Diabetes debate continues

By Sean Henehan

Recent studies suggest that some 20% of cataract patients have diabetes. But what are the chances that cataract surgery might exacerbate retinopathy in patients with diabetes? The jury is still out on that question.

"At first, there was a considerable amount of literature documenting that cataract surgery exacerbated or caused progression of diabetic retinopathy. Now, new data and new literature states this isn't true. I think it is still up for debate," says I. Howard Fine MD, outgoing President of the ASCRS.

But these questions need answers, he stresses. To begin with, he called for a prospective, randomised study that looks at early treatment of diabetic retinopathy, and measures what the retinopathy is prior to cataract surgery.

Another study should look at taking diabetic cataracts out earlier than they normally would be were there no diabetic retinopathy. The goal of that study would be to determine whether earlier cataract surgery in the absence of diabetic retinopathy would affect the future progression or appearance of diabetic retinopathy .

"From my own perspective, I think that diabetics, like everyone else, are candidates for cataract surgery based on their visual needs and the disruption of their vision due to cataract.

"These unanswered questions will obviously impact upon the timing of cataract surgery in this class of patients," he said.
In the meantime, Dr Fine emphasised that diabetic patients benefit most when cataract surgeons and retinal specialists work closely together in the management of those patients.

Dr Fine is the director of Oregon Eye Associates, Eugene, Oregon, USA.


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