 20/40 or better. On average, the age range is between the 5th and
6th decades.
            The central retinal artery supplies the inner 2/3 rd of the retina, the outer 1/3
rd being supplied by the choroidal circulation. The most common site of obstruction is
at the lamina cribrosa. Experiments have shown that the critical time after which
irreversible damage occurs is about 90-100 min
Afferent pupillary defect (APD) or Marcus Gunn pupil
-         The retina appears white because of intracellular edema except at the fovea
where it is thin and the choroid shows giving a 慶 herry red spot,?but this is not a
pathognomonic sign. In animal models, it was seen as early as 30 min after
obstruction.
-         Narrowing and irregularities of the arterioles and venules
-         In 1/5th of patients, a portion of the papillomacular bundle is supplied by a
cilioretinal arteriole from the ciliary circulation. This may preserve central vision.
Often the first sign of retinoblastoma that is noticed is leukocoria, a whitening
of the pupil that looks like a "cat's eye". This whiteness can be seen in certain
lighting conditions. It is often noticed in photographs of the child taken with a
flash, which usually causes the eyes to appear red in the picture. Instead of the
normal red reflex, you may notice a white pupil in the photo, which comes
from the white surface of the tumor itself. Other signs may include strabismus
or crossing of the eyes, which is noticed in 20% of children. Furthermore, in
approximately 10% of children, eye swelling with pain and redness occurs.
(Photo of leukocoria)
retinoblastoma can also spread into the brain, tumor cells may be floating in the cerebral spinal fluid (CSF)
that bathes the brain and the spinal column (inside the backbone).