Ophthalmologists tackle diabetes-related blindness at ground level.
Diabetes currently afflicts more than 30 million Americans (about 9.4% of the population). The American Diabetes Association estimates that more than seven million people are not even aware that they have this debilitating disease.
While many people with diabetes learn they have the disease via a high-fasting blood glucose test, fully 20% discover they are diabetic as a result of an eye exam.1
From diabetes to blindness
Diabetes may be associated with systemic co-morbidities including kidney disease, peripheral neuropathy and vasculopathy. Additionally, untreated diabetics are at risk for the disabling consequences of diabetic retinopathy, cataract and glaucoma.
Approximately 30% of people with diabetes have retinopathy; fortunately, early detection and treatment can reduce the risk of blindness by 95%.2 Recent advances offer hope to those at risk from the devastating effects of this disease. Aiello and colleagues at the Diabetes Control and Complications Trial, found the risk of developing diabetic retinopathy was reduced by 76% and progression slowed by 54% in response to intensive treatment.3
Early intervention is central to successful treatment of diabetic retinopathy. In its early stages, however, when treatment has the greatest likelihood of success, patients are typically asymptomatic. Thus, an annual eye exam – combined with a robust medical management program – is a critical component of any health and wellness program to reduce blindness from this disease.
Diabetes costs the United States an estimated $327 billion annually, with $237 billion coming from direct medical costs and $90 billion coming from decreased productivity.4 And with nearly 30% of diabetics suffering from retinopathy,5 diabetes-related visual impairment costs can total more than $500 million per year.6
A study by Zhang and colleagues found that medical costs for diabetics were significantly higher for those with diabetic retinopathy (DR) than those without retinopathy (DR).7 Specifically, those diabetics with even moderate diabetic retinopathy had notably higher medical costs than who did not have retinopathy, but had other diabetes-related conditions, such as neuropathy, vasculopathy and chronic kidney disease.7
A similar study by Schmeir and colleagues published in Retina looked at the costs associated with diabetic retinopathy in the Medicare population.8
Researchers examining 5% Medicare claims data from 1997 through 2004 identified 178,383 controls (people with diabetes but no evidence of diabetic retinopathy), 33,735 cases of nonproliferative diabetic retinopathy (NPDR) and 6,138 cases of proliferative diabetic retinopathy (PDR).
They found that average annual Medicare payments for care, as well as the average payments for ophthalmic care, were significantly higher for both the NPDR and PDR cases compared to diabetic patients without retinopathy.
1. Schaneman J, et al. The role of comprehensive eye exams in the early detection of diabets and other chronic diseases in an employed population. Popul Health Manag. 2010 Aug;13(4):195-9.
2. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventin....
3. Aiello LP; DCCT/EDIC Research Group. Diabetic Retinopathy and Other Ocular Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care. 2014 Jan;37(1):17-23.
4. The cost of diabetes. American Diabetes Association. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html.
5. Tomic M, et al. Inflammation, haemostatic disturbance, and obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes. Mediators Inflamm. 2013;2013:818671.
6. Diabetic retinopathy. Centers for Disease Control. https://www.cdc.gov/visionhealth/pdf/factsheet.pdf.
7. Zhang X, et al. Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore. PLoS One. 2017;12(7):e0180949.
8. Schmier JK, et al. Medicare expenditures associated with diabetes and diabetic retinopathy. Retina. 2009 Feb;29(2):199-206.