Diabetic Medications and Diabetic Eye Disease
In eye care, one of the physician quality reporting indicators is the presence or absence of diabetic macular edema. Macular edema is swelling, thickening or fluid retention in the central macular region of the retina. If left untreated, macular edema can have short-term and long-term effects on vision. It is a treatable diabetic condition and patients need to be aware of the varying medical treatments options.
One of the key categories of drugs used in the treatment protocol of Type II Diabetes is called thiazolidinediones (or glitazones). A recent study in the Archives of Internal Medicine (June 2012) showed patients receiving this class of drugs had a two to three-fold increased risk of developing macular edema. Actos and Avandia are commonly prescribed thiazolidinedione drugs.
The study supports the importance of comprehensive diabetic retinal exams for diabetic patients, as well as the importance of patients bringing an updated list of medications to each eye exam.
The image to the right shows a small pocket of fluid visible under the retina, and is an example of a patient with diabetic macular edema. This patient had good visual acuity but significant swelling of the retina. Macular edema resolved once the patient improved diabetic control. Because this patient was on multiple medications for the control of their diabetes (including Avandia), they are at increased risk of this re-occurring. This edema was not evident by direct exam, but scanning lasers were able to identify the retinal swelling and fluid.
In patients using Actos and Avandia, eye doctors should more aggressively manage risk factors for macular edema. Since vision is often affected, routine diabetic screenings should include testing for visual acuity. When there is a change in or reduced vision, the patient should be assessed with scanning lasers for macular edema. In fact, many practices now obtain a baseline macular thickness reading for diabetics as part of their routine diabetic workups.
Medicare recognized that macular edema was being under reported and hence included it in their new physician quality reporting guidelines. Eye care professionals should be up-to-date on the research to thoughtfully guide their patients and to work in conjunction with their patients’ other health care providers to meet individual needs.
Dr. Evans is the founding owner of Evans Eye Care in Palm Desert and can be reached at 760.674.8806.