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Clinical Questions In Managing Patients With Diabetic Eye Disease |
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Doctor Profile |
In 2002 the total economic cost of diabetes was estimated to be $132 billion, which translates to one in every ten healthcare dollars spent in the US.
Diabetes is the fifth deadliest disease in the US.
Nearly all patients who have Type 1 diabetes for about 20 years will have evidence of diabetic retinopathy.
Up to 21% of people with Type 2 diabetes have retinopathy when they are first diagnosed with diabetes, and most will eventually develop some degree of retinopathy.
In the United States, diabetes is responsible for 8% of legal blindness, making it the leading cause of new cases of blindness in adults 20-74 years of age. Each year 12,000 to 24,000 people lose their sight because of diabetes.
Glaucoma, cataract and corneal disease are more common in people with diabetes and contribute to the high rate of blindness.
Martha Jefferson Hospital And The Definitive Surgical Management Of Diabetic Retinopathy
Panretinal laser photocoagulation is not always successful in preventing progressive disease. Failure of laser therapy to halt new vessel proliferation can result in severe visual impairment due to extensive vitreous hemorrhage or to fibrous contraction of mature neovascularization causing traction retinal detachment. Pars Plana vitrectomy, an intraocular surgical procedure, is then required to treat these disorders. Although vitrectomy surgery is extremely effective in treating these disorders, visual acuity may still be limited due to retinal ischemia, edema or recurrent hemorrhage. The new Vitreoretinal Surgery program at Martha Jefferson Hospital offers comprehensive surgical capabilities in managing all aspects of advanced proliferative disease. Specifically trained OR staff and state-of-the-art microsurgical instrumentation allow full-function vitrectomy surgery to complete the armamentarium a retinal surgeon may need to treat even the most advanced cases.
New Directions In Diabetic Eye Disease
Several pharmacologic agents are in development to manage the complications of diabetic retinopathy. Anti-VEGF compounds such as pegabtanib sodium (already approved for macular degeneration) and ranizumab are potent inhibitors of vascular permeability and neovascularization. Protein kinase C inhibitors such as ruboxistaurin are also currently in Phase III trials for the treatment of diabetic macular edema. Since intraocular steroids are felt to diminish diabetic macular edema, retinal specialists are optimistic that long-acting sustained-release steroid implants may be helpful in managing diabetics as well.
