Preventive Eye Care Lacking in 40% of People with Diabetes

medical health care concept with a human sight organ being erased by a pencilDespite recent advances in prevention and treatment of most diabetes-related vision loss, a new study in JAMA Ophthalmology shows that less than half of people with diabetic macular edema (DME) know about the association between the diabetes and visual impairment, and only 60% had their eyes fully examined in the year leading up to the study.

"As a nation, we are woefully inadequate as health care providers in explaining to our patients with diabetes that the condition can have a detrimental effect on their eyes," said lead author Neil M. Bressler, MD, Professor of Ophthalmology at the Johns Hopkins University School of Medicine and Chief of the Retina Division at the Johns Hopkins Wilmer Eye Institute, Baltimore, MD. "The earlier we catch diabetic eye disease, the greater the likelihood that we can help patients keep their good vision."

"While there has been a tremendous amount of advancement in treatment options for diabetic eye disease, particularly diabetic macular edema, these treatment options are limited if the patient is unaware of their eye disease," commented John Kitchens, MD, an ophthalmologist and vitreoretinal surgeon with Retina Associates of Kentucky in Lexington, KY, and clinical spokesperson for the American Academy of Ophthalmology. "The importance of ensuring that patients with diabetes understand the consequences of their condition on their eyes and the need for proper monitoring is essential," he said.

"We can prevent a lot of vision impairment or blindness if we can just get these people into the medical system," Dr. Bressler said. Possible causes of failure to see eye doctors is a lack of health insurance, lack of referral to eye care specialists, and a lack of understanding among patients about the risks, he said.

Lack of Education, Underuse of Medical Services Found
Dr. Bressler and colleagues examined 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES). DME was diagnosed in a total of 48 out of 798 people older than 40 years of age with a self-reported diagnosis of type 2 diabetes who underwent retinal imaging. Of these patients with DME, only 45% reported being told by a physician about the link between diabetes and vision problems.

In addition, only 47% visited a diabetes nurse educator, dietician, or nutritionist for diabetes care in the previous year and only 60% received an eye examination with pupil dilation in the previous year. Approximately 30% of the individuals with DME already had some type of vision loss related to the disease.

Key Findings and Study Limitations
The key finding from the study is that "people with diabetes lack adequate understanding of the impact of retinopathy on their vision," commented Dr. Kitchens. "This impacts not only patients at risk for developing the complications of diabetic eye disease, but also those currently affected by the most common cause of vision loss from diabetic retinopathy—diabetic macular edema—in which only 45% of affected patients were told that diabetes can affect their eyes."

"The authors do a good job of describing the limitations of this study, the most important of which are the small sample size and the fact that the answers to the questions which generate the results are self-reported by the patients (ie, there is a potential for recall bias)," Dr. Kitchens said.

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