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Recommended care reduces low vision, blindness among diabetic patients
Ophthalmology. 2009;116(8):1515-1521.
Patients diagnosed with diabetes mellitus who received recommended care experienced a reduction in low vision and blindness over a 3-year interval, a study showed.
The retrospective, longitudinal cohort study included 5,989 patients diagnosed with diabetes mellitus but not with diabetic retinopathy. Investigators followed patients for up to 3 years.
Recommended care was defined as patients undergoing, an average of 0.75 times annually, physician examination, evaluation by an ophthalmologist or optometrist, hemoglobin A1c measurement, lipid measurement and urinalysis. Investigators used propensity score matching to compare visual outcomes of patients who had guideline-recommended care and those who did not have recommended care.
Primary outcome measures were progression of diabetic retinopathy, proliferative diabetic retinopathy, macular edema, proliferative diabetic retinopathy complications, use of low-vision aids or blindness, the study authors said.
Patients with diabetes mellitus who received guideline-recommended care experienced earlier onset of background diabetic retinopathy. Data showed no differences between patients who received recommended care and other patients in time to onset of proliferative diabetic retinopathy, macular edema or proliferative diabetic retinopathy complications.
"However, persons who received care consistent with recommendations experienced much lower rates of onset of low vision/blindness than did others," the authors said.
This study confirms that diabetic patients who have regularly scheduled eye exams experience a lower rate of vision loss compared to those who do not have regular eye exams, but most diabetic patients do not have their eyes examined regularly. Although higher education may correlate with more frequent examinations, patients with higher household income were more likely to have their eyes checked, suggesting cost may still be a barrier to care, even for individuals with health insurance. While patients who receive appropriate eye care may cost Medicare more at least initially, from a societal perspective, preventing blindness from diabetes is very cost-effective. One hopes that the ongoing health care reform discussions will use this data to focus on strategies and incentives to increase the rate that diabetic patients have regular dilated eye exams performed by an ophthalmologist.
As busy clinicians we see patients with a broad range of diabetic retinopathy and a broad spectrum of diabetic control. By and large, patients who are educated regarding all aspects of their diabetic care tend to have superior clinical outcomes compared with patients who are not well informed. Investing time into the education process, particularly by eye professionals, may correlate with improved adherence with appointments and treatments all of which ultimately lead to improved clinical outcomes.
– Sunir J. Garg, MD, FACS
Assistant
Professor of Ophthalmology, Wills Eye Institute, Philadelphia
– Richard Kaiser, MD
Associate Professor,
Thomas Jefferson University, Associate Surgeon, Wills Eye Institute