Diabetic Retinopathy Reality Check

HOT TOPIC

A study in JAMA Ophthalmol determined that the number of adults in the United States living with diabetic retinopathy (DR) is significantly higher than previously estimated. Using data from the National Health and Nutrition Examination Survey, the prevalence of DR among adults with diabetes was assessed at 29.2%, which is much higher than the previously estimated 4.2%, based on claims data. Additionally, the study found that DR was more common among certain groups, such as those with longer duration of diabetes, non-Hispanic Black individuals, and those with lower income and education levels.

The study highlights the importance of early detection and treatment of DR to prevent vision loss. Screening for DR is recommended for all adults with diabetes. Based on the study findings, screening rates may not be sufficient to detect and treat all cases, as many patients fall through the cracks and don’t receive a proper referral to an eye care professional for a comprehensive eye exam. The authors called for increased efforts to improve access to screening and treatment for DR, particularly among underserved populations that may not have access to regular health care. They also emphasized the need for continued monitoring of the prevalence of DR to inform public health efforts aimed at addressing this growing problem. (Read more here.)

OUTSIDE THE LANE

Macular Pigments’ Role in Eye and Brain Health

A paper recently published in Exercise and Sport Sciences Reviews shows how macular pigments work to improve eye health and functional vision. Researchers at the University of Georgia have shown that eating dark leafy greens or vegetables that are yellow or orange, which contain high levels of the plant compounds lutein and zeaxanthin, improves both eye and brain health.

According to Jack Harth, a doctoral candidate in the University of Georgia’s College of Public Health, “A lot of the research into macular lutein and zeaxanthin has focused on health benefits, but from a functional perspective, higher concentrations of these plant pigments improve many aspects of visual and cognitive ability.” The paper discusses how consuming such foods can improve vision in the far distance or visual range (visual range meaning how well a patient can see a target clearly over a distance).

It is believed that these pigments reduce the effect of blue light, similar to how eye black or blue-blocking sunglasses work, but they also improve the eye’s natural ability to be less bothered by bright light. (Read more here.)

My Two Cents

Obviously, substantially more research is needed before our practice patterns change, and before most of us begin to recommend dietary supplements rich in these compounds to our athletes; however, the logic put forth by the paper’s authors makes sense. As a doctor who works in a large college town (Baton Rouge, Louisiana), I see my fair share of college athletes and will be interested to see if I can give them a competitive edge with such a supplement.

CAN YOU RELATE

Last week, a 50-something-year-old Black male walked into my clinic with complaints of worsening blurred vision after beginning treatment for his “pink eye.” When I inquired him about his diagnosis and what his previous doctor prescribed him, he simply shrugged and replied that the doctor on his phone sent him a drop, which he had brought in. The drop was a generic combination therapy drop that he was supposed to use 4 times daily; however, he felt the need to use it more often, as symptoms were not improving (see photo below).

As you can see, the patient had a pretty gnarly dendrite through his visual axis. The teledoc prescribed a steroid drop that fed the dendrite, thus worsening his situation. We discontinued the drop, added a broad-spectrum antibiotic for coverage, plus oral valaciclovir, and saw him 2 days later. After little improvement, I broke out the big guns and added topical trifluridine (Viroptic, Pfizer). He’s about 75% improved after just 2 more days of treatment and will be fine with minimal long-term damage.

For all the Chicken Littles and Doomsday preachers in our profession, the need for optometry is not going anywhere. Telemedicine can be leveraged effectively in many scenarios throughout eye care; however, I am extremely confident that it will never replace us. As optometrists, we are a needed profession that the public trusts and values. It behooves us to roll with the punches and evolve. Remember just a few years ago, when we thought LASIK was going to be the end of optometry? Or when the autorefractor came out? Technologies come and go, but optometry will remain.

QUOTE OF THE WEEK

“The bond of our common humanity is stronger than the divisiveness of our fears and prejudices.”

—President Jimmy Carter