Delivery of eye care for patients with diabetes

Despite clearly defined clinical guidelines for evaluating and treating diabetic retinopathy in a cost-effective manner, effective interventions, such as laser treatment, are underused, for a variety of reasons. While the available resources and methods differ from country to country, certain basic components of care should be present.

Patients should know that they have diabetes mellitus and that the condition requires care. General population screening for diabetes mellitus with existing methods is considered neither appropriate nor beneficial, although use of such methods to reach subpopulations with a very high prevalence of diabetes mellitus might be both appropriate and feasible for some Member States.

Patients should receive adequate care for diabetes mellitus. The only means of preventing diabetic retinopathy is regulating blood sugar, blood pressure and other risk factors that can be controlled by patients, under the guidance of their care provider. Often, however, physicians do not care for diabetes patients in the manner indicated by the results of randomized controlled trials.

Patients should undergo periodic eye examinations. Professional organizations advocate annual eye examinations for patients with diabetes and prompt treatment when indicated. Nevertheless, many patients with diabetes are not evaluated or treated adequately to prevent unnecessary blindness and visual loss.

Patients should receive adequate treatment for diabetic retinopathy. The prevention of vision loss from diabetic retinopathy should be an integral part of the management of diabetes mellitus. Specific treatment for sight-threatening stages of retinopathy should follow established guidelines.

Patients should be sufficiently aware and motivated to undergo not only an initial eye examination but also regular follow-up examinations. Understanding the difficulties and barriers to regular eye examinations is one step in addressing the prevention of blindness from diabetic retinopathy. It is not enough to provide information that patients can understand; a 'marketing' approach should be used, to 'sell' the patient the idea of the importance of regular eye examinations.

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