MThis weekend, in Barcelona, more than 150 specialists from different medical and health sectors involved in diabetic patient care debated, for the first time, the main strategies to prevent and treat ocular complications in this group of patients. According to Dr José García-Arumí, a retina specialist at IMO, Head of the Ophthalmology Department at Vall d’Hebron University Hospital and director of the course, “the meeting highlighted the need to increase interprofessional coordination protocols in monitoring of the diabetic patient, a chronic disease with numerous related complications, the incidence of which shows no signs of slowing down.”
Retinopathy and diabetic macular oedema may go unnoticed in the beginning
The main complication associated with diabetes is diabetic retinopathy, a serious retina lesion that still causes blindness in 10% of those affected. Therefore, the “Course on the comprehensive approach to ocular complications in diabetic patients,” coordinated by IMO's Diabetic Retinopathy Unit in collaboration with Vall d’Hebron Research Institute (VHIR), focused on prevention and early treatment of retina lesions caused by this disease. As has been reflected in several presentations and workshops, more and more primary care centres have non-mydriatic cameras (machines that take photographs of the retina without the need to dilate the pupil) to perform the first screening in diabetic patients. However, "there is still much progress to be made in this regard, since today patients with diabetes are still turning up for an ophthalmology consultation, having already developed a diabetic retinopathy or a diabetic macular oedema, who never knew they needed eye examinations to prevent the advance of these lesions, which, in their early stages, are asymptomatic," explained Dr Anniken Burés, a retina specialist at IMO, during a workshop on the schedule of ophthalmological appointments for diabetic patients.
Non-mydriatic cameras in primary care aid prevention
During the course, several options were examined so that the health system and the patients themselves are involved in these checks and adopt a preventative attitude with the aim being to reduce the high risk of blindness derived from diabetes; diabetic patients are 25 times more likely to experience total vision loss than the rest of the population. Yesterday, doctors Pere Romero, Head of the Ophthalmology Department at Sant Joan University Hospital in Reus, and Ramon Sagarra, Primary Care Doctor at Reus 1, discussed 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. While 80% of patients presented a healthy eye fundus, 18% raised doubts about a possible incipient lesion and were, therefore, the subject of a consultation with the ophthalmologist. Finally, diabetic retinopathy was diagnosed in around 7% of the patients screened. “The early diagnosis of these patients, who would not have visited the ophthalmologist, if it was not for the screening in primary care, allowed them to receive early treatment, which is effective in around 95% of cases, if it is given early enough and adequately," according to Dr Romero.
New treatments for diabetic retinopathy
On the other hand, the course has also included the presentation of important research studies on new treatments for diabetic retinopathy in both its incipient and advanced stages. Thus, Dr Rafael Simó, Director of Vall d'Hebron Research Institute (VHIR) and co-director of the course, presented yesterday the first results from the EUROCONDOR study, European Consortium for the early treatment of diabetic retinopathy, during which 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.
New research into cases of advanced retinopathy
There is also research going on for cases of advanced retinopathy, like the research taking place in Vall d'Hebron by Dr José García-Arumí, focusing on the application of gene therapies, with the aim being to solve the imbalance in genetic retina protection systems through the injection of nanoparticles to alter the genetic code of retina cells, increasing protective factors and re-establishing the balance lost, in order to inhibit the generation of neovessels harmful to the retina.