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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.
Q. Do antiplatelet agents (aspirin, dipyridamole and ticlopidine) increase the risk of intraocular bleeding in diabetic patients?
A. Because ischemia contributes to the ocular complications of diabetes, antiplatelet agents have been studied as a possible treatment and to determine if they are safe to use. The Early Treatment of Diabetic Retinopathy Study (ETDRS) evaluated 3711 patients with mild to severe retinopathy and followed them for eight years. Patients randomized to aspirin use had no effect (either positive or negative) on the development or progression of retinopathy. Antiplatelet agents can probably be used safely without exacerbating diabetic eye disease.
Q. How important are genetic factors in the development of diabetic retinopathy?
A. Genetic influences affect the severity of retinopathy. In 372 patients in the DCCT (Diabetes Control and Complications Trial), severe retinopathy was three times more frequent among the relatives of the retinopathy-positive patients.
Q. Does hypertension affect diabetic retinopathy?
A. Just as control of hypertension slows the rate of progression of diabetic nephropathy, it slows the rate of progression of diabetic retinopathy, and it reduces the risk of vitreous hemorrhage. Furthermore, there is increasing evidence that more rigorous blood-pressure control is warranted in patients with diabetes than in nondiabetic patients. The UKPDS (United Kingdom Prospective Diabetes Study) showed in 1148 patients that tighter BP control had an overall 24 percent reduction in diabetes-related endpoints.