Diabetic Retinopathy

Part
01
of five
Part
01

Diabetic Retinopathy - Impacts

Five ways in which diabetic retinopathy (DR) affects the daily lives of patients in the US, China, Germany and Japan include the ability to read, ability to work, ability to travel, ability to access services, and economic burden.

Methodology

Since many sources do not speak on how DR itself affects certain parts of a patient's life, we use the fact that DR causes visual impairment and combined that fact with how visual impairment affects different parts of a patient's life as a proxy to answer how DR affects the lives of those patients. Where there is a vast difference in the impact citizens of either Germany, Japan, China, or the US, we discuss the way in which they differ for that point, such as with economic burden.

ability to read

The weighted prevalence for the difficulty in reading in the US is 11.4%. With diabetic retinopathy, fluid accumulates in the part of the retina that helps with certain tasks such as reading, which is called macular edema. Macular edema often develops in people who have other signs of retinopathy. This part of the eye is also used for other tasks such as driving and recognizing faces. There is also contrast sensitivity, which affects the person’s ability to do simple reading tasks such as finding a telephone number in a directory or reading instructions. Hence, retinopathy can affect reading in many ways. For DR patients, it can interfere with how the markings on an insulin syringe or a display on a blood glucose monitor are read, which could cause conditions to worsen in the short and long term. Due to the decreased depth perception that comes with the lack of visual acuity, patients are less able to see edges and curves and to recognize faces in real life or in photographs, which ultimately affects their social life.

The Internet is the source of much reading and image content. Because of decreased contrast sensitivity and poor depth perception, text and images on a computer or handheld device are difficult to see. Also, patients with diabetic retinopathy often see dark blocking spots on a web page due to macular edema. The web is one of the places where things are changing for visually impaired individuals, as there is an increase in the use of screen readers. In the US, since 2001, the Bureau of Internet Accessibility has pushed web standards to make websites available to visually impaired people by way of screen readers, which converts text to speech. Things were very different in 2001 as there were not as many images on the Internet as there are now. With images now on nearly every page, screen readers can read these images using AI and simple algorithms to make the Internet more accessible to visually impaired individuals.

Ability to Work

For visually impaired people who seek work in the US, surveys have shown that employment of blind and visually impaired people is quite low, at 32%. Visually impaired people then face roadblocks with public financial support, lack of transportation, and problems with how their performance at work is rated. The weighted prevalence of US adults who experience the difficulty of working, especially with close-up work, is 9.7%. Some employees may struggle with doing their regular shifts at work because they have to time their medications and their meals. If they don't take their medication on time, they may worsen the retinopathy and make other diabetic symptoms, such as hypoglycemia worse.

If employers don't do a risk assessment and give the visually impaired employee the time needed for medication, eventual degradation of vision will occur. This is especially worriesome for those who operate heavy machinery, or for those who work in elevated areas. Poor depth perception, along with contrast sensitivity, both symptoms of diabetic retinopathy, have been associated with an increased risk of fall-related fractures. Visually impaired people are at a higher risk of injury. Many falls in the workplace come as a result of central and peripheral vision impairment.

Ability to Travel

The decreased visual acuity, loss of peripheral vision, and dark adaptation complications of DR can affect driving performance. The weighted prevalence of US adults who experience difficulty with driving is 1.8%, while the weighted prevalence of US adults who experience difficulty with their peripheral vision, as in only being able to see objects directly in front of them, is 4.43%.

Even though retinopathy can affect a person's ability to drive, it will most likely not restrict them from being able to obtain driving privileges, as studies have shown that driving with diabetic retinopathy does not translate to an increase in accidents. Depending on how severe the retinopathy is, medical evaluations by a doctor could be required before and after receipt of a drivers license. Most questionnaires and surveys required for a driver's license application ask applicants to disclose their medical conditions including diabetes.

People who are visually impaired are twice as likely as non-disabled people to not have access to transportation. Airports, however, are ahead in assisting the visually impaired as many of them have meet-and-assist programs. There are also apps such as the Aira app which connects visually impaired people with trained agents who can help with navigation.

Economic Burden

Economic burden from the treatment of DR differs from country to country. In Germany, a 60 to 69-year-old man could spend anywhere from 671 EUR to 2,933 EUR per quarter for treatment at the time of the event. These are large costs, but it can be even more exorbitant when considering the amount of money that is spent on other conditions that come along with diabetes. Comorbid conditions like heart disease and stroke could cost as much as 8,700 EUR per quarter in the time of the event. Retinopathy treatments could cost as much as 24,662 EUR in the year of the event. Since GDP per capita is 39,501 EUR, it is a significant investment if retinopathy is allowed to progress.

According to a recent study, in Japan the earlier the detection of diabetic retinopathy and the earlier treatments are given out, the higher the quality-adjusted life year. Per their analysis, if people over age 40 are screened early, their cost-effectiveness ratio will be 944,981 yen, or $11,857. The usual loss of well-being cost is 46,164 yen per capita. This means the average Japanese citizen suffering from this illness could lose as much as 46,164 yen per year, or save as much as 944,981 per year, depending on how early they screen and treat retinopathy.

In Chinese diabetic patients, retinopathy is less prevalent than hypertension and cardiovascular diseases. This means hypertension would be the number one cause of high costs. Overall diabetes medical costs range from 2,383 to 2,780 USD.

In the US, $16,752 in medical costs are racked up per patient each year, with $9,601 attributed to diabetes alone.

Ability to Access Services for Visually Impaired

The US Government provides two main programs to blind and low-vision people: the Social Security Disability Insurance program, and the Supplemental Security Income program. These programs are automatically available to blind citizens (those whose vision can't be corrected better than 20/200 for a period of 12 months or more), but they're also available to those who are just visually impaired and have paid into the social security system long enough. This means that patients who became blind from DR and have been blind for at least 12 months automatically qualify, but those who are still able to work and see in some way will have a harder time getting these benefits.

China's social programs provides basic rehabilitation for its blind and visually disabled citizens, especially children. Even though they put more emphasis on the blind, they also look after those with degenerative diseases like DR. However, in Germany, DR patients receive many of the programs that fully blind people receive. Germany focuses on basic rehabilitation for its visually impaired citizens, especially seniors. Their services treat blind and visually sighted people the same through educational, legal, cultural, medical, and social ways.
Part
02
of five
Part
02

Diabetic Retinopathy - US

Retina specialists who specialize in ophthalmology are responsible for treating diabetic retinopathy patients. Non-proliferative diabetic retinopathy patients only need to be monitored to determine when they are required to start their treatment. Treatment for proliferative diabetic retinopathy includes photocoagulation, panretinal photocoagulation, vitrectomy, and anti-VEGF therapy.

All the information is focused specifically on the US and was obtained from US-based sources including the American Society of Retina Specialists, All About Vision, American Academy of Ophthalmology, Mayo Clinic, American Optometric Association, and Stanford Health Care. The details of the findings are provided below.

PHYSICIAN SPECIALISTS FOR DIABETIC RETINOPATHY

According to the American Society of Retina Specialists, the physician specialist in the US who treats people with proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) is a retina specialist who specializes in ophthalmology. An "ophthalmologist is a medical doctor (MD) or a doctor of osteopathic medicine (DO) who is a specialist in eye care". Ophthalmologists conduct eye examinations, provide diagnosis and treatment for diseases, prescribe drugs and carry out eye surgery. They also give eyeglass and contact lens prescriptions.
A retina specialist can also be a subspecialist in illnesses and surgical operations of the retina and the eye’s vitreous body. This subspecialty is also referred to as vitreoretinal medicine. The American Society of Retina Specialists states that retina specialists in the US must complete "four years of medical school and specialized training in ophthalmology and vitreoretinal medicine. This includes one year of internship, three years of ophthalmology residency, and one or two years of retina-vitreous fellowship".
Many ophthalmologists in the US are board certified. An ophthalmologist becomes board certified after passing an exhaustive two-part examination conducted by the American Board of Ophthalmology.

TREATMENT PATH/PLAN FOR NON-PROLIFERATIVE (NPDR) DIABETIC RETINOPATHY

Non-proliferative diabetic retinopathy, usually referred to as early diabetic retinopathy, might not require immediate treatment. But the physician needs to monitor their patients' eyes closely to ascertain when they might need to be treated. The diabetes doctor (endocrinologist) can determine if their diabetes management can be improved. Prescribed diet, exercise and blood sugar level control can help to slow the progression.

If non-proliferative diabetic retinopathy advances to proliferative diabetic retinopathy, then the treatments outlined below will be applied.

TREATMENT PATH/PLAN FOR PROLIFERATIVE (PDR) DIABETIC RETINOPATHY

Treatment for proliferative diabetic retinopathy, also known as advanced diabetic retinopathy, depends on the specific problems affecting the retina, options include the following:

Photocoagulation: This is laser treatment, also referred to as focal laser treatment which can halt or slow down blood and fluid leakage in the eye. During the treatment, laser burns are used to treat abnormal blood vessels leakage. Focal laser treatment is normally performed in one session in the office of the doctor or eye clinic. The treatment may not restore blurred vision to normal, but it will likely reduce the chances of the disease getting worse.

Panretinal photocoagulation: This is another type of laser treatment which is also called scatter laser treatment. It can make abnormal blood vessels to shrink. During the treatment, scattered laser burns are used to treat the parts of the retina outside the macula. The burns shrink and scar the abnormal blood vessels. The treatment is normally performed in at least two sessions in the office of the doctor or eye clinic. The patient’s vision will become blurry for around one day following the treatment. It is possible to experience poor peripheral or night vision after the treatment.

Vitrectomy: In this procedure, a tiny incision is made in the patient’s eye to remove blood inside the eye and scar tissue on the retina. The treatment is performed in a surgical theater or hospital with anesthesia.

Anti-VEGF therapy: This involves the injection of medications called vascular endothelial growth factor (VEGF) inhibitors into the eye which can halt the “growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels”. Anti-VEGF therapy can be recommended as a “stand-alone treatment or in combination with panretinal photocoagulation”.

Since diabetes is a lifetime disease, surgery is not a cure for diabetic retinopathy, it can only slow or halt its progression. It is still possible to experience loss of vision and damage of the retina in the future. Many diabetic retinopathy patients require more than one treatment as the disease becomes worse.

Part
03
of five
Part
03

Diabetic Retinopathy - China

Available studies and reports indicate that, in China, it is the ophthalmologists (including retinal specialists) who treat patients with diabetic retinopathy, regardless of whether the condition is non-proliferative or proliferative. There are other health care professionals who deal with diabetic retinopathy, but their responsibilities are limited to screening or educating patients. Treatment of non-proliferative diabetic retinopathy in the country involves either close monitoring or focal laser therapy depending on the severity of the condition or whether the patient has pronounced macular edema. Treatment of proliferative diabetic retinopathy, on the other hand, often involves pan-retinal laser photocoagulation.

SPECIALISTS TREATING DIABETIC RETINOPATHY (DR)

The review article "Diabetic Retinopathy in the Asia-Pacific," which was published in the January/February 2018 issue of the Asia-Pacific Journal of Ophthalmology, indicates that the physician specialists in China who treat people with diabetic retinopathy are the ophthalmologists. Screening, however, can be done without the supervision of an ophthalmologist by trained non-physician graders. The Diabetic Retinopathy Barometer Report on China indicates the same thing as well. Though this Diabetic Retinopathy Barometer Report was published in late 2016, it is the latest report of the DR Barometer Program on the country, and it provides a comprehensive picture of the country's diabetic retinopathy landscape.

The DR Barometer Program, which promotes vision health across countries, is a collaborative effort of Bayer, the International Federation on Ageing (IFA), the International Agency for the Prevention of Blindness (IAPB), and the International Diabetes Federation (IDF). Based on the program's survey of 26 ophthalmologists in China, the factors that most commonly influence the treatment plan of ophthalmologists are the duration of diabetes and the presence of comorbidities, including hypertension and high glucose levels. Ninety-two percent or nearly all the polled ophthalmologists indicate diabetes, hypertension, and high glucose levels as the factors they often consider when preparing their treatment plan.

There are other health care professionals in the country who deal with diabetic retinopathy as well, but unlike ophthalmologists (including retinal specialists), they do not treat patients. Examples of such health care professionals include diabetes specialists, primary care providers, nurses, optometrists, and health educators. These health care professionals screen for diabetic retinopathy, refer patients to ophthalmologists when necessary, or educate patients on diabetic retinopathy.

TREATMENT OF NON-PROLIFERATIVE DIABETIC RETINOPATHY (NPDR)

The treatment of non-proliferative diabetic retinopathy in China varies depending on whether the patient has pronounced or significant macular edema. According to the study, "Chinese Medicines in Diabetic Retinopathy Therapies," which was first published online in 2018 in the Chinese Journal of Integrative Medicine, non-proliferative diabetic retinopathy patients in China with no pronounced macular edema do not require treatment. They require close monitoring only. In the aforementioned review article, "Diabetic Retinopathy in the Asia-Pacific," it was also mentioned that, in Asia, "patients are only treated when DR has progressed to advanced stages." Non-proliferative diabetic retinopathy patients in China with significant macular edema, on the other hand, are often treated with focal laser therapy. In a few instances, intravitreal injections are also performed to enhance visual acuity. These intravitreal injections involve either anti-VEGF agents or triamcinolone. Ranibizumab is one example of an anti-VEGF agent. VEGF stands for vascular endothelial growth factor. If resources permit, pan-retinal laser photocoagulation should be the treatment of choice for severe non-proliferative diabetic retinopathy.

TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

The treatment of proliferative diabetic retinopathy in China commonly involves pan-retinal laser photocoagulation. Based on the aforementioned study, "Chinese Medicines in Diabetic Retinopathy Therapies," pan-retinal laser photocoagulation is the preferred treatment in the country when it comes to patients with proliferative diabetic retinopathy. The purpose of this treatment is "to induce new vessel regression and prevent severe visual loss." Laser treatment may not be possible in most of the country's rural areas, however, as there was a survey suggesting that most rural hospitals have no laser facilities. This survey was mentioned in the recently published review article "Diabetic Retinopathy in the Asia-Pacific." Based on this review article, fewer than 10% of patients in the rural areas of China had received the recommended laser treatment.

The International Council of Ophthalmology (ICO) has recently released guidelines for diabetic eye care, and based on these guidelines, rural areas in China are considered low- or intermediate-resource settings. For reasons relating to long-term durability, cost-effectiveness, and non-compliant patients, the ICO does not recommend anti-VEGF therapy in the treatment of proliferative diabetic retinopathy in low-resource settings. This is despite the fact that anti-VEGF therapy is increasingly being used in high-resource settings such as the United States and Western Europe to treat proliferative diabetic retinopathy in highly compliant patients.


Part
04
of five
Part
04

Diabetic Retinopathy - Japan

Physician specialists that treat people with Diabetic Retinopathy (DR) in Japan, including those with proliferative (PDR) and non-proliferative diabetic retinopathy (NPDR), are Ophthalmologists and Diabetes Specialists. We have provided details on the treatment plan for patients with PDR and NPDR below.

DIABETIC RETINOPATHY

Diabetic retinopathy (DR) is one of the major chronic microvascular complications in long-standing type 1 and type 2 diabetic patients. Diabetic retinopathy damages blood vessels in the retina that resides in the back of the eye. The progression of diabetic retinopathy in patients defines the development of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy.

PHYSICIAN/SPECIALIST Responsible for Treatment

Diabetic Retinopathy (DR) patients on a whole (which include proliferative (PDR) and non-proliferative (NPDR)) in Japan are treated by Ophthalmologists and Diabetes Specialists.

TREATMENT PLAN FOR NON-PROLIFERATIVE (NPDR) DIABETIC RETINOPATHY

In Japan, the treatment plan for non-proliferative diabetic retinopathy (NPDR) patients involves the following:
  • Diet Therapy — The treatment plan always involves making changes to diet and lifestyle where necessary.
  • Oral Hypoglycemic Agents (OHAs) Only Treatment — Depending on the severity, only OHAs may be used in treating the patient.
  • Insulin Only Treatment — Depending on the severity and underlying cause, some patients may be placed on insulin therapy to manage the condition.
  • Oral Hypoglycemic Agents (OHAs) + Insulin Treatment — The treatment plan may involve the use of both OHAs and Insulin.

TREATMENT PLAN FOR PROLIFERATIVE (PDR) DIABETIC RETINOPATHY

In Japan, the treatment plan for proliferative diabetic retinopathy (PDR) patients involves the following:
  • Photocoagulation — This is a laser treatment that is also known as focal laser treatment. It is used to treat PDR and it can stop or slow the leakage of blood and fluid in the eye.
  • Vitrectomy — This is another procedure used to treat PDR in Japan. It involves making a tiny incision in the eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina.
  • Vascular Therapy — This involves using vascular endothelial growth factor (VEGF) inhibitors to treat PDR. The physician puts the anti-VEGF medication into the vitreous in the eye.

Part
05
of five
Part
05

Diabetic Retinopathy - Germany

People with Diabetic Retinopathy (DR), including those with Proliferative (PDR) and Non-Proliferative (NPDR) in Germany, are treated by ophthalmologists, optometrists, and diabetes specialists. The treatment options include laser treatment/photocoagulation, vitrectomy/surgery, and Anti-VEGF drugs.

METHODOLOGY

We began searching for information on which physician specialists treat people with Diabetic Retinopathy (DR), including those with Proliferative (PDR) and Non-Proliferative (NPDR) and their treatment with respect to Germany. Based on our research, we were able to learn that Diabetic Retinopathy (DR) patients, including those with proliferative (PDR) and non-proliferative (NPDR) in Germany, are treated by ophthalmologists, optometrists, and diabetes specialists.
Next, we were able to locate different types of treatments for Proliferative Diabetic Retinopathy (PDR) and Non-Proliferative Diabetic Retinopathy (NPDR) in Germany. We also found that Non-Proliferative Diabetic Retinopathy (NPDR) does not require any specific treatment except constant Physician monitoring and Proliferative Diabetic Retinopathy can be treated by options like laser treatment/photocoagulation, vitrectomy/surgery, and Anti-VEGF drugs which have been quoted in multiple sites specific to Germany. Later, for an in-depth explanation of each treatment, we searched for a few sources which have general information and not specific to any country.

Diabetic Retinopathy — Germany

Diabetic Retinopathy damages blood vessels in the retina that resides in the back of the eye. It is a very common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.

PHYSICIAN SPECIALISTS- GERMANY

Diabetic Retinopathy (DR) patients, including those with Proliferative (PDR) and Non-Proliferative (NPDR) in Germany, are treated by ophthalmologists, optometrists, diabetes specialists.

TREATMENT OF DIABETIC RETINOPATHY (DR), INCLUDING THOSE WITH PROLIFERATIVE (PDR) AND NON-PROLIFERATIVE (NPDR)

In general, the primary treatment of Diabetic Retinopathy includes adequate control of glucose, blood pressure (hypertension), and metabolic control. Non-Proliferative Diabetic Retinopathy (NPDR) does not require any specific treatment except constant physician monitoring. However, the treatment of advanced Diabetic Retinopathy or Proliferative Diabetic Retinopathy (PDR) include the following methods:

  • Laser treatment/photocoagulation: There are two types of laser treatments namely (i) Focal laser treatment and (ii) Scatter laser treatment for treating Proliferative Diabetic Retinopathy. These procedures involve laser burns on the bleeding of an abnormal blood vessel. Only 5-8% of Diabetic Retinopathy patients need laser treatment/photocoagulation.

  • Vitrectomy/Surgery: Vitrectomy is the surgical process that involves the removal of blood from vitreous with a tiny incision. Only 0.5% of Diabetic Retinopathy patients need vitrectomy.
  • Anti-VEGF drugs: Proliferative Diabetic Retinopathy (PDR) can also be treated with Anti-VEGF drugs such as bevacizumab, ranibizumab, aflibercept, etc. These medications are to be directly injected into the eye (vitreous) to stop abnormal blood flow.


Sources
Sources

From Part 01
From Part 03
Quotes
  • "The 2017 ICO Guidelines for Diabetic Eye Care serve as a general comprehensive guide for physicians, ophthalmologists, and health care providers with broad recommendations, incorporating best evidence-based management principles with practical, real-world experience in different settings. The key features of the guidelines are recommendations for diagnosis and definition, screening and referral, and follow-up and management options based on resource settings, which are divided broadly into high-resource settings (e.g., United States, United Kingdom, and Western Europe) versus low- or intermediate-resource settings (e.g., rural areas in China, India, Africa, and South America)."
  • "Laser PRP is considered the mainstay of treatment for PDR and also can be considered for certain high-risk patients with severe NPDR.11 This includes factors such as poor compliance with follow-up, impending cataract extraction or pregnancy, and status of the fellow eye (e.g., blind or advanced DR in the fellow eye)."
  • "For low- or intermediate-resource settings, recommendations for management generally are similar to those in high-resource settings. Where resources permit, PRP should be considered the preferred choice of treatment of severe NPDR and all stages of PDR. The contemporary PRP approach uses short-pulse 20- to 30-ms laser with 2000 to 4000 treatment burns depending on the PDR grade/severity."
  • "Recommendations were made for DR and DME in terms of screening, referral, follow-up schedules, and types of treatment for high-resource and low- or intermediate-resource settings, broadly classified on country income level as defined by the World Bank and World Health Organization51 as follows: (1) high-resource settings, advanced or state-of-the-art screening and management of DR based on current evidence and clinical trials; (2) low- or intermediate-resource settings, essential or core to midlevel service for screening and managing DR with consideration for availability and access to care in different settings."
  • "For PDR, in high-resource settings, clinicians are increasingly treating highly compliant patients with anti-VEGF therapy. Even then, there remains uncertainty regarding the cost effectiveness and long-term durability of anti-VEGF therapy for PDR, and in many situations (e.g., poorly compliant patients), laser PRP continues to be the standard of care for PDR. Thus, anti-VEGF therapy for treatment of PDR is not recommended in the guidelines for low-resource settings. These concepts may change over time when results of new clinical trials and cost-effective studies are released."
  • "Some areas do not have clear consensus, such as timing for PRP for the treatment of PDR. The guidelines recommend that PRP should be administered only if DR progresses to PDR for countries with low or intermediate resources (Table 4). However, one of the key problems for low-resource settings is tracking and referring patients who need treatment on a timely basis. Thus, it can be argued that in a low-resource environment, if a patient with severe or very severe NPDR has been identified by screening programs, it would be appropriate to consider PRP at that time."
Quotes
  • "In current clinical practice, only close monitoring is required for NPDR patients without pronounced macular edema. However, clinically significant macular edema often involves focal laser therapy. In addition, intravitreal injections of triamcinolone or anti-VEGF agents including ranibizumab are also effective in improving the visual acuity. For PDR patients, pan-retinal laser photocoagulation is the preferable treatment to induce new vessel regression and prevent severe visual loss."
  • "Therapies neovascularization play important roles in the development of DR, especially proliferative DR (PDR). Therapies with Chinese medicines (CMs) that improve microcirculation complementary to conventional treatments increase with Chinese medicines (CMs) that improve microcirculation complementary to conventional treatments increase the chances of delaying PDR development and improving visual acuity in diabetes patients."
Quotes
  • "Even though the use of retinal photocoagulation has been the mainstay of DR treatment for the past few decades, a 2000 national survey in China showed that 90% of rural hospitals had no laser facilities. This may explain the finding from the Handan Eye Study, where less than 10% of patients in rural China requiring laser treatment for diabetic eye disease had received it."
  • "Newer pharmacological developments have revolutionized DR treatment from vision stabilization to vision improvement. Xu et al reported good clinical efficacy using intravitreal ranibizumab and conbercept in 62 Chinese patients over a 12-month clinical study."
  • "Ophthalmologists in the Asian regions often select focal/grid laser photocoagulation as their mainstay of treatment and patients are only treated when DR has progressed to advanced stages."
Quotes
  • "The DR Barometer Program aims to improve the vision health of adults living with diabetes around the world. This collaborative program was initiated with the ground-breaking 41 country DR Barometer Study, that identified serious gaps in patient awareness and education of diabetic eye diseases, as well as barriers to screening and treatment services at a country level that require urgent attention."
  • "To address gaps and promote forward action, the DR Barometer Program brings together key stakeholders (including patients, ophthalmologists, diabetes specialists, primary care providers, diabetes educators, governments, and industry) to establish and maintain a global community."
From Part 04
Quotes
  • "This is a part of the Japan Diabetic Complications Study (JDCS), a multi-centred randomised trial of type 2 diabetes patients aged 40-70 years with an 8 year follow-up. There were 1,221 patients without diabetic retinopathy at baseline; incidence of diabetic retinopathy was defined as the development of any diabetic retinopathy. There were 410 patients with mild non-proliferative diabetic retinopathy at baseline; progression of diabetic retinopathy was defined as the development of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy"
Quotes
  • "The present study explored the influences of various treatment factors and patient characteristics on physicians (diabetes specialists and nonspecialists) when they select the first-line treatment for drug-naive patients with T2DM in a real-world setting in Japan"
Quotes
  • "As per Table 3: Background characteristics of patients with type 2 diabetes based on the presence of non-proliferative diabetic retinopathy. Treatment: Diet treatment only OHA only Insulin only HA +  insulin"
Quotes
  • "To report a case of proliferative diabetic retinopathy (PDR) exhibiting the appearance of scintillating particles presumed to be crystallin inside the intravitreal cavity after laser photocoagulation."
  • " In correlation with the treatment performed on the patient's right eye, we began panretinal photocoagulation on his left eye. Examination performed prior to the patient's third session of panretinal photocoagulation revealed a large number of scintillating particles in the posterior vitreous gel in front of the retina."
  • "No posterior vitreous detachment was observed, and since these particles were situated as if captured in the posterior vitreous gel, no eye-movement-associated mobility of the particles was observed."
Quotes
  • "If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment."
  • "Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. "
  • "Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns."
  • "Panretinal photocoagulation. This laser treatment, also known as scatter laser treatment, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar"
  • "Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia."
  • "Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels."
From Part 05
Quotes
  • "Seventy-five health care professionals completed the survey in Germany. Of these, 39 were diabetes specialist providers (52%), ten were ophthalmologists (13%), and seven were primary care providers (9.3%). The remaining respondents were optometrists, nurses, health educators or other types of professionals."
Quotes
  • "5%-8% of people with DR will need laser treatment. "
  • "0.5% of diabetic patients will need a vitrectomy. "
  • "Treatment strategies are effective in 90% of cases to prevent severe visual loss. Most important factor in medical management of diabetic retinopathy is good glycemic control, which is associated with reduced risk of newly diagnosed retinopathy and of progression of existing retinopathy. Diabetes Control and Complications Trial-United Kingdom Proliferative Diabetic Retinopathy Study (DCCT-UKPDS)."
  • "Adequate control of hypertension reduces progression of retinopathy and loss of vision (UKPDS) Encourage changes in lifestyles and good metabolic control in all diabetic patients Treatment options Laser therapy Anti-VEGF drugs (bevacizumab, ranibizumab, aflibercept) Surgery"
Quotes
  • "If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment."
  • "Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression."
  • "Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns."
  • "Panretinal photocoagulation. This laser treatment, also known as scatter laser treatment, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar."
  • "Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia."
  • "Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels."