Diabetic Retinopathy in Aging Patients Management and Special Considerations

It is important for the physician to recognize that patients may not fully understand how diabetes contributes to vision loss and may attribute it to a normal part of the aging process or an incorrect spectacles prescription. Diabetic retinopathy management includes management of both the level of retinopathy and diabetic macular edema. Macular edema is caused by an intercellular edema accumulation leading to thickening of the retina. Elevated blood sugar causes damage to the pericytes, leading to fluid accumulation. The ophthalmological exam should include visual acuity testing, stereoscopic biomicroscopic exam of the macula, and OCT and fluorescein angiogram (if macular edema is suspected). If the patient is found to have high risk progressive diabetic retinopathy, then panretinal photocoagulation should be applied to reduce the risk of severe visual acuity loss. Luckily, this condition is entirely treatable if caught and managed early in the process. Unfortunately, the United States has a poorer reputation among developing countries for diagnosing and managing this condition before the cases become extreme, which is why it is vital for physicians across specialties to be conscious of this comorbidity within the aging population.