Spotlight on diabetic eye disease

The prevalence and treatment of diabetes complications affecting the eye were analyzed by multiple studies published in the past month.

An international report, covering the U.S., France, Germany, Italy, Spain, the United Kingdom and Japan, calculated the prevalence of diabetic retinopathy. Those countries had 4,889,171 cases in 2012, which are expected to increase to 7,176,537 by 2022. The authors of the report by Research and Markets noted that while retinopathy is on the rise, it is not expected to increase at the same rate as diabetes, due to improving medical management of diabetic patients.

Patients diagnosed with diabetic macular edema (DME) were surveyed about their medical care in a study published online Dec. 19, 2013, in JAMA Ophthalmology. The study used data from the National Health and Nutrition Examination Survey to find that only 44.7% of U.S. adults age 40 and over with DME remembered being told by a physician that diabetes had affected their eyes. About 60% of the patients with DME had received an eye examination with pupil dilation in the past year. More than a quarter of the patients with DME were visually impaired at initial evaluation, and 16% had visual impairment even with correction. The results highlight the importance of educating diabetics about eye complications and ensuring they receive proper treatment for eye problems, the authors said.

The best way to treat DME was addressed by another study, a cost-effectiveness analysis published in the Jan. 7, 2014, Annals of Internal Medicine. Researchers used a Markov model to compare laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor and combination therapy. VEGF inhibitor alone or combined with laser treatment provided the greatest benefit, with combination treatment having a slight edge. The only option that didn't reduce costs was laser monotherapy, and the only option that didn't increase quality-adjusted life-years was triamcinolone monotherapy. The choice between VEGF inhibitor monotherapy and adding laser treatment may come down to patient preference, the authors concluded, recommending that primary care clinicians provide patients the information needed to share in this decision. They also noted that the choice of a specific VEGF inhibitor remains controversial.