Diabetic Retinopathy: Overview and Pathogenesis

Allen Dobson, Jr., MD, FAAFP: Welcome to this Patient Care® Around the Practice episode titled, “The Value of Screening and Early Detection in Diabetic Retinopathy.” I’m Dr Allen Dobson, chair of the Board of Managers of the Community Care Physicians Network, LLC in North Carolina. Joining me today are Dr Steven Peskin, the senior medical director and pilot lead at Horizon Healthcare Innovations, a Horizon Blue Cross Blue Shield of New Jersey company; Dr Wade Brosius, a board-certified family physician and medical director at Pottstown Medical Specialists in Royersford, Pennsylvania; and Dr Shelton Hager, a family physician at Holston Medical Group in Kingsport, Tennessee.

We’re going to reflect and discuss the importance of screening and early detection of diabetic retinopathy. We hope to review the barriers of early diagnosis and identification of the clinical and economic burdens of diabetic retinopathy. Let’s begin. First, Wade, could you talk a little about the pathogenesis of diabetic retinopathy, some of its causes, and some background information for everyone?

Wade Brosius, DO: Sure, Allen. As I’m sure you know, diabetic retinopathy has been recognized as one of the leading microvascular diseases. Hyperglycemia is considered to play an important role in the pathogenesis of the retinal microvascular damage. There are multiple metabolic pathways that have been implicated in hyperglycemia-induced vascular damage, including things like the polyol pathway, advanced glycogen end product accumulation, the protein kinase C pathway, and the hexosamine pathway. All of these play an important role in the pathogenesis of diabetic retinopathy and make things pretty ugly for the patients who get it.

Allen Dobson, Jr., MD, FAAFP: Thanks. Let’s talk a little about the epidemiology. We’ve had diabetes around and learned a lot about how to control it and treat it over the last 20 years or so. Shelton, in general, is diabetic retinopathy still common with all our ongoing treatments that we have? What are the risk factors we need to be looking for?

Shelton Hager, MD: Unfortunately, it is common, and it has a long, progressive silent pathway until it becomes very apparent with visual loss and problems with vision. It can also affect activities of daily living, but that comes late in the game. Screening is necessary, but there are a lot of barriers that we’ll go over. One of the things that patients can do, which is very hard, is control their diabetes, get their A1C [glycated hemoglobin] as close to 7% as possible, control their blood pressure, and get their blood pressure to less than 140 over 80 mm Hg.

Allen Dobson, Jr., MD, FAAFP: As far as risk factors for it, it sounds like blood pressure control and control of your glycemic levels. Are there any other things we know to be looking for?

Shelton Hager, MD: Those are the primary ones, and for the screening, too.

Transcript Edited for Clarity