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• W2154659269 abstract "Dr. Bandello writes that “planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected” and asks how to facilitate implementation of surgical interventions (photocoagulation and vitrectomy) that have been shown to reduce the incidence of visual loss. He is correct in his concern about the slow response in translating the findings of clinical trials into public health policy. In the United States, despite findings from the Diabetic Retinopathy Study1The Diabetic Retinopathy Study Research GroupPhotocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8.Ophthalmology. 1981; 88: 583-600Abstract Full Text PDF PubMed Scopus (999) Google Scholar over 20 years ago that early detection and treatment of proliferative retinopathy with high-risk characteristics with panretinal photocoagulation would reduce the incidence of severe visual loss, there are still considerable numbers of people with diabetes in the population at high risk who have not received a dilated eye examination.2Witkin S.R. Klein R. Ophthalmologic care for persons with diabetes.JAMA. 1984; 251: 2534-2537Crossref PubMed Scopus (113) Google Scholar, 3Sprafka J.M. Fritsche T.L. Baker R. et al.Prevalence of undiagnosed eye disease in high-risk diabetic individuals.Arch Intern Med. 1990; 150: 857-861Crossref PubMed Google Scholar, 4Brechner R.J. Cowie C.C. Howie L.J. et al.Ophthalmologic examination among adults with diagnosed diabetes mellitus.JAMA. 1993; 270: 1714-1718Crossref PubMed Scopus (239) Google Scholar, 5Weiner J.P. Parente S.T. Garnick D.W. et al.Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetes.JAMA. 1995; 273: 1503-1508Crossref PubMed Scopus (313) Google ScholarIn response to these concerns, numerous US government agencies, such as the National Eye Institute and the Centers for Disease Control; specialty organizations, such as the American Diabetes Association, the American Academy of Ophthalmology, and American Optometric Society; and international organizations through the World Health Organization’s St. Vincent’s Declaration, have developed and implemented programs to educate patients and physicians regarding the need for dilated eye examinations.6The National Institutes of Health.The National Eye Health Education Program. NIH, Bethesda, MD1990Google Scholar, 7American Diabetes AssociationDiabetic Retinopathy.Diabetes Care. 1999; 22: S70-S73Google Scholar However, while data from some studies suggest that more patients may be receiving dilated eye examinations than in the past, there are still significant numbers of individuals not receiving such care. Reasons for this are described, in part, by Dr. Bandello as well as by others.8Moss S.E. Klein R. Klein B.E.K. Factors associated with having eye examinations in persons with diabetes.Arch Fam Med. 1995; 4: 529-534Crossref PubMed Scopus (115) Google Scholar Thus, continued efforts to educate patients and their physicians are still warranted.There is also a need to remove economic and political barriers before people with diabetes can achieve optimal eye care. In some societies, such as Iceland, this appears to have been achieved, at least in people with type I diabetes. In that country, 94% of the population with type I diabetes was estimated to be receiving regular screening for retinopathy, and the prevalence of diabetic blindness was reported to have decreased from 2.4% in 1980 to 0.3%–0.6% in 1994 (Stefansson, Kristinsson, Jonasson, Gislason. Association for Research in Vision and Ophthalmology annual meeting, May 1997). They did not report on their experience with people with type 2 diabetes. Whether similar results can be achieved in persons with type 1 and 2 diabetes in other countries remains to be seen. Dr. Bandello writes that “planning and putting into practice policies to prevent diabetes-related blindness are proving more difficult than expected” and asks how to facilitate implementation of surgical interventions (photocoagulation and vitrectomy) that have been shown to reduce the incidence of visual loss. He is correct in his concern about the slow response in translating the findings of clinical trials into public health policy. In the United States, despite findings from the Diabetic Retinopathy Study1The Diabetic Retinopathy Study Research GroupPhotocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8.Ophthalmology. 1981; 88: 583-600Abstract Full Text PDF PubMed Scopus (999) Google Scholar over 20 years ago that early detection and treatment of proliferative retinopathy with high-risk characteristics with panretinal photocoagulation would reduce the incidence of severe visual loss, there are still considerable numbers of people with diabetes in the population at high risk who have not received a dilated eye examination.2Witkin S.R. Klein R. Ophthalmologic care for persons with diabetes.JAMA. 1984; 251: 2534-2537Crossref PubMed Scopus (113) Google Scholar, 3Sprafka J.M. Fritsche T.L. Baker R. et al.Prevalence of undiagnosed eye disease in high-risk diabetic individuals.Arch Intern Med. 1990; 150: 857-861Crossref PubMed Google Scholar, 4Brechner R.J. Cowie C.C. Howie L.J. et al.Ophthalmologic examination among adults with diagnosed diabetes mellitus.JAMA. 1993; 270: 1714-1718Crossref PubMed Scopus (239) Google Scholar, 5Weiner J.P. Parente S.T. Garnick D.W. et al.Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetes.JAMA. 1995; 273: 1503-1508Crossref PubMed Scopus (313) Google Scholar In response to these concerns, numerous US government agencies, such as the National Eye Institute and the Centers for Disease Control; specialty organizations, such as the American Diabetes Association, the American Academy of Ophthalmology, and American Optometric Society; and international organizations through the World Health Organization’s St. Vincent’s Declaration, have developed and implemented programs to educate patients and physicians regarding the need for dilated eye examinations.6The National Institutes of Health.The National Eye Health Education Program. NIH, Bethesda, MD1990Google Scholar, 7American Diabetes AssociationDiabetic Retinopathy.Diabetes Care. 1999; 22: S70-S73Google Scholar However, while data from some studies suggest that more patients may be receiving dilated eye examinations than in the past, there are still significant numbers of individuals not receiving such care. Reasons for this are described, in part, by Dr. Bandello as well as by others.8Moss S.E. Klein R. Klein B.E.K. Factors associated with having eye examinations in persons with diabetes.Arch Fam Med. 1995; 4: 529-534Crossref PubMed Scopus (115) Google Scholar Thus, continued efforts to educate patients and their physicians are still warranted. There is also a need to remove economic and political barriers before people with diabetes can achieve optimal eye care. In some societies, such as Iceland, this appears to have been achieved, at least in people with type I diabetes. In that country, 94% of the population with type I diabetes was estimated to be receiving regular screening for retinopathy, and the prevalence of diabetic blindness was reported to have decreased from 2.4% in 1980 to 0.3%–0.6% in 1994 (Stefansson, Kristinsson, Jonasson, Gislason. Association for Research in Vision and Ophthalmology annual meeting, May 1997). They did not report on their experience with people with type 2 diabetes. Whether similar results can be achieved in persons with type 1 and 2 diabetes in other countries remains to be seen." @default.
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• W2154659269 title "Diabetes and visual loss: authors’ reply" @default.
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