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Diabetic Retinopathy
Diabetes mellitus (DM) is a large and growing problem worldwide. The prevalence in the United States is growing at epidemic proportions. All patients with DM are at risk for DR, a major cause of avoidable vision loss and blindness. Diabetic retinopathy (DR) occurs when high blood sugar damages the blood vessels of the retina. There are two primary types of DR: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). With NPDR, the blood vessels of the retina leak, causing the macula to swell (macular edema). There are three stages of NPDR: mild, moderate, and severe. Mild NPDR refers to the early stages where blood vessels begin to swell and leak. In moderate cases of NPDR, blood vessels continue to swell and become unable to transport blood. NPDR is considered severe when the retina becomes oxygen deprived and signals growth factors to form new blood vessels. In PDR, new blood vessels form, but are weak and prone to leakage. Scar tissue forms which may lead to retinal detachment and blindness. Nerve damage can also occur with diabetic retinopathy. Diabetic macular edema (DME) is the swelling of the macula and can occur at any stage.
The term vision-threatening DR (VTDR) is defined as the presence of severe NPDR, proliferative DR, or clinically significant macular edema (CSME). Most vision loss due to DR is avoidable, as there are effective treatments for DR and macular edema (laser treatments and intravitreal injections). However, treatments are most effective when patients are asymptomatic, but disease is advanced sufficiently to warrant treatment. Evidence-based guidelines universally adopted require that every patient have an annual retinal evaluation to determine the presence of VTDR so they can be treated. Compliance with the guideline for annual retinal evaluations is very poor, largely because of an ineffective care delivery system. Detecting and managing DR is highly cost-effective. An optimal solution to manage DR must be accurate, convenient and economically sustainable detection. The best solution today is one that focuses on the primary care setting (family medicine, internal medicine, endocrinology offices) where diabetes patients visit most frequently.
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