Current Trends Screening for Diabetic Eye Disease --
Mississippi
Diabetes mellitus is a major cause of visual impairment and
blindness in the United States. Diabetes predisposes people to
retinopathy and maculopathy, diseases of the small vessels that
nourish the retina. People with diabetes are also at increased
risk
for developing glaucoma and cataracts.
Of the estimated 5 million people with diabetes in the United
States, 25%-50% may have retinopathy, and 10% of those may be at
risk
for visual loss. Proliferative retinopathy is more prevalent among
people with insulin-dependent (Type I) diabetes, but since many
more
people have non-insulin-dependent (Type II) diabetes, there may be
as
many people with proliferative retinopathy and Type II diabetes as
there are with Type I diabetes. All people with diabetes are at
risk
for developing diabetic maculopathy, but those with Type II
diabetes
appear to be at increased risk. People with diabetes are 1.3 times
more likely to have glaucoma and 1.6 times more likely to have
cataracts than nondiabetic individuals.
Early age of onset and long duration of diabetes are risk
factors
for the development of diabetic retinopathy. Poor glycemic control
and coexistent hypertension may accelerate the natural history of
retinopathy. Pregnancy increases the risk of visual loss in
diabetic
women with serious preexisting retinopathy.
The Diabetic Retinopathy Study, conducted by the National
Institutes of Health's National Eye Institute, demonstrated that
panretinal photocoagulation can delay or prevent severe visual loss
in
more than 50% of eyes with proliferative retinopathy (1). Surgical
vitrectomy can restore vision in some people with severe visual
loss
due to vitreous hemorrhage or macular detachment. Some studies
have
suggested that focal photocoagulation may preserve vision in some
people with diabetic macular edema. Medical and surgical therapies
are often effective in treating open-angle glaucoma, and surgery
can
be effective in restoring vision in up to 95% of people with senile
cataracts and no significant retinopathy.
In January 1983, the Mississippi Diabetes Control Program
instituted a comprehensive screening and treatment program for
diabetic eye disease in its public health eye clinics. Patients
are
examined clinically and with fluorescein angiography. Treatment is
provided as indicated by the examination, and patients are tracked
and
placed into a system for annual re-examination to assure follow-up
and
to assess the impact of the intervention. To date, 48 individuals
with diabetes have been screened at the public health eye clinic in
Greenville. Twenty-seven percent had diabetic retinopathy by
clinical
examination; by fluorescein angiography, 31% were found to have
retinopathy, including 8% with preproliferative retinopathy. Four
percent had increased intraocular pressure, and 17% had cataracts.
Twenty-five percent had other non-diabetes-related eye conditions.
Based on these findings, seven of the 48 patients required
treatment,
including one with a detached retina, one with intraocular
hypertension, one with glaucoma, and four with blepharitis.
Although
none required treatment for retinopathy, six required careful
follow-up at less than the usual yearly interval.
Reported by E Thompson, MD, B Parker, Bureau of Personal Health
Svcs,
Mississippi State Dept of Health; Div of Diabetes Control, Center
for
Prevention Svcs, CDC.
Editorial Note
Editorial Note: Epidemiologic studies are needed to more clearly
define risk factors for the development of diabetic eye disease.
It
is clear, however, that timely diagnosis and treatment can preserve
vision in large numbers of people with diabetic eye disease.
Programs
like that being conducted by Mississippi help prevent visual
impairment and blindness caused by diabetic eye disease.
Reference
The Diabetic Retinopathy Study Research Group.
Photocoagulation
treatment of proliferative diabetic retinopathy. Clinical
application of diabetic retinopathy study (DRS) findings. (DRS
report no. 8). Ophthalmology 1981;88(7):583-600.
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