Diabetic eye disease is the leading cause of blindness in Americans under 55 years of age. Of the 16 million people who have been diagnosed with diabetes, more than 5 million have diabetic retinopathy. Many patients are undiagnosed and at risk for vision problems. Obesity is also increasing nationwide and will dramatically affect the incidence of diabetic eye disease and hypertension.
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 Treatment
Visual 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.