Dr. Jessica Randolph: The Risk of Diabetes-Related Eye Disease

Diabetes is the leading cause of new cases of blindness in adults aged 18–64 years. Diabetic retinopathy is the most common diabetic eye disease. Some, including racial and ethnic minorities, are disproportionately affected by diabetes. While genetic factors likely play a role, so do social, economic, and environmental barriers.

DocWire News spoke with Dr. Jessica Randolph about the risk of diabetes-related eye disease, and the importance of access to care.

DocWire News: Can you provide us with some professional background on yourself, and the work you do with the American Diabetes Association?

Dr. Jessica Randolph: Sure. I’m Jessica Randolph. I’m a medical doctor MD in Richmond, Virginia. I’m an assistant professor in the department of ophthalmology at Virginia Commonwealth University. I have special interest in diversity equity inclusion issues in ophthalmology and retina specifically, and also in medical education. I work with the ADA on their focus on diabetes eye health initiative because I’m a retina specialist. So a lot of the patients that I see are diabetic patients who are coming to me for eye exams for problems related to their diabetes. So this diabetes eye health initiative is led by the ADA in collaboration with their visionary partners, VSP and Regeneron. It works to raise awareness about diabetes related eye disease and provide resources and support to people who are at risk from diabetic eye disease.

What is diabetes-related eye disease, and what are the symptoms?

The most important thing to remember is that the initial symptoms, there aren’t any. It’s asymptomatic. There is nothing that would let you know that something is going on in your eye until things are really progressed and far along and we’re starting to get into the complications end of things. That’s when you start to notice changes from the diabetes. So the most important thing is to remember that there are no symptoms at all and so it’s really important to get that annual diabetic eye screening.

Diabetes is the leading cause of new blindness in adults aged 18 to 64. So that’s a wide range of people that are affected by diabetes and more often it’s patients that are racially or ethnic minority patients because of diabetes is worse in these patients. So all sorts of things, socioeconomic status, access to healthcare and historic disparities in the medical system all end up wit racial and ethnic minority patients having worse diabetes and therefore having worse diabetic eye disease. So it’s really, really important to get that screening.

Why are minority populations disproportionately affected by diabetes-related eye disease, and what can be done about that?

So racial and ethnic minorities are disproportionately affected by diabetes. Black American adults are 60% more likely to be diagnosed with diabetes and more than 800,000 Black Americans have diabetic retinopathy that can lead to blindness. Three million Hispanics or Latinos are at risk of losing their sight in 2030 as a result of the complications from diabetes. These patients are usually less likely to have had an eye exam or be evaluated for diabetes. There can be cultural or language barriers, health insurance barriers that are preventing them from getting access to this care that is so, so important for preserving vision.

Why is access to quality care so vital?

It’s vital because patients don’t know if they are having problems from diabetes without the screening. Like I said, it’s asymptomatic. There are no symptoms that a patient may have to let them know that they have diabetes. So it’s important for these screenings to happen so that we can catch things early and then talk about ways to fix it, like keeping the A1C under better control and really controlling the diabetes. Often knowing that there’s potential impacts on the vision can help some patients become more motivated to really get that sugar under better control. Once diabetic retinopathy has been identified in patients, then screening them even more frequently in the clinic and treatment, if needed, to prevent vision loss from the diabetes. Over 70% of vision loss from diabetes is preventable with screening. So it’s really, really important that we get our patients in to see someone and have a good dilated eye exam to screen for these changes.

What else should people with diabetes know about protecting their vision?

The most important thing is that it’s just essential to have your yearly eye exam. So many patients don’t know and aren’t screened. Then they come see me and it’s been many years since they’ve had an eye exam and they can be really bad off in their eyes and not know it. They come in thinking they’re just going to get some glasses and then they leave and we’re talking about doing surgery. So it’s really, really important to have those screenings. Diabetic retinopathy when it starts out is mild, there are no vision symptoms at all. So it’s so important to get those screenings done and get the patients in for checkups. Since these are medical problems, they’re covered with medical insurance. Some patients also just don’t know education wise, either about retinopathy or they don’t know that their insurance will cover these screening exams. There’s a lot of misinformation and lack of education out there for patients. So really just encouraging them to go and get those eye screenings done and have a complete dilated exam to check for this diabetic retinopathy changes.

Any closing thoughts?

Thank you so much for having me. It’s been really nice talking to you about diabetes. If you need more information, you can go to the ADA website diabetes.org/diabetes/eyehealth and find more information there.