The general practitioner and the diabetic eye - abstract

ABSTRACT

Diabetic patients are 25 times more likely to suffer blindness than non-diabetics. General practitioners form the first link in the clinical care of diabetic patients, and their role as screeners is extremely important. An early detection and a prompt control of the disease can greatly minimize the disabilities and the associated psychological and social consequences. The aim of the therapy is to prevent the development, or at least to reduce the severity, of retinopathy, nephropathy, neuropathy and macro-vascular disease. It may not be possible to adequately control this non-specific vascular disease, but the risk factors like hypertension, hyperlipidaemia and obesity can be fully controlled by using simple measures to reduce the morbidity. A good control of diabetes mellitus certainly decreases the incidence as well as the severity of retinopathy. It is well accepted now that the lower the mean blood glucose level, the lower are the micro-vascular complications, and the younger the patient the tighter should be the glycaemic control. The quality of glycaemic control can be assessed more accurately nowadays by the levels of glycated haemoglobin. Primary care physicians must be particularly thorough when examining these patients and look for abnormalities in other systems also. The rising incidence of morbidity is related to increased longevity and an inability to detect and prevent the various complications. A regular observation for an early recognition of retinal complications is essential. Non-insulin-dependent diabetics should be examined by an opthalmologist at the time of diagnosis and insulin-dependent diabetics should be seen once every year. A diabetic patient should be encouraged to actively participate in the self-management of the disease with proper education and motivation with a frequent review of compliance. A general practitioner may not have sufficient experience in recognizing the ocular complications of diabetes mellitus. Their screening performance can be greatly improved by short courses of instruction in opthalmology departments at various institutions (AU)