Facing a Rising Tide, Optical Industry Discusses Prevention and Treatment of Diabetes-Related Eye Diseases

The incidence of diabetes is on the rise across the U.S, studies show, bringing with it an increase in the onset of diabetes-related eye diseases, and, specifically, a spike in cases of diabetic retinopathy (DR). Advocates, ECPs and industry experts point both to community educational initiatives as well as efforts to boost patient understanding as they look to mitigate risks associated with these diseases. VMAIL Weekend spoke with those in the optical community who are leveraging discussions around prevention and treatment as they work to stem the rising tide of diabetes-related eye disease.

Jeff Todd, CEO of Prevent Blindness, notes that cases of DR are expected to grow. He points to recent data from a study commissioned by Prevent Blindness titled, The Future of Vision: Forecasting the Prevalence and Costs of Vision Problems, which found the prevalence of diabetes-related eye disease is projected to increase by 35 percent to 10.9 million by 2032 and by 63 percent to 13.2 million by 2050.

Earlier this month, VMAIL reported that the organization had launched the Diabetes + the Eyes Advisory Committee to help people learn about the importance of protecting their vision as they live with diabetes, in addition to steps they should take now to save their vision in the future.

	Jeff Todd.

“These trends are especially concerning because the longer a person has diabetes, the greater their risk for significant vision loss,” Todd said. “People with diabetes are also at increased risk for cataracts, glaucoma, and retinal detachment. That’s why early intervention, regular eye exams, and access to quality health care are critical.

“In fact, some eye doctors can detect diabetes and other serious health conditions during a comprehensive eye exam,” he said, noting that as part of its initiatives, Prevent Blindness regularly advocates for vision and eye health funding in the federal budget, which he says supports the only national surveillance of vision loss and eye disease in the U.S., as well as critical community-level research projects to develop strategies for early intervention and care coordination in high-risk populations.

Through its programs, Todd says, Prevent Blindness offers expert-reviewed resources to help educate individuals with diabetes, as well as their care partners and eye health professionals. The organization encourages ECPs to visit the diabetes section on the Prevent Blindness website to discover comprehensive information on the different types of diabetes-related eye disease.

“I’m very excited about some of the new diabetes and eye health programs we have rolling out soon,” he said. “We invite all eyecare professionals to join us in our efforts to prevent unnecessary vision loss from diabetes.”

A study published in JAMA Ophthalmology, “Prevalence of Diabetic Retinopathy in the US in 2021,” found that in 2021, an estimated 9.6 million people in the U.S. (26.4 percent of those with diabetes) had diabetic retinopathy, and 1.84 million people (5.1 percent of those with diabetes) had vision-threatening diabetic retinopathy (VTDR). Further to these statistics, the study notes, the number of people aged 40 years and older living with diabetes-related eye disease more than doubled since 2004, and the instances of VTDR have almost doubled during the same time period.

Premilla Banwait, OD, MPH, FAAO.

“Yes, there has been an increase in U.S. diabetic retinopathy (DR) prevalence. VanderBeek et al. examined eye exam claims data and found a 15 percent increase in DR prevalence in people with type 1 diabetes and a 7 percent increase in those with type 2 diabetes between 2015 and 2022,” said Premilla Banwait, OD, MPH, FAAO, vice president of clinical programs at UnitedHealthcare Vision. “However, it should also be noted that in this same period, a decrease was found in the most serious forms of diabetic eye disease, such as diabetic macular edema and proliferative diabetic retinopathy.”

She adds that over recent years, youth-onset diabetes has had the most rapid progression of DR, noting that since it takes 5 to 10 years to appear after the initial diagnosis of diabetes, her office is seeing more DR occurring in young adults than ever before.

“Increased rise of DR rates is directly correlated to increased rise in prediabetes rates, which has to do with poor diet and lifestyle habits starting at a young age,” she said, pointing to the United States Diabetes Surveillance System (USDSS) analysis of NHANES data, which found that in 2023, an estimated 32.7 percent of the U.S. adolescent population, aged 12 to 17 years, had prediabetes.

To mitigate this, she advises that patients and families need to prioritize healthy lifestyle habits that can prevent the development of diabetes.

“Eating healthy, by observing sugar intake in foods, and staying active are the most important factors. Other factors include scheduling regular visits to their primary care doctor and eye doctor to understand their blood sugar levels and how it may be impacting their eye health,” she said.

Options for managing diabetic retinopathy can vary depending on the state of the disease. Dr. Banwait said for all stages of retinopathy, decreasing sugar intake, having a more nutritious diet, incorporating daily exercise, and adhering to prescribed medications can reverse early signs of retinopathy. In more severe stages of retinopathy, she adds, laser treatment and anti-VEGF injections can help curb the progression of retinopathy and prevent the onset of visual impairment.

	Karen Allison, MD, MBA, FACS. Photo courtesy of Ken Shung

Karen Allison, MD, MBA, FACS, associate professor of clinical ophthalmology, glaucoma division, at Flaum Eye Institute at the University of Rochester Medical Center, points to GLP-1s, a medication rising in popularity in the U.S. that has traditionally been used to manage diabetes and control weight, as having the potential to make inroads in treating DR.

“I am observing an increase in diabetic retinopathy that is resulting in neovascular glaucoma,” said Dr. Allison, who chairs the Prevent Blindness Scientific Committee and is a member of the Prevent Blindness board of directors. “With the introduction of new GLP-1 medications, there is potential for a reduction in cases in the future. Patients are becoming more aware of this disease through social media, new campaigns, and now through Prevent Blindness.”

She added that enhancing awareness and adherence to treatment is one of the simplest ways to reduce the risk of developing the disease, and recommends the implementation of dietary and lifestyle modifications to better manage blood sugar levels. Dr. Allison believes this can be achieved through group and individual therapy, along with education and information for patients. She recommends patient collaboration with their primary care provider, family physicians, relatives and the community to not only raise awareness but also to promote lifestyle changes, noting that this can include encouraging ECPs to offer information about social services, physical education, and nutritional support for patients with diabetes.