Findings from a study appearing in
the March issue of Ophthalmology, the journal of the American Academy of
Ophthalmology, indicate more than one third of people with diabetes do not
adhere to vision care guidelines established by both the Academy and the
American Diabetes Association.
According to the study, nearly all people with diabetes will experience
some form of diabetic retinopathy over time. Diabetic retinopathy is a
potentially serious condition in which the blood vessels inside the retina
become damaged from the high blood sugar levels associated with diabetes. The
retina is the nerve layer that lines the inside of the eye and converts light
into nerve signals that the brain can interpret. Diabetic retinopathy is the
leading cause of new cases of blindness among adults in the United States each
year, accounting for 8,000 cases annually and costing the United States
$500 million in lost income.
Researchers asked 2,308 people with diabetes if they had a yearly dilated
eye examination as recommended in the guidelines, and then evaluated factors
affecting whether or not they received the examinations. The study was
conducted by the Department of Preventive Medicine at the University Medical
Center at Stony Brook, New York and supported by a grant from the National Eye
Institute. Eight hundred thirteen study participants (35 percent) reported
they had not received dilated eye examinations in the year prior to the study
Academy president and retina specialist George Blankenship, M.D. said, "It
is important to dilate the pupils when examining eyes of people with diabetes
to get an adequate view of the retina. Without dilating the eye, it's like
looking inside a room through a keyhole instead of an open door." Treatment is
most effective in saving vision if diabetic eye disease is diagnosed in the
early stages. Previous studies have shown that effective treatments for
diabetic retinopathy can reduce severe vision loss by up to 94 percent.
Researchers said factors affecting whether or not patients with diabetes
received dilated eye examinations included:
-- Physician Referrals: Patients were more likely to have regular eye
examinations when recommended by their physicians;
-- Type of Eye Care Professional: Patients who were examined by
ophthalmologists (Eye M.D.s) were more likely to have a dilated eye
examination than those examined by optometrists;
-- Age: Older patients were more likely to follow the guidelines than
-- Education: Patients who participated in formal diabetes education
programs were more likely to adhere to the vision care guidelines.
Another finding was that people with type 1 or insulin-dependent diabetes
were more likely to have annual dilated eye examinations than those with type
2 or adult-onset diabetes. Although vision loss tends to be more severe in
patients with type 1 diabetes, the lack of adherence among those with
type 2 diabetes was considered a public health concern, since approximately
90 percent of diabetic patients have type 2 diabetes. The differences in
examinations by diabetes type may reflect the practices of some health care
providers who believe it is not cost effective for people with
type 2 diabetes, without signs of diabetic retinopathy, to have an annual
dilated eye examination.
The study also found many patients had received eye examinations that did
not include dilation. "This suggests a missed opportunity to supply
comprehensive vision care to persons with diabetes and highlights a potential
weakness in the current health care system," the study stated.
The study's recommendations included:
-- Providing both patients with diabetes and health care providers
information about diabetes and diabetes-related eye disease;
-- Educating both patients with diabetes and health care professionals
about the importance of dilated eye examinations;
-- Encouraging physicians to recommend annual dilated eye examinations to
their patients with diabetes.
"This study underscores the importance of educating both people with
diabetes and health care professionals about diabetic retinopathy and the
importance of receiving regular dilated eye examinations," Dr. Blankenship
said. "It is also important that health care professionals and those in charge
of heath care policy realize that following these guidelines makes sense, both
medically and financially."