The Role of Optometry in Managing Visual Impairment in Patients with Diabetes: Prevention and Treatment Options

Abstract

Diabetic retinopathy (DR) is a leading cause of vision loss globally, affecting both the working-age population and the elderly. DR progresses from mild non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Risk factors include prolonged diabetes duration, hyperglycemia, hypertension, and dyslipidemia. DR pathogenesis involves inflammatory, oxidative stress, angiogenesis, and apoptosis pathways. Diagnosis is based on characteristic retinal changes observed during ophthalmoscopy, with additional imaging modalities like fluorescein angiography and optical coherence tomography. Prevention strategies focus on strict glycemic control, while the impact of managing dyslipidemia and hypertension remains inconclusive. Treatment options include laser photocoagulation, anti-vascular endothelial growth factor (VEGF) therapy, and intravitreal steroids. Pars plana vitrectomy is indicated for advanced cases with vitreous hemorrhage or tractional retinal detachment. Fenofibrate, pemafibrate, finerenone, and semaglutide have shown potential in managing DR. Lifestyle modifications, such as a balanced diet, physical activity, and smoking cessation, are crucial adjuncts to medical interventions. Pregnant women with diabetes require close monitoring due to the increased risk of DR progression. Traditional medicine and acupuncture may offer complementary approaches, but further research is needed. A multidisciplinary approach involving ophthalmologists, endocrinologists, and primary care physicians is essential for the optimal management of DR and the preservation of vision in diabetic patients.