Diabetic Retinopathy in the
Latino Community
Jose de la Cruz MD, MS
Director,
Comprehensive Ophthalmology Service
University of Illinois Eye and Ear Infirmary
Chicago IL
Diabetic Retinopathy
A frequent cause of blindness in the United
States.
Leading cause of blindness in the population
aged 20-64
In recent decades the prevalence of diabetes has
been steadily increasing worldwide, and
projection of the year 2030 indicate the United
States along with China and India, will have the
largest number of people with diabetes.
The health consequences of uncontrolled
diabetes and the repercussions for health care
costs are immense.
In the United States, diabetes is more likely
to affect minority populations
In one study, compared with non Hispanic
white individuals, the ratio of age- and sex-
standardized prevalence of diabetes was
1.9 for Hispanic individuals and 1.6 for
African American individuals
Diabetes prevalence is expected to increase by 44%
by the year 2020
– This increase is especially alarming, as the Hispanic
population is the largest growing community, with a
population estimated to double by 2025
Currently, 1 in 5 Hispanic persons older than 40 years
has diabetes, and almost half have the diabetic
retinopathy
The limited use of health care services in minority
groups may take them more susceptible to the
complications of uncontrolled diabetes.
In addition, a substantial proportion of those with
diabetes are unaware of their condition, although
already presenting signs of moderate to severe
diabetic retinopathy, a silent but blinding disease
The importance of appropriate and timely care for
diabetic retinopathy or macular edema is
paramount, as it is the leading cause of visual loss
among working age Hispanic individuals.
Knowledge of Diabetic Eye Disease
and Vision Care Among Hispanic
Individuals
Baltimore Study (July 2008)
Objective
– To determine gaps in knowledge and
barriers to care for diabetic eye disease in
Hispanics in Baltimore, Maryland
Methods
– Interviews of random sample of self
reported Hispanics
Results
– Less than 10% of participants preferred reading English
– 50% report having providers who do not speak Spanish
as a barrier to care.
– Knowledge of eye disease as a consequence of
diabetes was reported by
18% of nondiabetic participants with no family history
29% of nondiabetics participants with a family history
36% of newly diagnosed diabetics patients
52% of participants diagnosed with diabetes more than 1 year
before the study.
Only 16%, 28%, 13%, and 34% respectively , knew that strict
control could prevent eye problems, and 33%, 51%, 31% and
48% respectively, knew that dilated eye examinations were
important
A total of 30% of diabetic participants had had an eye
examination in the previous year.
Conclusion
– KNOWLEDGE!! of the ocular complication of
diabetes is low
– The frequency of eye examinations among
Hispanic individuals with diabetes is less than
the national average for Hispanics individuals
– Culturally, appropriate health education and
innovations to reduce barriers to eye care are
needed.
Biological Risk Factors Associated With
Diabetic Retinopathy
The Los Angeles Latino Eye Study
Objective
– To identify biological risk factors associated with
having diabetic retinopathy in Latinos with Type
2 diabetes mellitus (T2DM)
Participants
– 6357 Latinos ages >or = to 40 years from
census tracts in Los Angeles, California.
Conclusions
– High risk of diabetic retinopathy in adult Latinos
is independently associated with both
modifiable and non modifiable risk factors
– Findings suggest that controlling hyperglycemia
and hypertension in this ethnic group may
reduce the high risk of having diabetic
retinopathy associated with Type 2 Diabetes
Mellitus.
The Effect of Systemic Conditions
on Diabetic Retinopathy
Elevated Serum Lipids
– Assoc. with presence and severity of retinal disease
Hypertension
– Assoc with higher risk of progression diabetic retinal disease
in general when poorly controlled for many years
Carotid artery occlusive disease
– May result in advanced proliferative diabetic retinopathy
Advanced diabetic renal disease and anemia
– May also have an adverse influence on diabetic retinopathy
Pregnancy
– Assoc with worsening of retinopathy
American Diabetes Association
Guidelines for Vision Care
ADA guidelines for vision care for persons
with Type 2 Diabetes Mellitus
– To have a dilated eye examination at diagnosis
and the examination be repeated yearly
thereafter.
Suggested Timetable for Detailed
Ophthalmologic Exam of Diabetic Patients
American Academy of Ophthalmology
Age of onset of Rec. time of 1st Routine min.
DM/Pregnancy Eye Exam follow up
0-30 Within 5 yrs of Annually
diagnosis
31 and older Upon diagnosis Annually
Pregnancy Before conception Every 3 mths or at
or early in first the discretion of
trimester ophthalmologist
Summary
Need for more awareness in the Hispanic
Community about potentially blinding disease.
Preventable!!
Emphasis on initial evaluation and adequate follow
up for prevention
Strict glycemic control & working on modifiable risk
factors
Demographics Studies of Diabetic Retinopathy in
Hispanics in Illinois?
Thank you!!
For more information:
Comprehensive Ophthalmology Service
University Of Illinois Eye and Ear Infirmary
Chicago IL
312 996 6562
Jose de la Cruz MD
Email: josedlc@uic.edu