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Diabetic Eye Disease: From Diagnosis To Treatment

posted by Elizabeth Klunk, RN, BSN, CCM-R, SVP Medical Management, Versant Health

on November 14, 2019

Imagine if there was a deadly and debilitating disease the affected nearly 30 million Americans, yet nearly 25% of them weren’t even aware they had the disease. We are talking about diabetes, and left undetected or untreated, diabetes can lead to a number of horrific consequences, including neuropathy, amputation, blindness, and even death.

In the case of type 2 diabetes, there are relatively few symptoms to indicate a person even has the disease until their condition is quite progressed. As such, most people discover they have diabetes one of two ways.

  1. In many cases, risk factors such as obesity, smoking, or low activity levels may cause their primary care physician to run a high-fasting blood glucose test.
  2. In other cases, they learn about their disease from an eye care professional during a routine eye exam.

Diabetes, Vision, and Early Detection

During an eye exam, an eye care professional can examine the optic nerve, the retinal blood vessels, and the back of the eye. The physician may notice leakages in the small capillaries in the retina, which often indicates diabetic retinopathy. This is when high blood sugar levels cause damage to blood vessels in the retina.

Even if diabetes has not been diagnosed, those telltale leakages are a sure sign that the patient has the disease. In fact, 20% of people first learn that they are diabetic as a result of an eye exam.

About 30% of people with diabetes have diabetic retinopathy; fortunately, early detection and treatment can reduce the risk of blindness from the disease by 95%. To this point, one study from Diabetes Care found that risk of developing diabetic retinopathy was reduced by 76% and progression slowed by 54% in response to intensive treatment.

Yet, even with the threat of blindness, many diabetics skip their annual eye exam. One study of nearly 2,000 diabetics over the age of 40 found that just 40% actually adhered to eye care recommendations. Despite the encouragement of doctors and health insurance providers, 60% of known diabetics fail to get an annual eye examination.

Not surprisingly, the same study found that once a person developed severe diabetic retinopathy, they were more likely to follow their eye exam schedule. However, by that time, significant damage to the eye and to vision has already occurred. Consistent annual eye exams likely could have detected issues sooner and led to earlier treatment, before the condition worsened.

The High Cost of Diabetic Retinopathy

 Diabetes-related blindness costs can total more than $500 million per year. In fact, diabetics with even moderate diabetic retinopathy have been found to have notably higher medical costs than those associated with other diabetes-related conditions, including neuropathy and chronic kidney disease.

A study looking at the costs associated with diabetic retinopathy in the Medicare population found that the average annual Medicare payments for all care, as well as the average payments for ophthalmic care specifically, were significantly higher for diabetics with both nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR), as compared to those diabetics with no evidence of diabetic retinopathy. Moreover, payments for both medical and vision care were substantially higher for PDR cases than NPDR.

In other words, the earlier the disease was detected, the sooner treatment could begin. This not only improved outcomes for the patient, but lowered costs as well.

This is why we are so passionate when it comes to early detection and early intervention of both diabetes and diabetic retinopathy. There is no doubt that an annual eye exam is a critical component of any health and wellness program to reduce the risk blindness from this disease.

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