Coordinated care essential for managing diabetic eye disease
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It is a well-known fact that individuals with diabetes have an increased likelihood of developing ocular complications.
According to a 2018 report in Population Health Metrics, the number of adults with diabetes is projected to triple by 2060, making it essential for vision health providers to find innovative ways to reduce the burden of care for patients experiencing diabetic eye disease. And while several effective treatment options remain the primary means of managing the condition, they are often inaccessible to many patients due to high costs and the ongoing nature of the procedures involved.
The three primary treatments for diabetic macular edema or proliferative diabetic retinopathy are intravitreal anti-VEGF injections, intravitreal steroids and various laser procedures. While several anti-VEGF agents are available, their high price point, variable response to treatment and indefinite management period complicate their use.
Recent innovations help address challenges with follow-up care and compliance.
A port delivery system that supplies intravitreal anti-VEGF to patients to extend the time between visits may help reduce the burden of care. The initial system that was on the market has since been recalled, but it is only a matter of time before other similar solutions will emerge.
The FDA recently approved a currently available intravitreal anti-VEGF agent for a higher dosage, which, in theory, may extend the time between visits or treatments.
Protocol V of DRCR.net found it is appropriate to monitor patients closely if their visual acuity is 20/25 or better (Baker CW, et al.). With this, there is now an option to defer treatment even in the presence of diabetic macular edema.
Preliminary research also suggests nutritional supplements like fish oil may reduce the progression of diabetic retinopathy, but there is still a need for more conclusive evidence.
Optometrists can also continue to work collaboratively with other health care providers in a team-based approach to treating individuals with diabetes, including carefully screening for other systemic conditions such as high cholesterol and hypertension, which are common comorbidities. Coordination of individualized, innovative care among providers allows for the best prognosis for patients’ systemic and ocular health. As all medical providers consider how to respond to the future burden of diabetes, it’s essential for optometrists to play an important role in delivering better health outcomes for their patients.
References:
- Baker CW, et al. JAMA. 2019;doi:10.1001/jama.2019.5790.
- Lin J, et al. Popul Health Metr. 2018;doi:10.1186/s12963-018-0166-4.
For more information:
Emily Stephey, OD, FAAO, is an assistant professor and chief of ocular disease and special testing at Marshall B. Ketchum University in Fullerton, California.
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