Awareness of eye screening still lacking among patients with newly diagnosed T2DM

A sizable proportion of patients with newly diagnosed type 2 diabetes mellitus (T2DM) do not understand the seriousness of eye complications related to the disease. A local study noted that only 20.4 percent of the patients went for eye screening on their own while 78.8 percent had to be urged by their physician although 86.1 percent were aware that eye problems may already exist upon diagnosis of T2DM. [Int J Ophthalmol 2011;4(5):519­-524]

Patients with T2DM may develop diabetic retinopathy, which can impair blood vessels in their retina potentially causing irreversible vision loss. The prevalence of diabetic retinopathy in Malaysia increased from 44.1 percent in 1981 to 51.6 percent in 2005. Furthermore, the prevalence in Malaysia is much higher than that of other countries such as UK (22.7 percent) and Japan (39.6 percent). [Int J Ophthalmol 2011;4(5):519­-524]

“[Diabetic retinopathy] poses a dual threat to vision … [it causes] bleeding within the retina or the swelling of this delicate tissue, referred to as vitreous hemorrhage, and macular edema,” said Dr Tara Mary George, a consultant ophthalmologist and medical retina specialist. Diabetic retinopathy may not present warning signs in the early stages. In Malaysia, 29.2 percent of patients with T2DM were found to have retinopathy in their first eye test. [Int J Ophthalmol 2011;4(5):519­-524] Thus, Tara emphasized the importance of advising patients to consult an eye specialist as soon as they are diagnosed with T2DM. Thereafter, they should go for regular eye examinations including a comprehensive retina evaluation.

In addition to early diagnosis of T2DM and routine eye screening, a comprehensive strategy for forestalling vision loss in diabetes should cover effective diabetes management, which can significantly reduce the risk of diabetic retinopathy. Thus, HbA_1C levels should be regularly monitored, with the recommended target being below 7.5 percent. The availability of screening and testing services has increased in recent years. “Many private hospitals and government health centers have adopted these technologies, rendering screening expedient and hassle-free,” said Tara.

Tara explained the various treatment options for diabetic eye complications include systemic treatment ie, diabetes control, blood pressure and cholesterol management; intravitreal injections with anti-VEGF* agents; and laser treatment. She said the advancements in treatment, notably the adoption of anti-VEGF injections, have yielded significant improvements. “The root of our success lies in patient empowerment, emphasizing understanding and compliance in diabetes management and regular eye screenings. Treatment choice hinges on individual circumstances and severity, with physicians opting for combinations of injections and laser therapy as deemed appropriate.”

In conclusion, Tara advocated regular eye screenings as safeguard of patients’ vision as prevention remains the mainstay in preventing the complications of diabetic retinopathy. The key determinants of diabetic retinopathy are diabetes control and the duration of living with the condition; age is not the deciding factor, added Tara.