23/05/2018

DIABETIC RETINOPATHY HAS TRIPLED OVER THE LAST 15 YEARS

This disease is one of the main causes of affiliation to the ONCE and the leading cause of blindness in the working age population of industrialized countries1

As of 20 years having type 1 diabetes, practically 100% of patients have some degree of diabetic retinopathy2

Corneal donations and transplants have increased in Spain

This REVIEW also approached the latest advances in glaucoma, cataract and refractive surgery, cornea and ocular surface, oculoplastics, and eye inflammation

The progressive ageing of the population and the increase of diabetes translate into a higher rate of diabetic retinopathy. According to the experts gathering at ESTEVE’s 5th Annual Review, the incidence of diabetic retinopathy has tripled over the last 15 years and is presently the leading cause of blindness in industrialized countries1. Also emphasized at this meeting held in Bilbao was the increased rate of corneal transplants, and the advances made in ocular surface, surgery, eye inflammation and oculoplastics presented at national and international congresses were approached.

According to Dr. José Luis Encinas, president of the Spanish Society of Ophthalmology (SEO) and scientific coordinator of ESTEVE's 5th Annual Review, ''diabetes is a chronic systemic disease with an enormous impact on the retina''. Basically, ''the main retinal diseases caused by diabetes are diabetic macular edema and diabetic retinopathy, and both may cause vision loss and even blindness''.

Diabetic retinopathy is caused by an impairment of the blood vessels that supply the retina, while diabetic macular edema (DME) is an accumulation of fluid in the macula —the part of the retina responsible for central vision. Both conditions are directly related to diabetes evolution time, and their prevalence also varies with type 1 or type 2. ''80% of patients having had type 1 diabetes for 15 years have some degree of diabetic retinopathy. This becomes practically 100% as of 20 years with the disease''.

Insulin dependency is another important factor. ''60% of non-insulin-dependent diabetics having had the disease for more than 15 years suffer from diabetic retinopathy, versus 80%-90% of insulin-dependent diabetics''. Experts also point out other risk factors, such as obesity, poor metabolic control, proteinuria, alcohol and smoking, among others.

Type 1 diabetes increases the risk of DME. ''People having had diabetes for 15+ years have a 15% chance of DME, and this increases to 28% as of 20 years. These figures are somewhat lower in type 2 diabetes: 22.5% have DME as of 20 years''.

REVIEW, organized and sponsored by ESTEVE, has moderators and panelists from the major scientific societies of ophthalmology: The Spanish Society of Ophthalmology (SEO), the Spanish Society of Glaucoma (SEG), the Spanish Society of Cornea and Ocular Surface (GESOC), the Spanish Society of Implantation Refractive Eye Surgery (SECOIR), the Spanish Society of Retina and Vitreous (SERV), the Spanish Society of Eye Inflammation (SEIO), and the Spanish Society of Oculoplastic Surgery (SECPOO).

According to Dr. José Luis Encinas, ''attending all congresses of this specialty is practically impossible and this meeting reviews the national and international congresses held over the last year, which is a big advantage. This meeting also reveals updated data of these congresses provided by experts, who offer their interpretation and transmit their importance to the attendees. This is why REVIEW has been and is a success''.


All AMDs affect both eyes within 5 years of their onset

Age-Related Macular Degeneration (AMD) is a disease that affects part of the retina and the macula, and appears most frequently as of 50 years of age. Reportedly, up to half the cases will be bilateral —will affect both eyes— within 5 years. ''This, however, will eventually happen in all cases''.

According to Dr. Encinas, ''25 million people worldwide are affected by AMD, of which 3.5 million people in Europe and 750,000 people in Spain''. Current treatment is limited to the administration of anti-angiogenic products by intravitreal injection to prevent the proliferation of new abnormal blood vessels in the macula (which are responsible for vision loss), thereby improving or maintaining macular health. Here, the experts emphasized the importance of intraocular devices, which release the drug at a constant rate for days or weeks.

Short-sighted persons have an increased risk for retinal detachment

Dr. Encinas explained that ''retinal detachment affects one in 10,000 people (1% of the population) and usually appears in middle age or old age. There are, however, very clear risk groups such as short-sightedness as of 5 or 6 diopters, basically due to retinal thinning caused by eyeball distension''. Its causes include lattice degeneration, which appears in 8% of the population and accounts for up to 30% of retinal detachments; cataract surgery complications; or posterior vitreous detachment, which may lead to retinal dragging.

Increased corneal donation and transplant rates in Spain

In the section on cornea and ocular surface, dry eye disease was a central issue on account of ''the recent publication of the last Definition and Classification Report on this disease —TFOS DEWS II3—, its high consultation rates, and the fact that it becomes a problem when considering some eye surgeries'', according to Prof. Juan Durán, medical director at the Surgical Clinical Institute of Ophthalmology of the UPV and scientific coordinator of REVIEW. ''Specific anti-inflammatory collyria or plasma derivatives are providing solutions to severe cases of dry eye disease''.

Prof. Juan Durán also said that ''there is concern about the severity of keratitis, an infection associated with the use of contact lenses, where increasingly aggressive germs are present'', for which reason this was also analyzed at this meeting.

Regarding corneal transplants, their increased rate in Spain ''due to the interest of tissue banks leading to a considerable reduction in waiting times'' was emphasized. In this sense, ''lamellar techniques have revolutionized this field since the beginning of the new millennium and provide better outcomes in diseases such as Fuchs' dystrophy or keratoconus''. Also emphasized was the fact that ''artificial cornea transplants remain a complex issue and are performed in reference centers only".

References
1.- Fundación Retina+
2.- Osakidetza
3.- TFOS DEWS II Definition and Classification Report

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