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Back To Vidyya Diabetics Not Receiving Adequate Opthalmological Care

Study Appearing In The March Issue Of Ophthalmology

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 interview.

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 younger patients;

-- 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."

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Editor: Susan K. Boyer, RN
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