The Diabetic Patient with No Visual Complaints
Roger T. Adler, M.D., A.S.R.S.*
This abbreviated synopsis is intended for all medical personnel involved in the caring for patients with Diabetes Mellitus (DM) and not just involved in the patient’s glucose control directly. Examples of such health care providers may include anyone from chiropractors to podiatrists. We all know that diabetes affects the retina. The main question that will be answered in this summary is “When should a diabetic patient have a retinal evaluation?” The key point and take home message is to not wait for your patient to have visual complaints.
EXCELLENT “VISION” DOES NOT NECESSARILY IMPLY HEALTHY EYES!
Diabetic patients may indeed have superb subjective vision even with a very abnormal retina which may lead to permanent vision loss if left untreated. Unfortunately, in the United States of America a significant percent of people who are “newly” diagnosed with diabetes have in fact had diabetes for some time, perhaps years. The prevalence of diabetes is rising in the U.S. Factors that contribute are increasing life span, lifestyle, and awareness of the disease and an increase in screening to mention a few.
When should a diabetic patient have a retinal evaluation?
If the “newly” diagnosed patient is fortunate enough to have no visual complaints, a retinal evaluation and potential treatment to the retina may certainly be indicated TO STATISTICALLY HELP PRESERVE THE VISION THAT THE PATIENT CURRENTLY ENJOYS (ETDRS Study). Although there are many studies related to diabetic eye disease two in particular deserve mention here: The Diabetic Retinopathy Study (DRS) and the already mentioned Early Treatment Diabetic Retinopathy Study (ETDRS). One major conclusion of the ETDRS has proven the beneficial affects of treatment to macular edema regardless of visual acuity. The basis of such is to significantly decrease the “…incidence of moderate visual loss by approximately 50% at all time points…”
One of the major conclusions of the DRS is to treat diabetic patients who have either bled into their eye (vitreous hemorrhage) or at “high-risk” for this event. Treatment is indicated AND recommended for these “high-risk” patients even if when there are no complaints of visual loss or subjective ocular complaints.
“…The DRS findings strongly indicated that prompt scatter photocoagulation should be performed in eyes with high-risk proliferative diabetic retinopathy because of the high risk of severe visual loss without photocoagulation. The DRS photocoagulation treatment protocol effectively reduced the risk of severe visual loss by greater than 50%…”
*A.S.R.S. Member of the American Society of Retina Specialists