Diabetic retinopathy: The FP’s role in preserving vision

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doi:10.1038/nphys1170

Applied Evidence

Diabetic retinopathy: The FP’s role in preserving vision

J Fam Pract. 2020 April;69(3):120-126 | 10.1038/nphys1170

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References

1. National Diabetes Statistic Report 2020: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed March 20, 2020.

2. Fitch K, Weisman T, Engel T, et al. Longitudinal commercial claims-based cost analysis of diabetic retinopathy screening patterns. Am Health Drug Benefits. 2015;8:300-308.

3. Centers for Disease Control and Prevention. Common eye disorders. September 29, 2015. www.cdc.gov/visionhealth/basics/ced/index.html. Accessed March 20, 2020.

4. American Academy of Ophthalmology PPP Retina/Vitreous Committee, Hoskins Center for Quality Eye Care. Diabetic Retinopathy PPP 2019. San Francisco, CA: American Academy of Ophthalmology. October 2019. https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp. Accessed March 20, 2020.

5. Zhang X, Saaddine JB, Chou C-F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304:649-656.

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Time since diagnosis. The Wisconsin Epidemiologic Study of Diabetic Retinopathy found that the prevalence of diabetic retinopathy varied from 28.8% in people who had DM for < 5 years to 77.8% in people who had DM for ≥ 15 years. The rate of proliferative diabetic retinopathy was 2% in people who had DM for < 5 years and 15.5% in those who had DM for ≥ 15 years.¹¹

Diabetic retinopathy can deteriorate during pregnancy but generally reverts to the pre-pregnancy level; long-term progression of retinopathy is not affected.

Demographic variables. The prevalence of diabetic retinopathy is higher in men, non-Hispanic blacks (38.8%), and people with type 1 DM.^4,5,11-13The Veterans Affairs Diabetes Trial found a higher prevalence of moderate-to-severe diabetic retinopathy in Hispanics (36%) and African Americans (29%) than in non-Hispanic whites (22%).¹⁴

Among people with DM who have diabetic retinopathy, systolic and diastolic BP and the HbA1C level tend to be higher. They are more likely to use insulin to control disease.^4,5,13 In a recent cross-sectional analysis, the prevalence of vision-threatening retinopathy was higher among people ≥ 65 years of age (1%; 95% confidence interval [CI], 0.7%-1.5%) than among people 40 to 64 years of age (0.4%; 95% CI, 0.3%-0.7%) (P = .009).⁵

Does pregnancy exacerbate retinopathy? Controversy surrounds the role of pregnancy in the development and progression of diabetic retinopathy. The Diabetes Control and Complications Trial found a short-term increase in the level of retinopathy during pregnancy that persisted into the first postpartum year. A 1.63-fold greater risk of any deterioration of retinopathy was observed in women who received intensive DM treatment from before to during pregnancy (P < .05); pregnant women who received conventional treatment had a 2.48-fold greater risk than nonpregnant women with DM who received conventional treatment (P < .001).

Deterioration of retinopathy during pregnancy had no long-term consequences, however, regardless of type of treatment.¹⁵ More importantly, in most cases, changes in the level of retinopathy revert to the pre-pregnancy level after 1 year or longer, and pregnancy does not appear to affect long-term progression of retinopathy.¹⁵

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