Many people with diabetes still lose vision, despite availability of vision-sparing treatment

Despite recent advances in prevention and treatment of most vision loss attributed to diabetes, a new study shows that fewer than half of Americans with damage to their eyes from diabetes are aware of the link between the disease and visual impairment, and only six in 10 had their eyes fully examined in the year leading up to the study.

The research, described online on Dec. 19 in JAMA Ophthalmology, also found that nearly half of those with and damage had not visited a clinician charged with managing their disease in that same time period.

High blood sugar levels associated with poorly controlled diabetes can damage the small blood vessels in the retina, the light-sensitive tissue lining the back wall of the eye. This can cause or leaking of fluids from these blood vessels, which brings on swelling of the retina. The condition, known as , can cripple central vision and the ability to see detailed images, such as the face of someone looking directly at you. Left untreated for a year or longer, macular edema can lead to permanent vision loss.

"As a nation, we are woefully inadequate as in explaining to our patients with diabetes that the condition can have a detrimental effect on their eyes," says study leader Neil M. Bressler, M.D., a professor of ophthalmology at the Johns Hopkins University School of Medicine and chief of the retina division at the Johns Hopkins Wilmer Eye Institute. "The earlier we catch , the greater the likelihood that we can help patients keep their good vision. Clearly, this research shows how far we have to go to educate people about this frequent and feared complication."

People with diabetes have at least a 10 percent risk of developing diabetic macular edema during their lifetime, and estimates suggest that close to 745,000 of them in the United States have swelling in the macula, the center portion of the retina.

Until recently, 15 percent of patients who developed the condition and were treated for it with the standard laser therapy still lost their vision. Now, Bressler says, drugs injected into the eye reduce the swelling and risk of vision loss to less than five percent. With treatment, moreover, half of patients find their vision improves, making prompt diagnosis critical.

For the study, the Johns Hopkins-led team of researchers used data collected between 2005 and 2008 from Americans enrolled in the National Health and Nutrition Examination Survey (NHANES). Among the 798 people over the age of 40 with a self-reported diagnosis of type 2 diabetes and who had retinal imaging done, 48 had diabetic macular edema and were asked in the survey whether a physician had told them about the link between diabetes and vision problems (44.7 percent were). They were also asked whether they had seen a heath care provider about their diabetes in the previous year (46.7 percent had), and whether they had received an eye examination, including pupil dilation, in the previous year (59.7 percent had). Some 30 percent of the individuals with diabetic macular edema already had some type of related to the disease.

Bressler says some people fail to see eye doctors or diabetes educators because they lack insurance. He adds that most of the problem is likely a lack of understanding about the risks, and most people probably aren't referred to eye care specialists who can quickly determine retinal vulnerability.

"We can prevent a lot of impairment or blindness if we can just get these people into the medical system," Bressler says. Now that the extent of the problem is known, Bressler says, strategies can be developed to address issues of patient education, access to specialists and costs.

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jamesinraro
not rated yet Dec 22, 2013
Diabetes causes the destruction of the blood supply to the retina, retinal neuropathy.

There are measures people can and should take to prevent Diabetes. One important addition to the diet is a supplement extracted from the red wine grape skin called transmax resveratrol, the supplement which has been shown in multiple double blind, peer-reviewed studies to lower blood glucose, reduce body fat, increase insulin sensitivity and protect against the adverse health consequences of both Type 1 and 2 Diabetes.  Two new human clinical trail results were just released ten days ago by prestigious medical schools, one using Bioforte and the other using Transmax Resveratrol on patients who were also taking Metformin like drugs.  In these studies blood pressure and the above parameters were all improved versus taking Metformin alone.