Prevention of diabetic blindness

We ophthalmologists know how to prevent diabetic blindness, but we are not doing it. The scientific principles of treatment of diabetic retinopathy and prevention of blindness have been known for over 20 years. In spite of this, diabetic eye disease remains a major public health problem with large numbers of people with diabetes going blind worldwide from what is largely a preventable cause of blindness.1–6 The problem will expand rapidly in the decades to come with the ongoing worldwide epidemic of type 2 diabetes mellitus.7 Is it possible that our efforts in this field are directed too much towards new inventions in diagnostic technologies and treatment and not enough towards old fashioned public health efforts and health care, using the equipment and knowledge we already have?

Specific treatment for diabetic retinopathy was initially limited to pituitary gland destruction. In the 1970s this was replaced with photocoagulation, and the Diabetic Retinopathy Study8 confirmed the benefit of xenon arc or argon laser photocoagulation to reduce the risk of visual loss in people with diabetes with proliferative retinopathy. A few years later the Early Treatment Diabetic Retinopathy Study9 confirmed the utility of macular laser photocoagulation to reduce the risk of visual loss in patients with diabetic macular oedema. In both proliferative diabetic retinopathy and diabetic macular oedema …