Active prevention in diabetic eye disease

Abstract

ABSTRACT. Ten years after the foundation of a national diabetic eye screening program in 1980, we have established a low prevalence of blindness and partial sight in type 1 and type 2 diabetics in Iceland. We ask whether the screening program is also associated with a low incidence of blindness in diabetics. We now report the results of a prospective study on the 4-year incidence of diabetic retinopathy and visual impairment in type 1 diabetics with age at onset less than 30 years. Out of 205 patients participating at baseline, 175 patients (85.4%) participated over the full 4-year period. Patients were examined annually and received laser treatment according to Diabetic-and Early Treatment Diabetic Retinopathy Study criteria. The 4-year incidence of any retinopathy was 38.1' 36, of proliferative retinopathy 6.694 and of macular edema 3.4%. Out of 174 patients, 7.4% showed improvement in visual acuity of 2 Snellen lines while 2.5% experienced worsening of visual acuity of 2 Snellen lines during the 4-year period. No diabetic suffered more than 2 lines deterioration of vision and none became legally blind. The incidence of retinopathy in Icelandic type 1 diabetics participating in our annual eye screening program is low and the visual acuity stable. Our results suggest that visual impairment in diabetics can be prevented with active regular screening and standard laser therapy.

Enucleation in Iceland 1992–2004: study in a defined population

“…It is well established that the screening of diabetic retinopathy in Iceland is effective and the prevalence of blindness is low (Kristinsson et al 1997). Therefore, it is not particularly surprising that only one eye is lost because of neovascular glaucoma secondary to diabetic retinopathy, and this demonstrates how an intensive screening programme, effective treatments and thorough follow-up visits can prevent severe disease progression leading to enucleation.…”

Generalized Vascular Damage Including Glomerular Dysfunction in Newly-Detected Type 2 Diabetic Patients

“…This is true at the level of macrovascular disease as most of mortalities among diabetics are due to CAD (70). Likewise, an effective screening and early treatment programme could reduce diabetes morbidity by increasing the chances for detection and subsequent institution of protective measures that may lower the burden of both ESRD and cardiovascular morbidity and mortality, as stated by Manjunath and colleagues (2003) (71) and as well for reducing the risk of blindness by more than half (72) using standard laser therapy (73).…”

Kronisk pankreatitt – utredning og behandling

“…Studier viser at strukturerte,systematiske øyeundersøkelser fører til redusert forekomst av alvorlig diabetesretinopati og diabetesrelatert synstap og at dette gir økonomiske besparelser over tid (Jones 2010, Javitt 1996, Kristinsson 1997, Backlund 1997, Agardh 1993. De økte ressursene som vil medgå til å undersøke de pasientene som nå ikke blir fulgt opp i henhold til gjeldende retningslinjer, vil sannsynligvis oppveies av den innsparing man vil få ved at en del pasienter som nå undersøkes årlig, kan undersøkes hvert 2. år.…”

“…Sensitiviteten og spesifisiteten påvirkes av undersøkelsesmetode og av kvaliteten/utdanningen på det personell som utfører og vurderer resultatet av undersøkelsen (Hutchinson 2000). Der systematiske undersøkelser for påvisning av diabetisk retinopati er gjennomført, har man vist at blindhets-og svaksynsinsidensen går ned (Agardh 1993, Kristinsson 1997). …”