The prevalence of diabetes has doubled in the past decade, and the resulting increases in diabetes-related eye disease pose a new challenge to eye specialists, according to an editorial in the March issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Two editorials and a research article in the issue focus on ophthalmologic implications of metabolic diseases, and are being published in conjunction with a JAMA theme issue on diabetes, obesity and their comorbidities. The March issue of Archives of Neurology, along with the April issues of Archives of Pediatrics & Adolescent Medicine, Archives of Dermatology and Archives of Surgery, will also focus on this theme.
"By 2050, the number of Americans with diabetic retinopathy [affecting blood vessels in the retina] is projected to triple from 5.5 million to 16 million, and the number of those with vision-threatening retinopathy will increase from 1.2 million to 3.4 million," write Thomas W. Gardner, M.D., M.S., and Robert A. Gabbay, M.D., Ph.D., of Penn State College of Medicine, Hershey, Pa., in the first editorial. "The number of cataracts will increase by 235 percent and glaucoma among elderly Hispanic individuals with diabetes will increase 12-fold."
To effectively treat these conditions, ophthalmologists must go beyond surgically treating late-stage eye disease and work with other clinicians to help patients control their diabetes before eye complications worsen, Dr. Gardner and Dr. Gabbay note. "Ophthalmologists have a unique opportunity to influence patient behavior because vision loss is one of the most feared complications of diabetes. Helping patients make the connection between their eye disease and the ABCs of diabetes (A1C, blood pressure and cholesterol) can motivate them to improve their health."
(Arch Ophthalmol. 2009;127[3]:328-329. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This work was supported by grants from the Juvenile Diabetes Research Foundation, American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Gardner is a Jack and Nancy Turner Professor and Dr. Gabbay is a Laurence M. Demers Career Development Professor. Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Steroid Treatment Shows No Long-Term Benefit For Diabetes-Related Eye Disease
The steroid triamcinolone does not appear to offer a long-term benefit in the treatment of diabetic macular edema (swelling of the retina due to excess fluid build-up), and patients who take the drug are likely to require cataract surgery, according to a report in the same issue. Authors writing on behalf of the Diabetic Retinopathy Clinical Research Network report the three-year outcomes of a clinical trial in which 306 eyes of patients with diabetic macular edema were randomly assigned to receive either photocoagulation (laser treatments to stop fluid leakage), 1 milligram of intravitreal (administered through the eye) triamcinolone or 4 milligrams of intravitreal triamcinolone.
"Our three-year results, analyzed from a subset of the randomized subjects, are consistent with the previously published results after two years of follow-up," the authors write. "There was no long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation [laser treatment] for patients with diabetes macular edema receiving treatment as performed in this clinical trial. Rather, visual acuity outcomes slightly favored the laser group over either of the two triamcinolone groups. It appears that most eyes receiving this 4-milligram triamcinolone preparation will require cataract surgery, though only a few will develop glaucoma that will require surgery."
(Arch Ophthalmol. 2009;127[3]:245-451. To contact members of the Diabetic Retinopathy Clinical Research Network, e-mail Michael S. Ip., M.D., at msip@wisc.edu.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Recent Study Results Validate Long-Term Value of Blood Glucose Control
Results of the Epidemiology of Diabetes Interventions and Complications (EDIC) study, published in the December 2008 issue of the Archives, provide more proof that tight blood glucose control after diagnosis with diabetes significantly reduces the risk of diabetic retinopathy at least 10 years later.
Previous investigators coined the term metabolic memory to describe the lasting reduction of diabetes complications following initial efforts to reduce blood glucose levels, writes Robert N. Frank, M.D., of the Wayne State University School of Medicine in a second editorial in the March issue.
"The present results of the EDIC study dramatically show the long-term benefit of initial tight glycemic control through the phenomenon of metabolic memory," he concludes. "But the presence of metabolic memory also sets a critical parameter that any proposed mechanism through which prolonged hyperglycemia [high blood glucose] leads to the complications of diabetes must fulfill to be biologically plausible."
(Arch Ophthalmol. 2009;127[3]:330-331. To contact Robert N. Frank, M.D., call Andrea Pecoraro at 313-577-8907 or e-mail apecoraro@med.wayne.edu.)
Editor's Note: Please see the article for additional information, including, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
Journal
Archives of Ophthalmology