Revisiting Diabetes 2000: challenges in establishing nationwide diabetic retinopathy prevention programs.

PURPOSE: To evaluate the impact of the Diabetes 2000 program, an initiative launched by the American Academy of Ophthalmology in 1990 to improve nationwide screening of diabetic retinopathy (DR) and to reduce the prevalence and severity of the condition. DESIGN: Retrospective, observational case study of Diabetes 2000 program. METHODS: This is a perspective piece with a review of literature and personal opinions. RESULTS: Patients with diabetes are likely to see an increase in the disease burdens associated with DR unless effective programs for early detection and control of DR are implemented. CONCLUSIONS: Despite recent efforts to educate both patients and physicians alike about the importance of routine DR screening, the lessons learned from the Diabetes 2000 program illustrate the need for new strategies capable of improving accessibility to high-quality eye care, increasing involvement of primary care physicians in DR screening and encouraging at-risk individuals to seek testing.

Challenges to establishing nationwide diabetic retinopathy screening programs.

PURPOSE OF REVIEW: To review the results of recently published studies on diabetic retinopathy screening. RECENT FINDINGS: Despite numerous public health campaigns and the existence of guidelines designed to promote annual retinal exams for diabetes patients, an unacceptably high number of patients are not screened for diabetic retinopathy. Current findings suggest the need for novel methods to improve compliance with retinal screening exams among diabetes patients to preserve vision functionality in this population. SUMMARY: Diabetic retinopathy represents a major cause of acquired vision loss. The following review addresses the factors that contribute to inadequate retinopathy screenings among diabetes patients and proposes solutions that have the potential to increase the quality and accessibility of screening programs for diabetes patients.

Retrospective comparison of 25-gauge transconjunctival sutureless vitrectomy to 20-gauge vitrectomy for the repair of pseudophakic primary inferior rhegmatogenous retinal detachment.

PURPOSE: To compare anatomical and functional outcomes of 25-gauge transconjunctival sutureless pars plana vitrectomy (PPV) to standard 20-gauge 3-port PPV for the treatment of pseudophakic rhegmatogenous retinal detachments with inferior breaks. METHODS: Retrospective review of 78 consecutive eyes from 78 patients undergoing primary vitrectomy with a minimum of 3-month follow-up. Thirty patients underwent 25-gauge PPV and 48 patients underwent 20-gauge PPV from May 1993 to July 2008. Variables and outcome measures included patient demographics, retinal reattachment, best-corrected visual acuity, macular status, postoperative intraocular pressures, and surgical complications. RESULTS: Preoperative characteristics were similar in both groups. Single operation success rate was 25/30 (83.3%) for 25-gauge cases and 43/48 (89.6%) for 20-gauge cases (P = 0.50). Transient hypotony occurred in 6/30 25-gauge eyes and 1/48 20-gauge eyes (P = 0.01), whereas hypertension occurred in 10/30 25-gauge cases and 15/48 20-gauge cases. All but 2 eyes were attached at final follow-up (97%). At final follow-up, mean best-corrected visual acuity was 0.28 and 0.32 for the 25-gauge and 20-gauge groups (P = 0.74). CONCLUSION: Outcomes of 20-gauge versus 25-gauge PPV for the management of pseudophakic inferior rhegmatogenous retinal detachments were not significantly different, with hypotony being the most significant postoperative complication in the 25-gauge group as compared with the 20-gauge group.