By Fia Curley

More than 20 million people have diabetes, and 6 million people have yet to be diagnosed, increasing their chances of suffering from diabetes-related complications such as vision loss.

According to Agency for Healthcare Research and Quality (AHRQ), the burden of diabetes is much greater for minority populations than for the white population. For example, 10.8 percent of non-Hispanic blacks, 10.6 percent of Mexican Americans, and 9.0 percent of American Indians have diabetes, compared with 6.2 percent of whites. Certain minorities also have much higher rates of diabetes-related complications and death, in some instances by as much as 50 percent more than the total population.

As more individuals are finding themselves at risk for diabetes, attention is being shifted to preventing the No. 1 cause of sight loss in diabetics ages 20 to 74.

"It seems strange, but we don't know why people who have diabetes lose their vision," said Dr. Tom Gardner, professor and vice chair for research and ophthalmology of the Penn State M.S. Hershey Medical Center, adding that the topic is critical to minority groups because of the higher rates of diabetes in the communities.

Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness a year and affects about 40 to 45 percent of people with diabetes, according to the National Diabetes Information Clearinghouse. It occurs when there is damage to the blood vessels in the eyes. Blood vessels may swell and leak fluid or they may develop on the surface of the retina. Gradually vision loss occurs.

"Diabetic retinopathy tends to be diagnosed fairly late, when people are already losing their vision," said Gardner, co-course director for the upcoming meeting, ‘Preventing Vision Loss in Diabetic Retinopathy'. "If we're losing the battle now, we're going to be farther behind if we don't learn how to diagnose it now and treat it earlier."

Recent research has shown the possibility of preventing diabetic retinopathy, according to the Association for Research in Vision and Ophthalmology.

The study used male Sprague Dawley rats with the early stages of diabetic retinopathy and tested the use of insulin injections into the subconjunctive layer of the eye in doses of .01U to 1U (U=units). They found the insulin released into the eye did not raise glucose levels or interfere with normal eye functions. Instead the study said it retarded the development and progression of early diabetic retinopathy. The study also looked at insulin-releasing hydrogels that were implanted into the eye and meant to release insulin from 6 months to a year.

"The way we presently treat some diseases, we have some shortcomings," said Dr. Ravi Singh, head researcher for the study, "particularly for diabetic retinopathy, because we only treat at the advance stages, because that's when the benefits would outweigh the risks.

With positive results being shown for four or five rounds of about two dozen rats, Singh said he can see where the research may soon pay off.

"I'm optimistic, but my optimism is guarded because science doesn't always go the way you expect it," said Dr. Ravi Singh. "This treatment, if it goes the way we think, would hold promise for people with early disease stages."

Correcting vision loss is associated with decreasing the likelihood of falls, hip fractures, stress on the family and depression, according to an article by Dr. Dorothy Godhes and several co-authors entitled, Age-related eye diseases: an emerging challenge for public health professionals. This article, in the July 2005 issue of Preventing Chronic Diseases, highlighted the need for public health to address the leading eye diseases linked to aging.

The benefits of preserving eyesight can also be seen in daily activities like reading the newspaper, driving a vehicle or eating meals, according to Sarah Hecker, director of media relations for Prevent Blindness America.

"At Prevent Blindness America, we feel that research is the key to helping preserve sight in both adults and children," Hecker said. "It's so important, but sometimes it falls by the wayside, because there are so many life-threatening issues in front of it. We just want to emphasize that vision issues can be quality of life issues."

But instead of just taking reactionary measures, Dr. Jeffrey L. Weaver, OD, clinical care director for the American Optometric Association encourages people to start early.

"Unfortunately, we don't think about prevention until it's too late in the process," Weaver said. "Probably one of the best things that can be done is periodic eye examinations."

Everyone between the ages of six months to 60 years should have an eye exam every two years, Weaver said. After the age of 60, eye exams should be part of a person's annual routine.

For diabetics, this means being vigilant about eye exams, but also monitoring glucose levels so diabetic retinopathy doesn't become a complication.

"There is a need to continually evolve," Singh said. "Better health care means you also have a better population that is economically productive. For the larger good this needs to be done."

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Fia Curley is a writer for the OMHRC. Comments? Email: fcurley@omhrc.gov

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