Screening and prevention of diabetic blindness

Stefánsson, Einar; Bek, Toke; Porta, Massimo; Larsen, Nikolaj Birk; Kristinsson, Jóhannes Kári; Agardh, Elisabet

doi:10.1034/j.1600-0420.2000.078004374.x

Cited by 254 publications

(197 citation statements)

References 28 publications

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“…In Iceland, where most patients with Type I diabetes have been screened by a central Unit since 1980, only one has been registered blind over the last few years [71]. Encouraging results are reported also for Icelanders with Type II diabetes.…”

Section: Impact Of Screeningmentioning

confidence: 99%

Diabetic retinopathy

2002

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Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

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Section: Impact Of Screeningmentioning

confidence: 99%

Diabetic retinopathy

2002

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“…DIABETES CARE, VOLUME 31, NUMBER 6, JUNE 2008prevalence of diabetic visual loss (3,21), but it is difficult to separate the beneficial effect of screening from the effect of better general diabetic disease management, since the two factors frequently coexist. After 2003, digital retinal photography became almost the sole means of screening in Tayside for patients with diabetes.…”

Section: Vallance and Associatesmentioning

confidence: 99%

Diabetic Retinopathy: More Patients, Less Laser

et al. 2008

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OBJECTIVE -We aim to correlate the incidence of diabetic retinopathy and maculopathy requiring laser treatment with the control of risk factors in the diabetic population of Tayside, Scotland, for the years 2001-2006.RESEARCH DESIGN AND METHODS -Retinal laser treatment, retinal screening, and diabetes care databases were linked for calendar years [2001][2002][2003][2004][2005][2006]. Primary end points were the numbers of patients undergoing first or any laser treatment for diabetic retinopathy or maculopathy. Mean A1C and blood pressure and retinal screening rates were followed over the study period.RESULTS -Over 6 years, the number of patients with diabetes in Tayside increased from 9,694 to 15,207 (57% increase). The number of patients receiving laser treatment decreased from 222 to 138 and first laser treatments decreased from 100 (1.03% of diabetic population) to 56 (0.37%). The number of patients with type 2 diabetes treated for maculopathy decreased from 180 in 2001 to 103 in 2006 (43% reduction, P ϭ 0.03). Mean A1C decreased for type 1 and type 2 diabetic populations (P Ͻ 0.01) and a reduction in blood pressure was observed in type 2 diabetic patients (P Ͻ 0.01). The number of patients attending annual digital photographic retinopathy screening increased from 3,012 to 11,932.CONCLUSIONS -Laser treatment for diabetic maculopathy in type 2 diabetic patients has decreased in Tayside over a six-year period, despite an increased prevalence of diabetes and increased screening effort. We propose that earlier identification of type 2 diabetes and improved risk factor control has reduced the incidence of maculopathy severe enough to require laser treatment.

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“…The mortality of patients with diabetes before and after the discovery of insulin [7] thanks to screening programmes and development of telemedicine. The first screening tests for DR were conducted in 1980 in Iceland [31,32]. Another mass screening programme commenced in 1991 in Singapore.…”

Section: Diagnosing Diabetic Retinopathymentioning

confidence: 99%