Researchers Recommend New Eye Exam Screening for Patients with Type 1 Diabetes: Five Things to Know

12538332 - looking through the glasses at eye chartTreatment guidelines for patients with type 1 diabetes have long called for yearly eye exams. But is there an alternative to this one-size-fits-all approach that could reduce patient burden and costs while providing a quicker diagnosis? Findings from a recent study, published in the New England Journal of Medicine, lend insight into a possible new eye screening protocol. Here are five things to know:

  1. Diabetic retinopathy is the leading cause of blindness among adults. It occurs when chronically high blood sugar from diabetes damages the light-sensitive tissue in the back of the eye. Fortunately, screening can catch this disease before irreparable damage is done, and there are several therapies available to treat the condition. Guidelines currently recommend routine yearly eye exams within three to five years of a type 1 diabetes diagnosis, but these recommendations were based on now-outdated research.
  1. To reevaluate the current recommendations, David Nathan, MD, Director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital, and a team of researchers analyzed approximately 24,000 retinal exams obtained over 30 years from about 1,400 participants with type 1 diabetes.
  1. Based on their analysis, researchers developed new recommendations that suggest patients with type 1 diabetes should get eye exams to detect diabetic retinopathy based on the presence and severity of diabetic retinopathy, rather than on the automatic, annual schedule that is currently recommended. For patients with type 1 diabetes and a current average blood glucose level of 6 percent (within the American Diabetes Association’s recommended target range), researchers recommend the following eye exam schedule:
  • With no retinopathy, every four years.
  • With mild retinopathy, every three years.
  • With moderate retinopathy, every six months.
  • With severe retinopathy, every three months.
    Researchers suggest patients with higher current average blood glucose levels (for example, 8-10 percent as opposed to 6 percent) have eye exams more often, as they are at higher risk to develop the disease. The new recommendations also call for taking photographs of the back of the eye rather than physical examination with an ophthalmoscope, which is thought to be less accurate.
  1. Overall, researchers say the new, individualized schedule would result in earlier detection of the advanced retinopathy that requires treatment to save vision compared with annual exams, while at the same time reducing the frequency of eye exams by half. That would translate into an overall savings of $1 billion.
  1. Researchers are still questioning whether physicians would adhere to these new recommendations, if implemented. “The risk is that physicians may find it easier to schedule an annual eye examination compared with the new individualized schedule, which may be more difficult for physicians and patients to remember,” says Nathan. The next step is to discuss how to potentially incorporate the guidelines into patient care. They also plan to conduct further studies to investigate if this screening strategy could be applied to patients with type 2 diabetes.

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