What is the Future of Diabetes Eye Health?
In this article, we will report on emerging research and new eye technology and therapies that could transform eye care for people living with diabetes including work to reduce the burden of annual eye screenings. Researchers are seeking to find new and better ways to protect the eyes, treat eye disease, and decrease or prevent vision loss. This is critical as diabetes-related eye complications can damage not just our physical but our psychological well-being. A ten-year study of nearly 96,000 adults, found that people with diabetes-related retinopathy had higher rates of depression than people with diabetes who did not have eye disease showing that vision loss is profoundly emotionally challenging.
The approval of new therapies for diabetes-related eye disease over the past few years are providing many improved treatment options for people with diabetes and eye disease as we have discussed. Even more promising products are being investigated. One example is an eye drop that is currently being developed to treat macular edema. This topical eye drop uses a unique technology to overcome some of the limitations of conventional eye drops. The new eye drops, if approved, will be able to deliver medication more effectively to the retina, offering a more convenient treatment option than ocular implants and injections. Critical to any therapy’s success is early detection of eye conditions. And to do that, the annual comprehensive, dilated eye exam is critical.
What can your eyes tell you about your health?
Your eyes can tell you a lot about your health which is why getting an eye exam is important. In a dilated eye exam, your eye care professional is able to look inside your eye at both your retina and optic nerve. It is known that the retina develops from the same tissue as the brain and the optic nerve physically connects the eye and the brain. So perhaps we should not be surprised that recent studies reveal that images of the retina can be used to help detect multiple sclerosis, schizophrenia, detect early signs of Alzheimer’s, and even help diagnose brain injuries and mild concussion. As a result, the eye can give a window into what may be happening in your brain and body. The routine eye exam turns out to be more important than we knew, having the power to help not just your eyes, but also your overall health. And finding health issues early on can help prevent their progression.
In an earlier article, we noted that less than half of people with diabetes in the United States are getting the recommended yearly eye exam so critical to protecting against vision loss. An international survey discovered that 85% of people feared losing vision more than any other sense, yet only 33% of respondents reported having an eye exam each year. The American Diabetes Association (ADA) reports some advancements in their 2024 standards of care that may help. The ADA says that the use of retinal photography with remote reading by experts has great potential to provide screening services in areas where expert eye care professionals are not available. The ADA says that high-quality retinal photographs can detect most clinically significant diabetes retinopathy. This could reserve the expertise of ophthalmologists for more complex examinations and for therapy.
U.S. Food and Drug Administration (FDA) approved artificial intelligence (AI) systems that detect more than mild diabetes-related retinopathy and macular edema, are an alternative to traditional screening. According to the ADA, there are three FDA-approved algorithms for diabetes-related retinopathy screening and examination, and these are now covered by most health insurances. The ADA calls for AI-enabled services to provide a clear pathway for referral to a specialist for further examination and treatment if problems are detected. The ADA stresses that retinal photos are not a substitute for dilated comprehensive eye exams which should still be conducted yearly.
Why do so many people put off regular eye exams and other health screenings?
While most people with diabetes know the importance of regular complications screening, and that early detection and treatment will likely result in better outcomes, it turns out that is not enough. Many of us will look for any excuse to put off making or going to our screening appointment.
- Routine eye exams can be disruptive. We may need to plan time off work or school. If pupil dilation is required (and it usually is), we will need to ask a family member or friend to take us to our eye doctor appointment. Since the blurry vision and headache from the dilation drops and bright lights can persist for several hours after the exam, the rest of the day is often unproductive.
- Routine eye exams can be scary. It is not unusual to be anxious about results from screening checks. Sometimes it seems easier to just put off the exam than to risk hearing bad news. If we have missed appointments, we are concerned that we will be scolded for this.
How can we make doing the right thing the easy thing to do?
Several different initiatives are underway to make screening checks more convenient. Bringing screening to the people, rather than expecting people to travel long distances, will reduce a significant barrier to keeping up to date with screening checks. In some areas, pharmacies are being used to provide initial screening checks, using a retinal scanning camera. This way the initial screening check is done somewhere convenient and familiar, and without the need for dilating drops. If changes are detected, a referral to an expert ophthalmologist is arranged.
Here are how people with diabetes say that eye care clinics and professionals can help:
·Provide automated reminder systems coordinated with easy ways to schedule needed appointments.
·Be compassionate and thoughtful when discussing the results of screening with people with diabetes. Offering counseling before and/or after screening could help address anxieties and provide people with practical coping tips.
·Simply acknowledging how difficult it can be for someone to show up for a screening appointment, and thanking those that do so would be a big encouragement.
Never underestimate the power of peer support
Peer support can be hugely beneficial. Whether it be sharing stories about how people manage their anxieties about screening checks, or how people have dealt with a diagnosis, speaking with others who share your experiences can help lessen the isolation you may feel. Join a DiabetesSisters meetup to network and learn from other women who have similar lived experiences.
Schedule an eye exam today
Our first call to action was to schedule an eye exam for yourself if you have not had one in the past year. Hopefully you have done that. If not, do so now. We end this special newsletter with one final challenge. Reach out to a friend or family member with diabetes and help them schedule their own eye exam. Be there to support and encourage them. Remember 90% of diabetes-related vision loss is preventable. Tell a friend.
References:
Olson D, Le P, Vu T, et al. Association Between Anxiety, Depression, and Severity of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3836.
Woo M. Eyes hint at hidden mental health conditions. Nature Outlook: The Eye. 2019; doi: https://doi.org/10.1038/d41586-019-01114-9
Richman EA (Contributing Writer Interviewing: Glenn Cockerham, MD, Col. (Ret.) Donald A. Gagliano, MD, MHA, Randy Kardon, MD, PhD, and Robert A. Mazzoli, MD). Traumatic brain injury and visual disorders: What every ophthalmologist needs to know. American Academy of Ophthalmology EyeNet Magazine. https://www.aao.org/eyenet/article/traumatic-brain-injury-visual-disorders-what-every-2
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