Joining Forces for Diabetes

I recently attended the tenth edition of COPHy (Controversies in Ophthalmology: Europe) meeting, held this year in Dublin, Ireland. COPHy is an annual congress based on discussions of the latest, most debatable and divisive topics in the field of ophthalmology. Each debate features two points of view from specialists and opinion leaders: the first speaks in favor of a specific approach, the second against it – and a lively discussion follows. The latest COPHy meeting included speakers and participants from all over the world, who presented and discussed some of the most interesting evolving strategies in disease diagnosis and management across all areas of ophthalmology.

One of the sessions featured the Vision Academy, a global collaboration of experts who work together towards reaching a consensus and developing guidelines on debatable topics in the field of retinal disease, as well as sharing best practice patterns with retina physicians. The group is sponsored by Bayer, but points of interest and discussion are totally independent and led by the retina specialists themselves.

The debate on the need for coordinated care for patients with diabetes was of particular interest to me. It is well known that diabetic patients suffer from a range of systemic disorders, including cardiovascular, renal and neurological diseases (1, 2, 3). Richard Gale from the University of York, UK, claimed that healthcare professionals involved in the treatment of patients with diabetes and diabetic eye disease are not currently communicating with each other. Emerging data show that an understanding of eye disease status can provide diabetologists with valuable prognostic information to help with the management of the systemic condition, in particular of other organs affected by diabetes. As one of the many complications of diabetes, the treatment of diabetic retinopathy should form part of a coordinated care plan between diabetologists and ophthalmologists.

There is enough data to suggest that a patient with diabetic retinopathy is more likely to develop diabetic nephropathy (4). It has also been shown that diabetic retinopathy is associated with peripheral, as well as cardiac neuropathy (5, 6), and that it is a strong predictor of stroke and atherosclerosis, and peripheral arterial disease.

Sobha Sivaprasad from the UCL Institute of Ophthalmology and Moorfields Eye Hospital, UK, argued that ophthalmologists do not have the capacity, expertise and resources to take into account other systemic complications of diabetes in the treatment of diabetic retinopathy. She mentioned multiple challenges of coordinated chronic disease approaches, including competing priorities, lowering of personal staff commitment, limited funding, reduced public understanding, and lack of communication across programs (7). The conclusion on this side of the debate is that monitoring is important, but it should be done independently.

The Vision Academy’s perspective that I presented was this: diabetic retinopathy is a strong predictor for the development of comorbid conditions associated with diabetes – therefore, timely referral and discussion between healthcare professionals involved in the management of diabetes and its complications are essential to improve patient care.

The overall consensus seems to be that a greater understanding of the wider implications of diabetic retinopathy may provide the opportunity to improve communication between diverse healthcare disciplines, which can help to identify those at increased risk of other diabetic complications, ultimately enhancing patient outcomes.