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Current Trends Screening for Diabetic Eye Disease -- Mississippi

Diabetes mellitus is a major cause of visual impairment and blindness in the United States. Diabetes predisposes people to retinopathy and maculopathy, diseases of the small vessels that nourish the retina. People with diabetes are also at increased risk for developing glaucoma and cataracts.

Of the estimated 5 million people with diabetes in the United States, 25%-50% may have retinopathy, and 10% of those may be at risk for visual loss. Proliferative retinopathy is more prevalent among people with insulin-dependent (Type I) diabetes, but since many more people have non-insulin-dependent (Type II) diabetes, there may be as many people with proliferative retinopathy and Type II diabetes as there are with Type I diabetes. All people with diabetes are at risk for developing diabetic maculopathy, but those with Type II diabetes appear to be at increased risk. People with diabetes are 1.3 times more likely to have glaucoma and 1.6 times more likely to have cataracts than nondiabetic individuals.

Early age of onset and long duration of diabetes are risk factors for the development of diabetic retinopathy. Poor glycemic control and coexistent hypertension may accelerate the natural history of retinopathy. Pregnancy increases the risk of visual loss in diabetic women with serious preexisting retinopathy.

The Diabetic Retinopathy Study, conducted by the National Institutes of Health's National Eye Institute, demonstrated that panretinal photocoagulation can delay or prevent severe visual loss in more than 50% of eyes with proliferative retinopathy (1). Surgical vitrectomy can restore vision in some people with severe visual loss due to vitreous hemorrhage or macular detachment. Some studies have suggested that focal photocoagulation may preserve vision in some people with diabetic macular edema. Medical and surgical therapies are often effective in treating open-angle glaucoma, and surgery can be effective in restoring vision in up to 95% of people with senile cataracts and no significant retinopathy.

In January 1983, the Mississippi Diabetes Control Program instituted a comprehensive screening and treatment program for diabetic eye disease in its public health eye clinics. Patients are examined clinically and with fluorescein angiography. Treatment is provided as indicated by the examination, and patients are tracked and placed into a system for annual re-examination to assure follow-up and to assess the impact of the intervention. To date, 48 individuals with diabetes have been screened at the public health eye clinic in Greenville. Twenty-seven percent had diabetic retinopathy by clinical examination; by fluorescein angiography, 31% were found to have retinopathy, including 8% with preproliferative retinopathy. Four percent had increased intraocular pressure, and 17% had cataracts. Twenty-five percent had other non-diabetes-related eye conditions. Based on these findings, seven of the 48 patients required treatment, including one with a detached retina, one with intraocular hypertension, one with glaucoma, and four with blepharitis. Although none required treatment for retinopathy, six required careful follow-up at less than the usual yearly interval. Reported by E Thompson, MD, B Parker, Bureau of Personal Health Svcs, Mississippi State Dept of Health; Div of Diabetes Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Epidemiologic studies are needed to more clearly define risk factors for the development of diabetic eye disease. It is clear, however, that timely diagnosis and treatment can preserve vision in large numbers of people with diabetic eye disease. Programs like that being conducted by Mississippi help prevent visual impairment and blindness caused by diabetic eye disease.


  1. The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of diabetic retinopathy study (DRS) findings. (DRS report no. 8). Ophthalmology 1981;88(7):583-600.

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