Run by doctors José García-Arumí, a retina specialist at IMO and Head of the Ophthalmology Department at Vall d’Hebron University Hospital, and Rafael Simó, Director of the Diabetes and Metabolism Research Group at Vall d’Hebron Research Institute (VHIR), the course on the "Comprehensive approach to ocular complications in diabetic patients" aims to examine options for reducing the high risk of blindness derived from diabetes, sufferers of which are 25-times more likely to suffer from total loss of vision than the rest of the population. Therefore, early detection in patients with incipient retinal damage is key, something which requires the collaboration of different professionals involved in the treatment of patients with diabetes, since diabetic retinopathy, the main complication of diabetes and the primary cause of blindness in the working population, is usually asymptomatic in its initial phase.
Non-mydriatic cameras and the interpretation of retinographs in diabetic patients
Thus, some of the course's sessions and workshops are based on the screening that primary care doctors and opticians can perform through the use of so-called non-mydriatic cameras, diagnosis instruments that obtain retinographs (photos of the retina) with no dilation of the pupil. An ophthalmology consultation is not required for these photos to be taken. Doctors Pere Romero, Head of the Ophthalmology Department at Sant Joan University Hospital in Reus and Ramon Sagarra, Primary Care Doctor at Reus 1, will discuss, during a workshop on interpreting retinographs in diabetic patients, the results of a study on screening using non-mydriatic cameras in over 13,000 diabetics, carried out by 135 family doctors from Baix Camp between 2007 and May of this year.
The importance of early treatment coordinated between family doctors, endocrinologists and ophthalmologists
Dr Joan Barrot, a family and community medicine specialist and member of GEDAPS (Network of Primary Healthcare Diabetes Study Groups), will discuss the importance of early treatment coordinated between family doctors, endocrinologists and ophthalmologists, emphasising the need for a shared clinical history, the creation of a clear and common online system between the different professionals involved, improved Primary Care training in managing and interpreting the results of retinographs and the establishment of a protocol for the use of these instruments in Primary Care. The specialist will not only discuss the benefits for the patient's quality of life that come from interprofessional collaboration for the prevention and early treatment of the diabetic retinopathy, they will also discuss the financial savings that would result from a sound monitoring policy, coordinated between primary care centres and ophthalmologists, considering that the healthcare costs for a patient with diabetic retinopathy are double those incurred by a patient without this pathology. Thus, Dr Barrot will discuss the results, which still have not been presented, of a study on the financial impact of these patients, carried out by the European Association for the Study of Diabetes. Similarly, Dr Miguel Ángel Zapata, an ophthalmologist at Vall d’Hebron, will present a session on Saturday on how screening using non-mydriatic cameras in primary care centres and opticians' is useful for the early detection of asymptomatic patients, although only as a first step before seeing an ophthalmologist, as there is no substitute for this consultation. According to Zapata, who is coordinating a remote diagnosis project involving 180 centres throughout Spain that have performed screenings on over 13,000 patients, the earlier ocular problems are detected, the sooner treatment can be started, which increases the effectiveness of the same and reduces the costs. During his speech, the ophthalmologist will also present the latest innovations in remote medicine, such as the use of smartphones to take and share retina images.
New treatments for diabetic retinopathy: first results from the EUROCONDOR study, European Consortium for the early treatment of diabetic retinopathy
On the other hand, the course will also include the presentation of important research studies on new treatments for diabetic retinopathy in both its incipient and advanced stages. Thus, Dr Rafael Simó will present the first results from the EUROCONDOR study, European Consortium for the early treatment of diabetic retinopathy, a project funded by the European Commission and coordinated by the Vall d’Hebron Research Institute (VHIR); this project was launched on 1 March 2012 and is expected to end on 28 February 2016.
During this time, ophthalmologists, endocrinologists and researchers from eleven European centres will implement the first clinical trial to assess if neuroprotective drugs administered topically in the form of eyedrops are able to prevent or slow the neurodegeneration of the retina, as well as the development and progression of the first stages of diabetic retinopathy. This study builds on the growing body of evidence that the origin of diabetic retinopathy is found in a retinal neurodegeneration process, thus the trial proposes a new therapeutic strategy based on neuroprotection.
Thus, the study will test two neuroprotective drugs: somatostatin (a type of hormone) and brimonidine (a drug currently used to treat glaucoma), the use of which, if their effectiveness is proven, could have a significant impact on the prevention of diabetic retinopathy. There is also research going on for cases of advanced retinopathy, such as the research taking place at Vall d'Hebron by Dr García-Arumí, focused on the application of gene therapies.
During his speech on the course, the ophthalmologist will discuss the progress of this trial, which is currently being performed in vivo in animals and the aim of which is to solve the imbalance in genetic retina protection systems through the injection of nanoparticles to alter the genetic code of retina cells, increasing the protective factors and re-establishing the balance lost, in order to inhibit the generation of neovessels harmful to the retina.
Diabetic retinopathy, the main complication of diabetes
Diabetic retinopathy is the most common vascular disease of the retina, the vessels of which are damaged by the metabolic decompensation of diabetes. This leads to the spontaneous creation of new, fragile vessels that lose fluid, which could significantly affect vision. This serious pathology of the retina is the main complication of diabetes and the most common cause of blindness among the active population in industrialised countries and accounts for between 20 and 30% of all blindness cases. The high rate of complications associated with the illness, such as macular oedema, vitreous haemorrhage and retinal detachment, means that diabetics must keep a strict control of their glycaemia, blood pressure and plasmatic lipids, avoid tobacco and undergo regular – at least once a year – retina check-ups, since, generally, diabetic retinopathy does not cause symptoms until the damage is severe.
Diabetic retinopathy in numbers:
- Main complication of diabetes
- Leading cause of blindness in the working population in the Western world
- The risk of total blindness is 25 times greater in diabetics than in the general population.
- 95% of patients with type 1 diabetes develop the pathology throughout life
- Over 50% of patients with over 15 years of evolution of the pathology present some kind of retinal vascular alteration
- 10% suffer from severe loss of vision 15 years after the diagnosis
- Adequate early treatment avoids blindness in over 90% of cases