Eye Health: Insights for Patients with Diabetes

If all individuals with diabetic retinopathy were treated in a timely manner, the incidence of blindness from diabetes could be decreased by 90%. Many factors that are completely within your own control have a notable impact on reducing your risk of diabetic retinopathy, including regulating blood sugar and blood pressure, and following recommended checkups.¹

What Can I Do?

Although some people may not feel they need eye care, most early eye disease has no signs or symptoms. Following recommended exam schedules detects and promotes treatment of diabetic eye disease and cuts the occurrence of severe vision loss by half or more,² and early detection and treatment of diabetic retinopathy reduces vision loss by up to 60%.^2-4 Half of adult patients with diabetes do not have annual eye care, however.¹ The most common reasons for skipping eye care given by individuals are that they do not feel they need it or they cannot afford it.²

Medicare covers a yearly exam for diabetic neuropathy, and many individuals now have vision coverage through their health insurance.⁵ Patients with health insurance are more likely to have recommended eye exams.² Lack of insurance increases the probability of eye problems.² Uninsured and lowincome individuals are the patients most likely to cite cost as a reason for not seeking care, but even without insurance, dilated eye exams have low upfront costs, reduce patients’ overall costs, and increase quality of life.^2,6

Who Is Going to Benefit?

Diabetes is on the rise¹: it currently affects nearly 26 million Americans, or about 8% of the US population.⁷ The Centers for Disease Control and Prevention (CDC) recently reported that nearly 2 million individuals were newly diagnosed with diabetes in 2010.⁷ Of that group, 30% of adults had prediabetes (high blood glucose or glycosylated hemoglobin [A1C] level, but not high enough to be considered diabetic) and half of the elderly population was prediabetic.⁷ It is estimated there will be 366 million individuals with diabetes worldwide by 2030.¹

Diabetic retinopathy is a complication of diabetes and is the leading cause of new-onset blindness in US adults.^1,7 Because vision decreases slowly with age, many patients do not even realize they have a problem.⁷ More than 33,000 new cases of diabetic macular edema and 86,000 cases of proliferative diabetic retinopathy are diagnosed every year in the United States, along with 12,000 to 14,000 new cases of blindness.¹ In addition, within 3 years after a diagnosis of diabetes, 28% of adults will develop diabetic retinopathy and 4% will have advanced retinopathy, which can lead to vision loss.⁷

Diabetic retinopathy happens in most patients with type 1 diabetes and is seen in over 77% of patients with type 2 diabetes within 20 years after receiving a diagnosis.¹ The longer a person has had diabetes, the higher the chance of retinopathy and blindness.^1,8 Therefore, the elderly are more affected by diabetic retinopathy, at a rate of 27% of individuals older than 65 years.⁷

What Can I Do for Myself?

Treating diabetes can reduce the risk of diabetic retinopathy by 90%.^1,8 The only ways to prevent diabetic retinopathy are by controlling blood sugar, blood pressure, and other factors.¹ For example, intensive blood glucose control reduces diabetic retinopathy, even if your A1C level does not improve.¹ In addition, hypertension worsens diabetic retinopathy, as do high cholesterol and high lipid levels.¹ Losing weight, exercising, and improving nutrition can significantly improve your health and slow or prevent complications from diabetes.^2,7,8 For instance, early use of antioxidants and zinc can reduce visionthreatening age-related macular degeneration by 25%.⁶

Adhering to health checks (glucose, blood pressure, and cholesterol monitoring; eye and foot exams) recommended by your primary care practitioner (PCP) can reduce the likelihood of eye problems.⁸ Detecting and treating diabetic eye disease can reduce the rate of severe vision loss by half.⁷

What if Self-Care Is not Enough?

For most (65%) patients with diabetes, vision is adequately helped by glasses.⁷ If glasses and other self-care are not enough, you can talk to your PCP about the following treatments:

• Laser photocoagulation more than halves vision loss from diabetic retinopathy, to less than 2%.1
• Early vitrectomy (removal of the clear gel that fills the eye between the lens and the retina) in patients with type 1 diabetes may reduce the amount of time they have poor vision after diabetic vitreous hemorrhage (bleeding).^1,3 Early vitrectomy showed no advantage for type 2 diabetes.^3,9

Taking control of your eye health can have long-lasting benefits. Following recommended exam schedules has been shown to reduce eye problems in people with diabetes.²

Debra Freiheit has been a practicing pharmacist and human services professional for over 25 years. Specializing in medical information, Debra has compiled a broad spectrum of experience obtained through research for companies including Cerner and PPD Inc. With an emphasis on clear and concise information transfer, Debra has built a career communicating data with medical professionals and patients. Education and knowledge have been her motivation for a rich career of caregiving through research. Debra’s current project involves the creation of a multinational database of drug information.

References

• World Health Organization. Prevention of Blindness from Diabetes Mellitus: Report of a WHO Consultation in Geneva, Switzerland, 11 November, 2005. Switzerland: World Health Organization; 2006. ISBN: 92 4 154712 X.
• Chou CF, Sherrod C, Zhang X, et al. Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006-2010. Diabetes Care. 2014;37(1):180-188. doi: 10.2337/dc13-1507.
• Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic neuropathy. Two-year results of a randomized trial. Diabetic Retinopathy Virectomy Study report 2. Arch Ophthalmol. 1985;103(11):1644-1652.
• Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol. 2012;60(5):428-431. doi:10.4103/0301-4738.100542.
• Your medicare coverage: is my test, item, or service covered? Medicare website. www.medicare.gov/coverage/yearly-eye-exam.html. Accessed September 9, 2015.
• Rein DB, Wittenborn JS, Zhang X, et al. The cost-effectiveness of welcome to medicare visual acuity screening and a possible alternative welcome to medicare eye evaluation among persons without diagnosed diabetes mellitus. Arch Ophthalmol. 2012;130(5):607-614. doi:10.1001/archopthalmol.2011.1921.
• National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Centers for Disease Control and Prevention website. www.familydocs.org/f/CDC%20Diabetes%20fact%20sheet-2011.pdf. Published 2011. Accessed September 1, 2015.
• Fout BT, Gilleskie DB. Does health insurance encourage or crowd out beneficial nonmedical care? A dynamic analysis of insurance, health inputs, and health production. Amer J Health Economics. 2015;1(2):125-164.
• Diabetic Retinopathy Vitrectomy Study. Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report No. 1. Ophthalmology. 1985:92(4):492-502.