Diabetic retinopathy: The FP’s role in preserving vision
Evaluation and Tx of this debilitating complication falls to the eye specialist, but you play a central role in assessing risk and optimizing prevention strategies.
PRACTICE RECOMMENDATIONS
› Refer patients with type 1 diabetes mellitus (DM) to an ophthalmologist or optometrist for a dilated and comprehensive eye examination within 5 years of disease onset. B
› Refer patients with type 2 DM to an ophthalmologist or optometrist for an initial dilated and comprehensive eye examination at time of diagnosis. B
› Control blood pressure—ideally, < 140/90 mm Hg—in patients with DM to reduce the risk of diabetic retinopathy. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Time since diagnosis. The Wisconsin Epidemiologic Study of Diabetic Retinopathy found that the prevalence of diabetic retinopathy varied from 28.8% in people who had DM for < 5 years to 77.8% in people who had DM for ≥ 15 years. The rate of proliferative diabetic retinopathy was 2% in people who had DM for < 5 years and 15.5% in those who had DM for ≥ 15 years.11
Demographic variables. The prevalence of diabetic retinopathy is higher in men, non-Hispanic blacks (38.8%), and people with type 1 DM.4,5,11-13 The Veterans Affairs Diabetes Trial found a higher prevalence of moderate-to-severe diabetic retinopathy in Hispanics (36%) and African Americans (29%) than in non-Hispanic whites (22%).14
Among people with DM who have diabetic retinopathy, systolic and diastolic BP and the HbA1C level tend to be higher. They are more likely to use insulin to control disease.4,5,13 In a recent cross-sectional analysis, the prevalence of vision-threatening retinopathy was higher among people ≥ 65 years of age (1%; 95% confidence interval [CI], 0.7%-1.5%) than among people 40 to 64 years of age (0.4%; 95% CI, 0.3%-0.7%) (P = .009).5
Does pregnancy exacerbate retinopathy? Controversy surrounds the role of pregnancy in the development and progression of diabetic retinopathy. The Diabetes Control and Complications Trial found a short-term increase in the level of retinopathy during pregnancy that persisted into the first postpartum year. A 1.63-fold greater risk of any deterioration of retinopathy was observed in women who received intensive DM treatment from before to during pregnancy (P < .05); pregnant women who received conventional treatment had a 2.48-fold greater risk than nonpregnant women with DM who received conventional treatment (P < .001).
Deterioration of retinopathy during pregnancy had no long-term consequences, however, regardless of type of treatment.15 More importantly, in most cases, changes in the level of retinopathy revert to the pre-pregnancy level after 1 year or longer, and pregnancy does not appear to affect long-term progression of retinopathy.15
Continue to: Proven primary prevention strategies
