Priorities Reduce Blindness

Priorities Reduce Blindness

DOCTOR SUGGESTS NEW PRIORITIES COULD REDUCE DIABETIC
BLINDNESS

James O'Rourke, MD, professor of pathology at University of
Connecticut Health Center, is calling for primary care deliverers to regularly
obtain an image of their diabetic patients' retinal blood vessels and then catalog
those as part of a permanent medical record. Today, one-half of all people with
diabetes will eventually develop some degree of retinal damage, and 10 percent
of these will become legally blind after having diabetes for 20 years. It doesn't
have to be so, Dr. O'Rourke believes.
New technologies, particularly in the field of diagnostic imaging,
are available to health care providers. The problem has been to chart changes
in an individual's eyes, and to do that, physicians need a "baseline,"
a clear idea of the condition of the patient's eyes at a given time. The tests,
already available, which Dr. O'Rourke advocates, will provide such a "baseline."
With this information in hand, doctors and nurses can easily
discern changes in a patient's retinal blood vessels in subsequent years, and
quickly invoke proper treatment. The expenses of making and maintaining the
record are outweighed by the savings of very expensive therapies and rehabilitation
for those who go blind because of diabetes.
"We're not using our available resources, manpower, or
skills to maximal advantage to combat this problem," Dr. O'Rourke said.
"Diabetes and diabetic blindness numbers are growing, and we're not properly
deployed. We're losing this fight," he said.
Dr. O'Rourke suggested misunderstandings and misconceptions
may have contributed to why we are where we are now. His assessment of the situation
includes:
* Diabetic blindness is not a disease of the retina, or an eye
disease; it is a disease of the blood vessels in the retina. Diabetes does not
just cause retinal blood vessel damage; the disease causes widespread blood
vessel damage, particularly the fine blood vessels of the kidneys, nerves, brain,
and feet. Diabetes affects the walls of blood vessels. There are more than 10
billion tiny blood vessels throughout the human body--or more than 600 square
meters of wall surface--about the size of three tennis courts.
* Viewing the retina is one of the most effective means of detecting
early blood vessel damage in diabetes. Unfortunately, viewing the retinal blood
vessels through an undilated pupil provides only a limited, transient image.
Seeing retinal blood vessel damage early on allows doctors to monitor and adjust
medication levels. While maintaining a normal blood sugar level is not easy,
one of the keys to it is early detection.
* New ways are needed to rapidly screen for retinal diabetes
at less cost. Proper planning and improved technology can help, but screening
has to be incorporated as part of a regular health maintenance program.
* The medical system is divided into specialties that manage
different aspects of diabetic care. Early detection and prompt treatment of
retinal diabetes requires more efficient interactions among specialists, if
we hope to reverse the diabetic blindness problem.
To improve efficiency, Dr. O'Rourke suggests primary care physicians
ought to obtain full digital color prints of retinal blood vessels, with pupils
dilated, from their patients who have had diabetes more than five years. These
images should be repeated annually, and maintained in the patient's medical
record, so that comparisons can be made if the occasion warrants.
Dr. O'Rourke also suggests that community hospitals make retinal
imaging available to primary care physicians.
"Convenient screening by retinal imaging is the key to
early detection," he said. "The procedure takes 10 minutes, and it
is painless. We do it here at the Health Center in our Vascular Radiology Division,
thanks to support from the Connecticut Lions. This is something that will materially
help reduce the growing problem of diabetic blindness."