[Diabetic maculopathy and retinopathy. Functional and sociomedical significance].
OBJECTIVE
The incidence of diabetic microvascular complications is expected to increase by 20-50% in the coming years. Diabetic macular edema (DME) is already a leading cause of blindness in the working-age population in developed countries, and its impact is expected to increase dramatically.


METHODS
Recent literature on the epidemiology and impact of diabetic microangiopathy (maculopathy) on visual function was reviewed to provide a comprehensive overview of the functional and socioeconomic consequences of diabetic retinal microangiopathy and new therapeutic strategies.


RESULTS
The first changes indicating diabetic microangiopathy are detectable shortly after the development of hyperglycemia, and in the long term they induce severe organ damage. More resources are used for this condition's treatment than for the treatment of hyperglycemia, corresponding to an enormous sociomedical burden of disease. Early detection of increased retinal vascular permeability may help control treatment effects. The control of recognized risk factors for the development and progression of DME, namely hyperglycemia and hyperlipidemia, as well as of hypertension has remained the cornerstone of therapy and serves as the basis for preserving visual function.


CONCLUSIONS
Modern treatment options, begun early, may result in a remarkably delayed occurrence of irreversible diabetic microvascular pathologies, particularly diabetic retinopathy and maculopathy. Ophthalmological screening nowadays aims at earlier recognition of at-risk individuals to optimize the therapeutic strategy--that is, before visual impairment is imminent. Close interdisciplinary medical cooperation and implementation of new therapeutic options may provide the foundation for success in terms of maintaining visual function.
Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Universität Bern, Bremgartenstrasse 119, 3012, Bern, Switzerland. garweg@augenklinik-bern.ch
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JG
Garweg
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Wenzel
D015897:Comorbidity; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D038622:Internationality; D008403:Mass Screening / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*