World Sight Day 2014 Congressional Briefing Addresses the Impact of Diabetic Eye Disease

Sandra Block, O.D. (Illinois College of Optometry and VISION 2020/USA Chair), Susan Bressler, M.D. (Wilmer Eye Institute/Johns Hopkins University School of Medicine) and Ann Williams, Ph.D., R.N., C.D.E. (Case Western Reserve University)

On October 9 and under the umbrella of VISION 2020/USA (see box below), fifteen United States-based vision organizations hosted a World Sight Day 2014 Congressional Briefing entitled The Economic and Societal Impact of Diabetic Retinopathy. Featured speakers included Susan Bressler, M.D., the Julia G. Levy, Ph.D. Professor of Ophthalmology at The Wilmer Eye Institute at The Johns Hopkins University School of Medicine, and Ann Williams, Ph.D., R.N., C.D.E., a Research Associate Professor of Nursing at Case Western Reserve University.

Since the goal of VISION 2020/USA is “no more avoidable blindness,” the briefing focused on the research and prevention activities necessary to reduce vision impairment and blindness in those with diabetic eye disease. Especially in last fifteen years, the U.S. has seen an epidemic of diabetes, with 24 million Americans diagnosed with it and potentially many more who don’t know they have it. Currently in the U.S., 29 million Americans have diabetes, with blood sugar levels high enough to cause physiological problems, and 86 million have pre-diabetes, with blood sugar a bit higher than normal-meaning that 115 million Americans are at risk for diabetic eye disease.

The most common cause of vision impairment from diabetes is Diabetic Macular Edema (DME), where elevated blood sugar levels cause leakage in the capillaries in the central macular region of the retina—the light-sensitive back of the eye—affecting central vision and concomitant activities such as reading and driving. In Diabetic Retinopathy (DR), after years of leaking the capillaries in the retina close up and die, causing retinal tissue to become hypoxic and die, creating “black holes” in the visual field. In both DME and DR, the body responds by liberating growth factors, such as Vascular Endothelial Growth Factor (VEGF), that promotes the growth of new capillaries that leak and repeat the cycle.

Dr. Bressler, a clinician-scientist who focuses on retinal diseases such as DR and Age-Related Macular Degeneration (AMD), reported that DR is the leading cause of blindness in adults 20-74 years old and occurs in about 40 percent of patients age 40 and older diagnosed with diabetes. Of those with DR, 20 percent have vision threatening DR. She noted that the National Eye Institute (NEI) within the National Institutes of Health (NIH) has funded a series of clinical research trials over the past forty years to determine the best treatments for DR and DME. Past trials developed a standard of care called Panretinal Photocoagulation, which used a laser scatter pattern to foster regression of new blood vessels, the hallmark feature of proliferative DR. Although this treatment reduced the risk of severe vision loss by more than 50% compared to no treatment, it had side effects that included loss of peripheral and night vision.

The NEI-funded Diabetic Retinopathy Clinical Research Network (DRCR), formed in 2002 and that currently includes about 363 physician investigators at 119 active clinic sites (university-based clinics and private offices) in 37 states, has confirmed that anti-VEGF therapy (ophthalmic agents that inhibit abnormal growth factors circulating in the eye) for DME, when combined with either prompt or deferred laser treatment, is more effective than laser treatment alone. This data, in conjunction with other industry-sponsored trials, has led to the Food and Drug Administration (FDA) approving these anti-VEGF ophthalmic agents for use in DME, stabilizing vision impairment in nearly all and, in many cases, improving lost vision.

Dr. Williams, a long-time leader in the American Association of Diabetes Educators (AADE), added that although the cost of treating diabetic retinopathy is expensive, not treating it is even more expensive, including direct medical costs, low vision and blindness services, and indirect costs (productivity loss, long-term care, government benefits/subsidies). Of the 5.3 million Americans with DR, about 2 million have significant vision loss such that it costs $6,680 per-person per-year, resulting in an annual cost of $13.3 billion of the total $145 billion annual cost of eye disorders in the U.S.

To put a face on the burden of diabetic eye disease, Dr. Williams profiled two clients: “Tom” with Type 1 diabetes since childhood and “Sarah” with Type 2 diabetes diagnosed in her mid-50s. She detailed their challenges with activities of daily living, such as mobility, self-care, and social participation. She concluded by stating that, although treatment and rehabilitation for diabetic eye disease is wonderful, prevention of blindness is even better through programs for screening for the disease and education about diabetes control.

From left: AEVR Executive Director James Jorkasky with Alicia Kerry Mica (American Optometric Association) and Ali Manson (Prevent Blindness)	From Left: Lester Marks (Lighthouse Guild), Ms. Manson, Dr. Block, and Tom Bruderle and Kevin Corcoran (Eye Bank Association of America)
Victoria Sheffield (International Eye Foundation) and Dr. Block