xPreface

the patient, as well as educating primary care physicians. The first edition of Monograph 14 was completed in 1999 and published in 2000 to coincide with a symposium entitled Diabetes 2000 at the AAO annual meeting. The second edition of Monograph 14 represents an additional 10 years of publications in the field of diabetes and ocular disease. Of particular note is the Diabetic Retinopathy Clinic Research Network, which has provided significant new information regarding the treatment of diabetic retinopathy. Additional chapters have been added on pharmacotherapies, optical coherence tomography, evidence-based medicine, evolving management strategies, telemedicine, and histopathology of diabetic retinopathy. We believe the current edition will serve as a valuable resource for ophthalmologists, researchers, as well as residents and medical students.

The educational objectives of this monograph follow:

•Provide an overview of the worldwide diabetes epidemic

•Review the classification of diabetic retinopathy

•Describe the histopathological manifestations of diabetic retinopathy

•Describe the pathogenesis of diabetic retinopathy

•Review the epidemiology and risk factors of diabetic retinopathy

•Summarize the history of evolving treatments for diabetic retinopathy

•Assess the use of photography, angiography, and ultrasonography in diabetic retinopathy

•Assess the use of optical coherence tomography in diabetic retinopathy

•Outline the clinical studies on treatment for diabetic retinopathy

•Explain the photocoagulation techniques for diabetic macular edema and diabetic retinopathy

•Analyze the use of vitrectomy for diabetic retinopathy

•Provide information on intravitreal pharmacotherapies for diabetic retinopathy

•Present evolving algorithms for managing diabetic macular edema

•Provide an evidence–based systematic review of the management of diabetic retinopathy

•Describe how cataract is managed in diabetes

•Identify nonretinal ocular abnormalities in diabetes

•Discuss the effect of systemic conditions on diabetic retinopathy

•Discuss medical management of the diabetic patient

•Describe telemedicine for diabetic retinopathy

•Explore future therapies for diabetic retinopathy

•Familiarize the reader with the major clinical trials for diabetic retinopathy

Ingrid U. Scott, MD, MPH

Harry W. Flynn, Jr., MD

William E. Smiddy, MD

Contents

Andrew A. Moshfeghi, MD, Ingrid U. Scott, MD, MPH,

Harry W. Flynn, Jr., MD, and Carmen A. Puliafito, MD, MBA

xi

Contributors

xiii

1

Medical Overview of the

Worldwide Diabetes Epidemic

ROBERT E. LEONARD II, MD,

AND DAVID W. PARKE II, MD

CORE MESSAGES

•Diabetes is a worldwide epidemic.

•Most of the increase in total numbers of diabetic patients is expected to occur in developing nations.

•Changing dietary and exercise trends appear to play a major role in the increasing prevalence of diabetes mellitus.

In recent decades, diabetes mellitus has progressed from a disease affecting primarily people in developed countries into a true worldwide epidemic. The World Health Organization (WHO) in 1999 defined diabetes mellitus as “a state of absolute or relative insulin deficiency, characterized by hyperglycemia and the risk of microvascular and macrovascular complications.” The purpose of this chapter is to emphasize the magnitude and impact of diabetes on developing nations and its implications for global health. The association of diabetes, pre-diabetes, and the metabolic syndrome will be discussed. By the end of this chapter, the reader should have a clear understanding of the demands that will be placed on health care providers around the world to cope with this looming healthcare crisis.

DIABETES: A WORLDWIDE EPIDEMIC

It is estimated that in 2005 nearly 200 million people worldwide had diabetes mellitus. Most of these patients are classified as having type 2 diabetes mellitus and the metabolic syndrome. The WHO data estimate the number of diabetic patients in Asia and India alone to be 52.4 million [1]: this number is expected to

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