6 things PCPs should know about diabetic vision loss

The Centers for Disease Control and Prevention (CDC) estimates that 29.1 million people, or 9.3% of the U.S. population, have diabetes. Over 8 million (27.8%) have the disease and are not diagnosed.

The number of diagnosed cases are projected to increase 165% from the year 2000 to 2050, according to the American Diabetes Association. By 2050, there will be 29 million diagnosed cases of diabetes in the United States.

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At the same time, the number of Americans with diabetic retinopathy and other eye complications associated with diabetes are expected to nearly double–from 7.7 million in 2000 to 14.6 million in 2050.

While diabetes can affect the human body in many ways, eye diseases associated with diabetes reduce a patient’s quality of life and lead to the loss of productivity. The growing number of diabetic patients suffering with associated eye diseases is, and will continue to be, a major public health problem.

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While the statistics for the diabetes epidemic are overwhelming, a positive point is that diabetic eye diseases can be treated when detected early, long before vision loss occurs. Primary care physicians (PCPs) can be instrumental in preventing vision loss and blindness among their diabetic patients.

Here is some information about diabetic eye disease and how PCPs can help reduce the number of diabetic patients with vision loss and total blindness.

1. What are diabetic eye diseases?

Patients with diabetes present a greater risk of developing various blinding eye diseases, including cataracts, diabetic retinopathy, and glaucoma. Vision loss and blindness associated with diabetic retinopathy is a major concern because of the damage the disease can inflect on the eyes if untreated.

According to the CDC, diabetes is the leading cause of blindness among adults aged 20 to 74 years. Diabetic retinopathy is responsible for 12,000 to 24,000 new cases of blindness each year.

All patients with diabetes, whether they have type 1, type 2, or gestational, are at risk of developing diabetic retinopathy. The longer patients have the disease, the more their odds increase of developing diabetic retinopathy.

So, what is diabetic retinopathy? In a nutshell, diabetes–when uncontrolled–induces the blood vessels in the retina to thin out and become fragile. Eventually, those blood vessels will swell or leak blood, leading to blocked vision.

Diabetic retinopathy occurs in four stages–mild, moderate, and severe nonproliferative retinopathy, and the advanced proliferative retinopathy. Patients usually do not experience vision loss until their disease progresses into the advanced stages.

2. There are also other causes of vision loss

Researchers have reported that early diagnosis and treatment can prevent vision loss in over 90% of the diabetic patients. However, about 50% of diabetic retinopathy patients are diagnosed at a stage when it is too late for effective treatment.

Other causes of visual loss in patients with diabetes include ischemia, macular edema, ischemia, neovascularization, traction retinal detachment, and vitreous hemorrhage. Most of these causes have effective treatments to prevent vision loss and blindness–if they are treated early.

From the PCP’s perspective, physicians can help patients delay the onset or progression of diabetic retinopathy by having patients control glucose levels, blood pressure, and cholesterol.

3. PCPs can play crucial role in preventing vision loss

Diabetic patients rely on their PCPs to manage all aspects of their disease. Although PCPs do not have training in ophthalmic care, they do manage the systemic diseases that affect vision health and they are in the position to prevent their patients’ vision loss and blindness with proper medical direction for their patients.

PCPs can be proactive in their consultation with patients by discussing specific eye diseases and complications associated with diabetes. When conditions are warranted, PCPs then can refer their patients to ophthalmologists for more advanced care.

PCPs’ proactive approach is important because when diabetic patients enter advanced stages of diabetic retinopathy, as the disease may be asymptomatic and unrecognized by their patients. Physician discussions regarding eye health thus play an important role for patients to obtain proper treatment.

4. Patients express confidence in their PCPs

The National Eye Institute (NEI) and the Lions Club International conducted a national study to assess public knowledge, attitudes, and practices in relation to eye health and associated diseases (www.nei.nih.gov/kap).

Results of the study showed that patients expressed strong confidence in their PCPs to assist and direct them in making the proper healthcare decisions, including eye care. The study reported that 96% of adults said they would be somewhat or very likely to have their eyes examined if their PCP advised and referred them to an eye care specialist.

To obtain the physicians’ perspective on eye health, NEI followed up on this report by presenting questions regarding eye health knowledge, attitudes, and practices in a national Web-based survey of PCPs. This survey­–called the DocStyles survey (www.ncbi.nlm.nih.gov/pubmed/20070013)–evaluated PCPs’ perceptions and attitudes in regard to patient communication.

The report found PCPs had positive attitudes and opinions regarding eye health. As physicians, they were in a strong position to be able to talk to their diabetic patients about their vision. More that 80% of PCPs reported they already have had a discussion about eye health with patients in general and more than 90% said they discussed diabetic eye disease with their diabetic patients.

In drilling down the data further, the survey found that about 90% of PCPs said they even counseled their diabetic patients about eye complications. Over 90% said they advised their diabetic patients to have their eyes examined every year.

5. Resources are available

While the studies have demonstrated that PCPs already are taking a proactive stance in addressing diabetic eye disease with patients, there are still 8 million people with diabetes who are not diagnosed. That number will only increase to epidemic proportions in the years to come.

As these diabetes statistics continue to increase, there is still a need and opportunity for PCPs to improve their understanding and knowledge of vision loss and blindness, especially when physicians are advising patients on diabetic vision loss. The NEI and the American Academy of Ophthalmology (AAO) provide evidence-based education resources which PCPs can use.

In February 2016, the AAO updated its Preferred Practice Patterns for diabetic retinopathy. Based on the latest scientific data, these guidelines outline guidance for the pattern of practice in treating diabetic retinopathy. The update can be downloaded from the AAO website (www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp-updated-2016).

NEI offers a list of educational resources for both physicians and patients through its National Eye Health Education Program (www.nei.nih.gov/nehep). Through the program, PCPs can utlilize resources and tools to promote eye health and educate patients on diabetes and vision loss.

6. How to have eye health conversations with diabetic patients

The NEI resources and tools include:

• Brochures and booklets that discuss eye diseases associated with diabetes and the importance of a yearly eye exam;

• e-Cards to send to patients reminding them of their annual eye exam;

• Patient education website (www.nei.nih.gov/diabetes);

• Scripts for phone recordings that are used when patients are on hold;

• Teaching tools that PCPs can use to educate patients about diabetes and eye health;

• Variety of public service announcements the practice’s newsletters, publications or web site.

Of all of the medical complications associated with diabetes, sight-threatening diabetic eye disease imposes the most on one’s quality of life. Whatever physicians can do to help diabetic patients understand the importance of vision health and to obtain annual exams, fewer patients will face vision loss and blindness.

With the growing number of diabetes cases, it is more important than ever to make sure that diabetic patients receive timely eye care.

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