Managing diabetic retinopathy: the partnership between ophthalmologist and primary care physician

Diabetic retinopathy (DR), an ocular complication of diabetes mellitus, is the leading cause of blindness in Americans age 20 to 74 today. The more severe stage of the disease, proliferative diabetic retinopathy, affects an estimated 700,000 Americans. Based on clinical findings, the disease is generally classified as nonproliferative DR or proliferative DR. While the former often begins as a symptomatically silent disease, it nevertheless may be progressing to itself cause significant visual loss. Based principally on evidence from several studies sponsored by the National Eye Institute, current treatment consists of regular observation by an ophthalmologist, laser photocoagulation, and vitrectomy. In addition, preventive methods such as tight glycemic control and ophthalmic screening of diabetics appear beneficial. While the ophthalmologist can provide specialized services for the DR patient, prevention and control lie largely in the hands of the primary care physician. Thus, only when primary and specialized care have established a strong partnership can they save the sight of the thousands at risk for diabetic retinopathy.