Eyeworld

146 | EYEWORLD | APRIL 2019 O UTSIDE THE OR by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Contact information Stehouwer: cda.stehouwer@mumc.nl Dr. Stehouwer explained that even patients with the usual risk factors and less severe classic complications have a considerably low quality of life that is often associated with symptoms such as depression, cognitive decline, heart failure, and shortness of breath, despite receiving the best possible care. Living with diabetes is complicated by cardiovascular disease, microvascular compli- cations, weight gain, and hypoglycemia, among many other serious side effects, which lead to considerable distress among individuals and cause both personal and societal expense. Toll of diabetes According to the Swedish National Diabetes Register, the average number of life years lost to individuals with type 1 diabetes is 10 years and 17 years in those with childhood onset, despite the improvement in the available therapeutic options. 1 This number is lower in type 2 diabetes, between 2 and 5 years, and largely dependent upon the age of onset. 2 A recent study that analyzed the effects of risk factors such as HbA1c, blood pressure, cho- lesterol, smoking, and albuminuria demonstrated increased mortality with a higher number of risk factors per patient, as well as a graded increase in M ore than 400 million individuals worldwide suffer from diabetes, which remains a complex disease with a relatively high disease bur- den. The years of life lost from the disease, its complications, comor- bidities, and treatment side effects are roughly 10 years in people with type 1 and 3 years in type 2 diabetes, despite state-of-the-art care. In a presentation by Coen D.A. Stehouw- er, MD, at the 36th Congress of the European Society of Cataract and Refractive Surgeons, a bird's eye view of diabetes helped update oph- thalmologists on the current progress in diabetes treatment. "Diabetes is a very prevalent disease, with both type 1 and type 2 increasing, owing in part to the increasing patient age. It is still a disease for which we have to improve outcomes," Dr. Stehouwer said. "The years of life lost and the overall prognosis very much depend on the age of onset and risk factor control. There are important recent developments, such as technol- ogies applied mainly in type 1 diabetes and novel treatments, notably GLP-1 agonists and SGLT-2 inhibitors, applied mostly in type 2, that do appear to improve the prognosis. An important caveat, however, is their price and the fact that their true long-term safety has not been established," he said. Bird's eye view of diabetes chart. What they are saying is they can't read a book. So if the practitioner evaluates the reading function, they will see that the patient is right and they cannot read as fast." One aspect not included in the study is the fact that patients tend to get fatigued. "We don't know the reason for the fatigue. It might be frequent blinking, it might be blurring of vision," Dr. Akpek said. For these patients, they need to keep in mind that they can't read all day. In cases where some- one works at a computer all day, they need to take breaks to periodically put drops in and rest their eyes, Dr. Akpek noted. "Whenever a patient complains of vision difficulties, the tear film has to be examined," she said. For example, a patient with diabetes may have macular edema, but they may also have a bad case of dry eyes, she pointed out, adding that improving just the dry eye may enhance the quality of their vision. Dr. Akpek hopes the study leaves practi- tioners with the understanding that what patients say is true: They are unable to read as fast as normal. Importantly, investigators also found a clinically measurable parameter, in the form of corneal staining that correlates with blurring of vision, and this can also be tracked by the vision subsection of the OSDI. "This is revolution- ary," Dr. Akpek said. "It's wrong to say signs and symptoms don't correlate. We just have to know how to look." continued on page 148 continued from page 144 About the doctor Coen D.A. Stehouwer, MD Maastricht University Maastricht, the Netherlands PRESENTATION SPOTLIGHT

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