Casting light on diabetic eye disease: Better understanding is key to prevention


Dr Tunde Peto explains that the rate of blindness from diabetes continues to increase by 8% annually and the only way to prevent this may well rest with well-planned, evidence-based services.

Reviewed by Dr Tunde Peto

The rate of blindness from diabetes continues to increase by 8% annually and the only way to prevent this rests with well-planned, evidence-based services, Dr Tunde Peto, professor of clinical ophthalmology at Queen’s University Belfast in Northern Ireland,said.

This increase in the incidence of blindness is accompanied by some astounding statistics: patients with diabetic macular oedema (DMO) report profound effects on their quality of life For example, 69% reported days of poor physical and mental health, and 79% said that DMO made driving and completing their everyday tasks difficult if not impossible.

Moreover, 21% of ophthalmologists have reported not having received training in the diagnosis and treatment of diabetic retinopathy (DR) and DMO and 44% had no written protocols to follow for managing visual loss related to diabetes, Dr Peto, who is also clinical lead for diabetic eye screening and a medical retina consultant, enumerated.

The good news is that this scenario is fixable by getting to the root of the problem: diabetes can be prevented, which lowers the incidence by 26% and prevention can have a great impact on the costs associated with diabetes in that 80% of the outlay by the National Health Service in the UK is for preventable diabetes complications.

To bring down the annual rate of blindness, Dr Peto believes that physicians need a better grasp of the disease process. “Our detailed understanding came from early trials such as Early Treatment Diabetic Retinopathy Study and the Diabetes Control and Complications Trial, but it is time for updating this knowledge,” she said.

In the early 1990s, The Airlie House fields classification of DR was modified to its current status to better capture DMO, but classification of the DR remained to be based on features such as microaneurysms, haemorrhages, vascular abnormalities and new vessels.

The advent of new cameras and imaging modalities with enhanced visualisation may mean that the disease classification needs further refinement leading to potentially better care provision. The key to better management is awareness on the part of physicians and patients. Diabetes-related damage happens over an extended period. Physicians must perform regular evaluations of patients and educate them about diabetes, with the recognition that the patients may not fully appreciate the potential for complications of the disease.

Dr Peto cited a 2013 study that reported that more patients with background bilateral DR advanced to maculopathy significantly faster compared with patients with no DR or unilateral DR. Laser treatment and intravitreal injections of vascular endothelial growth factor therapy are both effective and appropriate treatment approaches, but cost may be an issue.

The rate of blindness from diabetic eye disease is rising but can be slowed down or reversed by having regular eye examinations, and appropriate interventions are the only way to prevent blindness. Available treatment options, clinical pathways, the characteristics of the population and costs must be kept in mind when treating patients, Dr Peto concluded.

Dr Peto has no financial interest in this subject matter.

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