Home' Trinidad and Tobago Guardian : April 24th 2017 Contents A26 body & soul
guardian.co.tt Monday, April 24, 2017
Is an annual eye exam a must
for people with type 1 diabetes?
People with type 1 diabetes face the risk of
developing a disease that can cause blindness,
so treatment guidelines have long called for
annual eye exams.
But new research suggests this one-size-fits-all
advice is costly and ineffective, because people with
a low risk may need less-frequent screenings while
people at high risk may need to be seen more often.
Diabetic retinopathy can damage the light-sensitive
tissue at the back of the eye and trigger full vision
loss, the researchers explained. Screening can catch
this disease before irreparable damage is done, but
not every person with diabetes faces the same risk.
“For example, patients with no or minimal eye
changes and good blood sugar levels might not need
their next examination for another four years,” said
study author Dr David Nathan.
“On the other hand, if the patient already has de-
veloping eye disease and their blood sugar control has
not been in the recommended range, they might need
a repeat examination in as soon as three months,”
Nathan is the director of the Diabetes Centre and
Clinical Research Centre at Massachusetts General
Hospital, in Boston.
Current guidelines suggest getting an annual eye
screening within three to five years of a type 1 dia-
betes diagnosis. People with type 1 diabetes cannot
produce any insulin.
To assess that advice, the investigators focused on
type 1 diabetics (aged 13 to 39) who had enrolled in a
large, national diabetes trial between 1983 and 1989.
The latest analysis involved 24,000 eye exams con-
ducted over 30 years among roughly 1,400 people
with type 1 diabetes.
Retinal photographs were taken every six months
until 1993, and then—in a follow-up study—once
every four years until 2012. The study participants’
vision, advanced retinopathy status and general di-
abetes history were tracked for an average of nearly
The researchers determined that those participants
who had an average blood sugar level of six per cent,
but no signs of retinopathy, could forgo the annu-
al screening in favour of just one exam every four
years. Similar people with mild retinopathy should be
screened once every three years, the team concluded.
By contrast, those with severe or moderate retin-
opathy would do well to get screened every three to
six months, respectively, the study authors reported.
People with higher blood sugar levels (eight to 10
per cent) might also need to be screened more often,
the researchers cautioned.
The findings were published in the April 20 issue
of the New England Journal of Medicine.
Nathan described the results as “definitive.” How-
ever, he said the jury is still out as to “whether the
individualised frequency of eye examinations will be
implemented by physicians” and followed by people
with type 1 diabetes.
“The risk is that physicians may find it easier to
schedule an annual eye examination compared with
the new individualised schedule, which may be more
difficult for physicians and patients to remember,”
Courtney Cochran, senior manager of media rela-
tions for the American Diabetes Association (ADA),
noted that the ADA issued updated guidelines for
retinopathy screenings in February.
The new recommendations now state that people
with type 1 diabetes should start annual screenings
within five years of their diabetes diagnosis. But those
who remain free of retinopathy for a year or two may
“consider” the option of less-frequent exams.
However, the ADA also said that if and when “any
level” of retinopathy is detected, annual screenings
are a must, while those with progressing retinopathy
will require even more frequent screenings.
Dr Jamie Rosenberg, who wrote an editorial that
accompanied the study, suggested the new recom-
mendations reflect “a trend toward reducing unnec-
essary screening for eye diseases.”
“The upside to this new screening protocol would
be significant money saved for the health care system,
Side-by-side comparison demonstrating Normal vision vs Diabetic Retinopathy.
in addition to time saved for both patients and doc-
tors,” said Rosenberg, who is an associate professor
of clinical ophthalmology and visual sciences at the
Albert Einstein College of Medicine, in New York City.
Individualised schedules will make tracking pa-
tients more difficult, Rosenberg agreed. But, “this new
screening protocol has great potential if adherence to
the examination schedule could be assured.”
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