Reduce Diabetic Blindness

Reduce Diabetic 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 develop some degree of retinal damage during their lifetimes, 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."