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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.
Blindness in diabetes usually results from macular edema, vitreous hemorrhage or tractional detachment of the retina. While serious levels of visual loss are associated with Proliferative Diabetic Retinopathy (PDR) in Type I DM, chronic and progressive macular edema affects many more patients, most of whom are noninsulin dependent. Since most clinical trials have found that treatment is more effective at preventing visual loss, early intervention is essential in all aspects of diabetic eye disease.
Visual loss due to diabetic retinopathy frequently progresses without detection. Fewer than 50% of all diabetics undergo annual eye examinations.
Importance Of Early Diagnosis And TreatmentVisual loss due to diabetic retinopathy frequently progresses without detection. Fewer than 50% of all diabetics undergo annual eye examinations. Educational programs to enhance the awareness of diabetic eye disease among healthcare professionals and patients are critical in decreasing its overall morbidity.
A complete ophthalmic evaluation, including a dilated fundus exam, is extremely sensitive and specific in diagnosing diabetic retinopathy. Concomitant diseases such as cataracts and glaucoma, which occur with higher frequency in diabetics, can also be detected. Adjunctive testing, while usually not required for diagnosis, is often employed by retina subspecialists to better evaluate and treat diabetic retinopathy. Fluorescein angiography of the retina is helpful in delineating zones of capillary nonperfusion, retinal edema and neovascular proliferation. Optical Coherence Tomography (OCT), a new measurement and imaging technique, is a non-invasive method to examine retinal cross-sections with very high resolution. OCT is particularly helpful in diabetics to monitor macular edema.
All diabetics should undergo dilated ophthalmic examinations at regular intervals. Type II diabetics, many of whom have had poor glycemic control for many years prior to diagnosis, should be examined at the time of diagnosis.