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Disease Management by Prevention

The Prospects for Diabetic Retinopathy

  • Review Article
  • Published:
Disease Management and Health Outcomes

Abstract

Diabetic retinopathy is a significant cause of visual loss in developed countries. Data from epidemiological studies and controlled clinical trials have resulted in treatment strategies, which are highly successful in preventing blindness. These strategies involve measures that require both education and compliance of the individual with diabetes mellitus and the education of physicians and paramedical staff who deliver care to these patients. This paper presents the classification of diabetic retinopathy and the treatment strategies, both the preventive measures and the active treatment modalities used for diabetic retinopathy. Persons with diabetes should be invited from the first day of diagnosis to be active partners working towards the prevention of diabetic complications.

The management of patients with diabetes includes essential medical preventive measures such as tight glucose level and blood pressure control and the lowering of serum cholesterol levels to successfully decrease the risk of microvascular complications, namely diabetic retinopathy, neuropathy and nephropathy. Persons with diabetes should also be aware of the importance of screening for diabetic retinopathy and the beneficial effects of timely laser photocoagulation and other surgical interventions.

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References

  1. Davis MD, Fisher MR, Gangnon RE, et al. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: early treatment diabetic retinopathy study report #18. Invest Ophthalmol Vis Sci 1998; 39: 233–52

    PubMed  CAS  Google Scholar 

  2. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS Report no. 12. Ophthalmology 1991; 98: 823–33

    Google Scholar 

  3. Klein BEK, Moss SE, Klein R, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, X: relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology 1991; 98: 1261–5

    PubMed  CAS  Google Scholar 

  4. Chew EY, Klein ML, Ferris III FL, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Arch Ophthalmol 1996; 114: 1079–84

    Article  PubMed  CAS  Google Scholar 

  5. The Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. ETDRS report no. 1. Arch Ophthalmol 1985; 103: 1796–806

    Article  Google Scholar 

  6. Murphy RP. Management of diabetic retinopathy. Am Fam Physician 1995; 51: 785–96

    PubMed  CAS  Google Scholar 

  7. The Diabetic Retinopathy Study Research Group. Four risk factors for severe visual loss in diabetic retinopathy: the third report of the diabetic retinopathy study. Arch Ophthalmol 1979; 97: 654–5

    Article  Google Scholar 

  8. Diabetic Retinopathy Study Group. A modification of the Airlie House classification of diabetic retinopathy. Invest Ophthal Vis Sci 1981; 21: 210–26

    Google Scholar 

  9. Fong DS, Ferris FL, Davis MD, et al. Causes of severe visual loss in the Early Treatment Diabetic Retinopathy Study: ETDRS report no. 24. Am J Ophthalmol 1999; 127: 137–41

    Article  PubMed  CAS  Google Scholar 

  10. Kostraba JN, Klein R, Dorman JS, et al. The epidemiology of diabetes complications study. IV Correlates of diabetic background and proliferative retinopathy. Am J Epidemiol 1991; 133: 381–91

    PubMed  CAS  Google Scholar 

  11. Harris MI, Robbins DC. Prevalence of adult onset IDDM in the US populations. Diabetes Care 1994; 17: 1337–40

    Article  PubMed  CAS  Google Scholar 

  12. Klein R, Klein BEK, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984; 102: 520–6

    Article  PubMed  CAS  Google Scholar 

  13. Klein R, Klein BEK, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984; 102: 527–32

    Article  PubMed  CAS  Google Scholar 

  14. Klein R, Klein BEK, Moss SE, et al. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy. JAMA 1988; 260: 2864–71

    Article  PubMed  CAS  Google Scholar 

  15. Klein R, Klein BEK, Moss SE, et al. Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Arch Intern Med 1994; 154: 2169–78

    Article  PubMed  CAS  Google Scholar 

  16. Lloyd CE, Klein R, Maser RE, et al. The progression of retinopathy over 2 years: the Pittsburgh epidemiology of diabetes complications (EDC) study. J Diab Complications 1995; 3: 140–8

    Article  Google Scholar 

  17. Janka HU, Warram JH, Rand LI, et al. Risk factors for progression of background retinopathy in long-standing IDDM. Diabetes 1989; 38: 460–4

    Article  PubMed  CAS  Google Scholar 

  18. Teuscher A, Schnell H, Wilson PWF. Incidence of diabetic retinopathy and relationship to baseline plasma glucose and blood pressure. Diabetes Care 1988; 11: 246–51

    Article  PubMed  CAS  Google Scholar 

  19. Marshall G, Garg SK, Jackson WE, et al. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus. Ophthalmology 1993; 100: 1133–9

    PubMed  CAS  Google Scholar 

  20. Krolewski AS, Warram JH, Rand LI, et al. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-year follow-up study. Diabetes Care 1986; 9: 443–552

    Article  PubMed  CAS  Google Scholar 

  21. Arfken CL, Salicrup AE, Meuer SM, et al. Retinopathy in African Americans and Whites with insulin-dependent diabetes mellitus. Arch Intern Med 1994; 154: 2597–602

    Article  PubMed  CAS  Google Scholar 

  22. Krolewski AS, Barzilay J, Warram JH, et al. Risk of early-onset proliferative diabetic retinopathy in IDDM is closely related to cardiovascular autonomic neuropathy. Diabetes 1992; 41: 430–7

    Article  PubMed  CAS  Google Scholar 

  23. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86

    Article  Google Scholar 

  24. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. Arch Ophthalmol 1995; 113: 36–51

    Article  Google Scholar 

  25. The Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposures (HbA1C) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes 1995; 44: 968–83

    Article  Google Scholar 

  26. The Diabetes Control and Complications Trial Research Group. Perspectives in Diabetes. The absence of a glycemic threshold for the development of long-term complications: the perspective of the Diabetes Control and Complications Trial. Diabetes 1996; 45: 1289–98

    Article  Google Scholar 

  27. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 1993; 329: 304–9

    Article  PubMed  CAS  Google Scholar 

  28. Dahl-Jorgensen K, Brinchmann-Hansen O, Hanssen KF, et al. Rapid tightening of blood glucose control leads to transient deterioration of retinpathy in insulin-dependent diabetes mellitus: the Oslo Study. BMJ 1985; 290: 811–5

    Article  PubMed  CAS  Google Scholar 

  29. Kroc Collaborative Study Group. The Kroc Study patients at two years: a report on further retinal changes. Diabetes 1985; 34:39

    Google Scholar 

  30. Lauritzen T, Frost-Larsen K, Larsen HW, et al. Steno Study Group. Effect of one year of near-normal blood glucose levels on retinpathy in insulin-dependent diabetics. Lancet 1983; I: 200–4

    Article  Google Scholar 

  31. Klein R, Klein B, Moss S. Relation of glycemic control to diabetic microvascular complications in diabetes mellitus. Ann Intern Med 1996; 124: 90–6

    PubMed  CAS  Google Scholar 

  32. Ohkubo Y, Hideke K, Eiichi A, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diab Res Clin Pract 1995; 28: 103–17

    Article  CAS  Google Scholar 

  33. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53

    Article  Google Scholar 

  34. UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with Type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854–65

    Article  Google Scholar 

  35. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13

    Article  Google Scholar 

  36. Chaturvedi N, Sjolie AK, Stephen JM, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. Lancet 1998; 351: 28–31

    Article  PubMed  CAS  Google Scholar 

  37. Fong DS, Segal PP, Myers F, et al. Subretinal fibrosis in diabetic macular edema, ETDRS Report No. 23. Arch Ophthalmol 1997; 115: 873–7

    Article  PubMed  CAS  Google Scholar 

  38. Ferris FL. How effective are treatments for diabetic retinopathy? JAMA 1993; 269(10): 1290–1

    Article  PubMed  Google Scholar 

  39. Brechner RJ, Cowie CC, Howie J, et al. Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA 1993; 270: 1714–8

    Article  PubMed  CAS  Google Scholar 

  40. Wang F, Javitt JC. Eye care for elderly Americans with diabetes mellitus. Failures to meet current guidelines. Ophthalmology 1996; 103: 1744–50

    PubMed  CAS  Google Scholar 

  41. Diabetes care and research in Europe. The saint vincent declaration. Diabetic Med 1990; 7: 360

    Article  Google Scholar 

  42. Javitt JC, Canner JK, Frank RG, et al. Detecting and treatment retinopathy in patients with type 1 diabetes mellitus. Ophthalmology 1990; 97: 483–95

    PubMed  CAS  Google Scholar 

  43. Javitt JC, Aiello LP, Bassi LJ, et al. Detecting and treating retinopathy in patients with type 1 diabetes mellitus: savings associated with improved implementation of current guidelines. Ophthalmology 1991; 98: 1565–74

    PubMed  CAS  Google Scholar 

  44. Javitt JC, Aiello LP. Cost-effectives of detecting and treating diabetic retinopathy. Ann Intern Med 1996; 124: 164–9

    PubMed  CAS  Google Scholar 

  45. Savolainen EA, Lee AP. Diabetic retinopathy — need and demand for photocoagulation and its cost-effectiveness: evaluation based on services in the United Kingdom. Diabetologia 1982; 23: 138–40

    Article  PubMed  CAS  Google Scholar 

  46. American Academy of Ophthalmology. Diabetic retinopathy. Preferred practice pattern. San Francisco: American Academy of Ophthalmology, 1998

    Google Scholar 

  47. Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20: 735–44

    Article  PubMed  CAS  Google Scholar 

  48. Hanson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. HOT Study Group. Lancet 1998; 351: 1755–62

    Article  Google Scholar 

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Correspondence to Emily Y. Chew.

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Chew, E.Y. Disease Management by Prevention. Dis-Manage-Health-Outcomes 6, 279–290 (1999). https://doi.org/10.2165/00115677-199906050-00005

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