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Diabetic Retinopathy News

Is Diabetic Retinopathy Declining...or Increasing?

ATLANTA, January 2012 — According to data recently published by the U.S. Centers for Disease Control and Prevention (CDC), the percentage of people with diabetes who have vision problems from the disease has declined significantly in the past 14 years.*

But the news might not be as good as it sounds.

Though the CDC found that the age-adjusted percentage of adults in the U.S. with diagnosed diabetes who reported visual impairment declined from 23.7 percent in 1997 to 16.7 percent in 2010, the number of adults with vision problems from diabetes actually increased during this time frame.

The data showed that 3.9 million Americans reported having diabetes-related vision problems in 2010, up from 2.7 million in 1997 — an increase of 44 percent. The reason for this increase is the significant increase in new cases of diabetes in the United States over the past decade.

According to the United Health Foundation, diabetes affected 8.7 percent of the U.S. population in 2011 — a 42.6 percent increase since 2001.**

The declining trend in self-reported vision impairment from diabetic retinopathy and other diabetic eye disease may be due to the large number of persons who have not had diabetes long enough to develop vision problems. With time, the encouraging trend in self-reported vision impairment prevalence from diabetes might reverse, the researchers warned.

The researchers also said that too many people with diabetes-related vision problems aren't getting the vision care they need. The study found that only about 63 percent of the study respondents with diabetes and vision impairment visited an eye doctor for the annual dilated eye exam that is recommended for people with diabetes.

According to the CDC, nearly 26 million people in the United States had diabetes in 2010, and 79 million adults were at high risk for developing type 2 diabetes. However, people with diabetes can take steps to control the disease and lower their risk for complications, and those at high risk for diabetes can prevent or delay the onset of type 2 diabetes with weight loss and physical activity, the researchers said.

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Diabetic Kids at Risk for Vision Loss Are Not
Getting Regular Eye Exams

HONOLULU, November 2011 — Although they are at risk for diabetes-related vision loss, children and youths with diabetes are not getting enough eye exams, according to guidelines of the American Diabetes Association (ADA).

A recent study included 1,514 young people who answered a questionnaire regarding the diabetes care they had received. The ADA has recommended guidelines for eye exams, blood pressure, kidney care and blood levels of various substances such as glycohemoglobin, and five of these indicators were used to evaluate the surveys.

Here are the findings:

• 95 percent had blood pressure checks at all or most visits.
• 88 percent had lipid levels checked.
• 83 percent had kidney function tested.
• 68 percent had their glycohemoglobin checked.
• 66 percent had eye exams according to ADA recommendations.

The youths who were older, especially those over 18 with type 2 diabetes, tended to have fewer tests of all kinds performed. Also, youths in lower-income households were less likely to meet the ADA guidelines.

A report of this study appeared online in the journal Pediatrics in August.

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Scientists Regenerate Damaged Retinas Using
Stem Cells From Skin

BOSTON, May 2011 — Exciting new treatments for retinal diseases such as diabetic retinopathy, age-related macular degeneration and retinitis pigmentosa may result from a just-reported study involving conversion of skin stem cells from mice into pluripotent stem cells and then into retinal neurons.

Thirty-three days after the skin cells were harvested, the cells were ready to be placed into mouse eyes that had retinal disease. After four to six weeks the cells had begun to reside in the retina and assemble into retinal tissue that looked healthy and showed an increase in electrical activity — about half of what occurs in a normal retina.

Pluripotent skin cells are very similar to embryonic cells, but since they come from skin and not embryos, they aren't subject to the same ethical and other issues.

"We are very excited about these results," said Dr. Budd Tucker, the study report's first author, in a release. "While other researchers have been successful in converting skin cells into induced pluripotent stem cells (iPSCs) and subsequently into retinal neurons, we believe that this is the first time that this degree of retinal reconstruction and restoration of visual function has been detected."

The researchers, from Schepens Eye Research Institute, plan to test the procedure in larger animals and eventually in humans. The study report appeared in the online science journal PLoS ONE in May.

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Diabetes and Prediabetes Among the Fastest Growing
Diseases in the United States

WASHINGTON, D.C., December 2010 — More than 50 percent of Americans may have diabetes or prediabetes by 2020 if current trends continue, according to a new report. And the related health care costs could reach $3.35 trillion over the next 10 years.

With more diabetes comes a higher prevalence of sight-stealing diabetic retinopathy, as well as a host of other health problems, such as heart and kidney disease, nerve damage and limb amputation.

More than 27 million Americans are affected by diabetes now, with 67 million estimated to have prediabetes. Many people don't even know they have either condition.

The new statistics appeared recently in a report by UnitedHealth Group's Center for Health Reform & Modernization. The group urges Americans to reduce their risk of diabetes by, among other things, using wellness programs and creating public initiatives to combat obesity. The group also calls for better management of diabetes through improved medication and care compliance programs.

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Iluvien Insert Tests Show Promise for Diabetic Macular Edema

ALPHARETTA, Ga., November 2010 — Phase 3 clinical trial data for an intravitreal insert called Iluvien showed vision improvement for about 40 percent of 123 people with diabetic macular edema, after 30 months of treatment.

According to developer Alimera Sciences, each Iluvien insert is designed to work for up to 36 months in the eye. It delivers tiny amounts of fluocinolone acetonide (a corticosteroid) to the back of the eye and is inserted with a needle. Steroid-induced cataracts are a common side effect.

The FDA has granted priority review status to Iluvien, and approval may come by the end of 2010.

The clinical trial results were presented at October's annual meeting of the American Academy of Ophthalmology.

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Prevalence of Diabetic Retinopathy High Among Older U.S. Diabetics

ATLANTA, September 2010 — Are you a diabetic over 40 living in the United States? Then regular eye exams are a must for you, since an estimated 28.5 percent of this population group has diabetic retinopathy, with about 4 percent having vision-threatening retinopathy, says a survey.

The statistics, taken from the period 2005-2008, also show that non-Hispanic black individuals have the highest prevalence of diabetic retinopathy, an alarming 38.8 percent. Prevalence is high also for Mexican-American people.

Actually, all diabetics need regular eye exams, not just people over 40, because of the damage that blood sugar fluctuations can do to the eyes.

The study was reported in the Aug. 11 issue of The Journal of the American Medical Association.

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Two Therapies Shown To Slow Diabetic Retinopathy
Progression, Though With Risks

BETHESDA, Md., August 2010 — In high-risk adults with type 2 diabetes, intensive blood sugar control and lipid therapy with a fibrate and a statin may slow the progression of diabetic retinopathy, say results of the ACCORD study, supported by the National Institutes of Health.

The ACCORD Eye Study included 2,856 type 2 diabetics who were at especially high risk for heart attack, stroke or cardiovascular death. Researchers evaluated the treatment effects on diabetic retinopathy progression over four years.

Intensive blood sugar control was more effective than standard blood sugar control, and the combination fibrate/statin therapy was more effective than statin therapy alone.

However, over about three and a half years, people in the intensive blood sugar control group had a 22 percent higher risk of death and a three times higher risk of seriously low blood sugar than those in the standard blood sugar control group. In fact, the intensive blood sugar therapy was ended 18 months early because of the risks.

These study results appeared online June 29 in the New England Journal of Medicine.

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Lucentis Injections Plus Laser Therapy Improve Vision
in Diabetic Macular Edema

BETHESDA, Md., May 2010 — Laser treatment alone has been used for 25 years in diabetes-associated macular swelling (edema), according to the National Eye Institute (NEI).

But in a study of 854 eyes of 691 people in their early 60s on average, who had type 1 or 2 diabetes and macular edema, eye injections of Lucentis (ranibizumab), often in combination with laser treatments, resulted in nearly 50 percent of the eyes showing substantial visual improvement after a year. This compares with 28 percent of eyes improving with just the laser treatment.

The people with improved vision could read at least two additional lines on an eye chart with the treated eye, or letters at least one-third smaller than they could read before the study treatment.

The researchers will monitor the participants for at least three years to obtain more information about safety and effectiveness.

The NEI and the National Institute of Diabetes and Digestive and Kidney Diseases, both part of the National Institutes of Health, supported the research through the Diabetic Retinopathy Clinical Research Network. The study report appeared online in April in the journal Ophthalmology and includes more details on the results.

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Could a Topical Drug Treat Diabetic Macular Edema?

NEW YORK, April 2010 — Researchers have found the topical drug mecamylamine (CoMentis, Inc.) safe and effective in treating diabetic macular edema in a human clinical trial.

Participants were asked to use mecamylamine eye drops twice a day for 16 weeks. By the end of the trial, about 40 percent of the participants had significantly improved overall vision and/or retinal thickness. The trial also demonstrated that the drug could reach the retinal vessels even when applied to the surface of the eye.

About 40 percent of the participants showed no change, and the condition worsened for about 20 percent.

Study results appeared in the American Journal of Ophthalmology.

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Congressman Asks African-Americans With Diabetes
To Get an Eye Exam ASAP

SAN FRANCISCO, February 2010 — House Majority Whip James E. Clyburn, D-SC, has recorded a video to urge African-American diabetics to get an annual eye exam in February, which is Black History Month.

"Diabetes is an epidemic in the African-American community," said Rep. Clyburn. "People with diabetes are 25 times more likely to go blind, and African-Americans with diabetes are at an even higher risk — almost 50 percent more likely to develop diabetic retinopathy."

"If you have diabetes, it's critically important for you to receive an annual diabetic eye exam, because it will help detect and prevent eye disease," the congressman added.

In the United States, 3.7 million African-Americans over age 20 have diabetes, and the incidence is growing.

According to studies, African-Americans with diabetes are more likely to develop diabetic complications and experience greater disability from the complications than white Americans with diabetes. But this can be prevented with strict glucose control and annual dilated eye exams.

The video was produced in conjunction with the American Academy of Ophthalmology's EyeSmart campaign and the Stop Diabetes movement of the American Diabetes Association.

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Could Magnesium and Vitamins C and E Help Diabetics
Avoid Retinopathy?

CAMBRIDGE, U.K., February 2010 — Vitamins C and E suppress production of the growth factor VEG-F, which promotes abnormal blood vessels in the retina; and high dietary levels of magnesium are associated with lower blood pressure and blood sugar, which reduce the risk of retinopathy.

So does this mean that taking these supplements could help prevent diabetic retinopathy?

To find out, researchers at the Institute of Metabolic Science in Cambridge examined studies published from 1988 through 2008 and involving 4,094 people. The survey found that the evidence is not compelling enough to recommend supplements of vitamins C and E and magnesium to diabetics. However, the researchers said that studies should continue. For example, hospital-based studies did find that people with higher levels of vitamin C in their blood were less likely to have diabetic retinopathy, though population-based studies did not produce that finding.

The survey report appeared in the January issue of Ophthalmology.

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Too Many Calories, Too Much Sodium Increase Retinopathy
Risk Among African-Americans

NEWARK, N.J., February 2010 — In a six-year study of 469 African-American patients with type 1 diabetes, those who had the highest caloric intake at the beginning of the study were more likely to develop vision-threatening diabetic retinopathy than others.

And those who had a high intake of sodium at the beginning of the study were more likely to develop macular edema.

"These results suggest that low caloric and sodium intakes in African-American individuals with type 1 diabetes mellitus may have a beneficial effect on the progression of diabetic retinopathy and thus might be part of dietary recommendations for this population," concluded the researchers, who work at New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, and New York University College of Dentistry. The study was reported in the January issue of Archives of Ophthalmology.

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Steroid Injections Could Slow Diabetic Retinopathy Progression

BALTIMORE, Md., February 2010 — Injecting the corticosteroid triamcinolone into the eye can slow diabetic retinopathy progression, says a study by researchers at Johns Hopkins Wilmer Eye Institute.

However, they say, this treatment should not be used until a drug is developed that can deliver the benefits of steroids without the damage they cause, including increasing the risk of glaucoma and cataracts. For now, the preferred treatment is laser photocoagulation.

The study involved 840 eyes of 693 men and women from July 2004 to May 2006. The subjects had an average age of 63 and had diabetic retinopathy with macular edema. They were randomly assigned to receive laser photocoagulation or steroid injections.

The steroid injections did not perform better than the laser regarding increasing the chance of improved vision and decreasing the chance of vision loss. The study appeared in Archives of Ophthalmology in December.

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Hemoglobin A1C Proves Strong Retinopathy Predictor; Glucose Control and Blood Pressure Lowering Show Positive Renal Outcomes

ATLANTA & SYDNEY, January 2010 — A new study finds that hemoglobin A1C levels in blood tests are a stronger indicator for diabetic retinopathy than fasting plasma glucose. The study examined 1,066 individuals over 40 years old. Thirty-six percent were diagnosed diabetics, and 11 percent had retinopathy.

The findings show that the prevalence of retinopathy increased with A1C levels of 5.5 percent or greater and fasting plasma glucose of 5.8 mmol/L or greater.

The study was conducted by the U.S. Centers for Disease Control and Prevention, the National Institute of Diabetes and Digestive and Kidney Diseases and the University of Wisconsin School of Medicine and Public Health.

A related study by the University of Sydney in Australia examined renal outcomes in patients with type 2 diabetes. It found that the combined treatment of blood pressure lowering and intensive glucose control had better outcomes than treatments used independently.

The studies were reported in the November issue of Diabetes Care.

Please click here for more diabetic retinopathy news from 2009.

Resources:

*Self-Reported Visual Impairment Among Persons with Diagnosed Diabetes – United States, 1997–2010. Morbidity and Mortality Weekly Report. U.S. Centers for Disease Control and Prevention. November 2011.

**United Health Foundation's America's Health Rankings finds preventable chronic disease on the rise; obesity, diabetes undermining country's overall health. United Health Foundation press release. December 2011.

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[Page updated January 3, 2012]