Role of comorbidities in management of diabetic retinopathy

Beyond duration of the disease and status of the blood sugar control, other factors tat negatively influence the prognostic outcomes of patients with diabetic retinopathy.

Related: Diabetic retinopathy clinical pearl pictoral

Modifiable factors include:

• Patient’s poor compliance with follow-up care

• Tobacco use

• Sedentary lifestyle

• Obesity

Related: OCT in DR follow-up highlights importance of retina-vitreous attachment

Systemic comorbidities include;

• Hypertension

• Hyperlipidemia

• Sleep apnea

• Renal disease

• Autoimmune disease

• Blood dyscrasias, often overlooked

Related: New guidelines out for diabetes patient care

Case report

The case summarized here is that of a 47-year-old African-American female. At the time of her initial presentation, she had been diagnosed with poorly controlled type 2 diabetes and hypertension for approximately 15 years. She was on dialysis as well and was sporadically treated for anemia.

The patient was initially diagnosed with proliferative diabetic retinopathy and underwent a series of treatments including intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVI) and panretinal photocoagulation (PRP).

The retinopathy was subsiding, as shown in Figure 1, and the patient was asked to follow up in 2 months; she failed to appear.

Related: When to refer patients with diabetic retinopathy

Nearly 6 months later, she presents with a complaint seeing sudden onset floaters in the right eye. As evident in Figure 2, the patient’s symptoms were caused by a vitreous hemorrhage in the right eye, and a worsening of the retinopathy was noted in both eyes. Clinically, the observation of multiple deep vascular plexus retinal hemorrhages (also referred to as blot hemorrhages, as well as a number of white-centered hemorrhages (also called Roth spots was made, as seen in Figure 3. Although these types of hemorrhages can be associated with diabetic retinopathy, they often are associated with other blood disorders, including anemia and leukemia.

Clinicians also need to keep in mind the anemia, which is a complication of chronic kidney disease.

Related: Proliferative retinopathy leads to risk of sight loss

The patient was treated with anti-VEGF IVI in both eyes. The findings and concern with her blood count were communicated to her primary-care physician (PCP).

At the patient’s one-month follow-up visit, significant resolution of retinal hemorrhages was noted (Figure 4). The patient also indicated receiving additional iron therapy from her PCP.

ODs must pay close attention and manage all factors responsible for disease progression to improve the patient’s final outcome.