Long-term visual outcome of diabetic patients treated with pan-retinal photocoagulation
Between the first and the present conferences on the Diabetic Renal-Retinal Syndrome, no advance in therapy has been more important to patient rehabilitation than the application of panretinal photocoagulation. As recounted in this retrospective assessment of a single ophthalmologist’s private practice, 96% of long-term survivors (mean follow-up 20 years) of panretinal photocoagulation retained visual function in at least one eye that was sufficient to ambulate thereby facilitating self-sufficiency. Although 27% of treated subjects had an adverse consequence — most often a loss of 4 or more Snellen lines of vision — 62% scored 20/40 or better at most recent examination. While sample bias (predominantly white middle class subjects) is reason for caution in extrapolating these results to the general population, the favorable outcome supports the broad use of laser photocoagulation as an antiblindness technique. Every diabetic person referred for a renal evaluation must be seen by a collaborating ophthalmologist early and repeatedly as a component of state-of-the-art comprehensive management. Burning the retina to preserve sight though counterintuitive is nevertheless an essential intervention once neovascularization is discovered. Every laser surgeon looks forward to replacing the retinal injury imparted by photocoagulation with more subtle and specific interventive measures based on humoral or biochemical lock and key correction of whatever is found to cause diabetic retinopathy. The good news delivered in this report is that despite an absence of clarity in understanding why diabetic retinopathy occurs, an effective treatment is in hand. Ensuring universal availability of laser photocoagulation to all who might benefit is a vital challenge in health care delivery.
KeywordsVisual Acuity Diabetic Retinopathy Proliferative Diabetic Retinopathy Laser Photocoagulation Light Perception
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