A colleague recently told me that eye doctors should “stay within the lines” of traditional eye care because we barely have enough time as it is to do our jobs. My response was that today more than half of our adult patients have either diabetes or prediabetes,1 so our job now requires we go ”outside the lines” to avoid the leading cause of preventable blindness.2
The incidence of severe vision loss caused by proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) appear to have declined significantly over the last 40 years due to improvements in blood glucose control, improved surveillance of diabetes patients, and widespread use of effective interventional therapies like photocoagulation and anti-VEGF injections.3
Nonetheless, diabetic retinopathy (DR) and DME remain hugely important causes of vision impairment and blindness and remain the leading causes of vision loss in Americans of working age.2
Previously from Dr. Chous: How diabetes is linked to gut bacteria
Increased prevalence of DR and DME is linked to increasing prevalence of diabetes and reduction in macrovascular mortality achieved with better treatment regimens. Ironically, improved longevity allows patients with diabetes to live long enough for development of vision-threatening complications.4
With recent estimates showing more than 12 percent of all U.S. adults having diabetes, it is becoming increasingly important to identify and remediate patients at highest risk for progression to clinical diagnosis of diabetes and all of its attendant complications, including vision loss.5
Additionally, identifying diabetes patients at highest risk for developing sight-threatening retinopathy (STR) and attempting earlier intervention will play an increasingly important role as we strive to improve public health outcomes and reduce medical expenditures.