DOCTOR SUGGESTS NEW PRIORITIES COULD REDUCE DIABETIC BLINDNESS
James O'Rourke, MD, professor of pathology at University of Connecticut Health Center, is calling for primary care deliverers to regularly obtain an image of their diabetic patients' retinal blood vessels and then catalog those as part of a permanent medical record. Today, one-half of all people with diabetes will eventually develop some degree of retinal damage, and 10 percent of these will become legally blind after having diabetes for 20 years. It doesn't have to be so, Dr. O'Rourke believes.
New technologies, particularly in the field of diagnostic imaging, are available to health care providers. The problem has been to chart changes in an individual's eyes, and to do that, physicians need a "baseline," a clear idea of the condition of the patient's eyes at a given time. The tests, already available, which Dr. O'Rourke advocates, will provide such a "baseline."
With this information in hand, doctors and nurses can easily discern changes in a patient's retinal blood vessels in subsequent years, and quickly invoke proper treatment. The expenses of making and maintaining the record are outweighed by the savings of very expensive therapies and rehabilitation for those who go blind because of diabetes.
"We're not using our available resources, manpower, or skills to maximal advantage to combat this problem," Dr. O'Rourke said. "Diabetes and diabetic blindness numbers are growing, and we're not properly deployed. We're losing this fight," he said.
Dr. O'Rourke suggested misunderstandings and misconceptions may have contributed to why we are where we are now. His assessment of the situation includes:
* Diabetic blindness is not a disease of the retina, or an eye disease; it is a disease of the blood vessels in the retina. Diabetes does not just cause retinal blood vessel damage; the disease causes widespread blood vessel damage, particularly the fine blood vessels of the kidneys, nerves, brain, and feet. Diabetes affects the walls of blood vessels. There are more than 10 billion tiny blood vessels throughout the human body--or more than 600 square meters of wall surface--about the size of three tennis courts.
* Viewing the retina is one of the most effective means of detecting early blood vessel damage in diabetes. Unfortunately, viewing the retinal blood vessels through an undilated pupil provides only a limited, transient image. Seeing retinal blood vessel damage early on allows doctors to monitor and adjust medication levels. While maintaining a normal blood sugar level is not easy, one of the keys to it is early detection.
* New ways are needed to rapidly screen for retinal diabetes at less cost. Proper planning and improved technology can help, but screening has to be incorporated as part of a regular health maintenance program.
* The medical system is divided into specialties that manage different aspects of diabetic care. Early detection and prompt treatment of retinal diabetes requires more efficient interactions among specialists, if we hope to reverse the diabetic blindness problem.
To improve efficiency, Dr. O'Rourke suggests primary care physicians ought to obtain full digital color prints of retinal blood vessels, with pupils dilated, from their patients who have had diabetes more than five years. These images should be repeated annually, and maintained in the patient's medical record, so that comparisons can be made if the occasion warrants.
Dr. O'Rourke also suggests that community hospitals make retinal imaging available to primary care physicians.
"Convenient screening by retinal imaging is the key to early detection," he said. "The procedure takes 10 minutes, and it is painless. We do it here at the Health Center in our Vascular Radiology Division, thanks to support from the Connecticut Lions. This is something that will materially help reduce the growing problem of diabetic blindness."