Diabetes-Related Vision Loss a Major Issue

In a recent survey, less than half of Americans with diabetes-related vision loss and impairment indicated that they were aware of the connection between the disease and their eyesight. In the year prior, only 6 in 10 patients with diabetes and visual impairment had a full eye exam and nearly half had not visited a clinician to manage their condition, according to the results published in JAMA Ophthalmology. “Our study determined the magnitude of the problem, but did not determine the crux of the problem,” says lead author Neil M. Bressler, MD, a professor of ophthalmology at the Johns Hopkins University School of Medicine and chief of the retina division at the Johns Hopkins Wilmer Eye Institute. “Nevertheless, the study indicates that we need to identify the problem, and then determine solutions to the problem, since these complications are common, of importance to the patient and the public health, and have excellent treatments.” Diabetic patients have at least a 10% risk of developing diabetic macular edema, a condition that devastates central vision and the ability to see detailed images. When left untreated for a year or more, it can lead to permanent vision loss. However, with prompt diagnosis and proper treatment, visual impairment can be improved and vision loss can be prevented in these patients. “We certainly need to be sure that all primary care providers are telling their patients with diabetes that they need to have the retina examined periodically to determine if diabetic macular edema and other retinal problems associated with diabetes are developing or need treatment, even in the absence of any symptoms,” Bressler says. He and his colleagues performed a cross-sectional analysis of data from participants in the 2005 to 2008 National Health and Nutrition Examination Survey. They narrowed it down to 798 patients age 40 or older who had a diagnosis of type 2 diabetes and who had retinal imaging done. Of these, 48 had diabetic macular edema and participated in the survey. Only 44.7% reported being told by a physician that diabetes had affected their eyes or that they had retinopathy. Just 46.7% said they had visited a diabetes nurse educator, dietician, or nutritionist for their diabetes mellitus more than 1 year ago or never, and 59.7% indicated that they had received an eye exam with pupil dilation in the last year. “The study identified the magnitude of the problem—which is substantial—but does not provide hypotheses to suggest strategies to mitigate the problem,” Bressler says. “Armed with the information from this study, researchers should place a high priority on determining which strategies would mitigate this problem, and it is hoped that funding agencies such as the government-sponsored National Institutes of Health will use this information to justify a high priority to fund strategies that peer review suggest should be pursued.” —Colleen Mullarkey Reference Bressler NM, Varma R, Doan QV, Gleeson M, Danese M, Bower JK, et al. Underuse of the health care system by persons with diabetes mellitus and diabetic macular edema in the United States. JAMA Ophthalmol. December 19, 2013. [Epub ahead of print].