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Diabetic Retinopathy

By David Mendosa

Last Update: September 14, 2005

The most difficult problem for anybody who writes about health is to provide something of value to both professional and lay audiences. Yet that's what Dr. David Ormerod and his team attempted with its case study on diabetic retinopathy and its management. It is online again and the URL is

Andrew Cole is…not his real name.

The Virtual Health Care Team has written up a case about a person with diabetic retinopathy and resulting low vision. It describes medical treatment, rehabilitation principles, and resources. It's one of the interdisciplinary cases sponsored by the School of Health Professions and the School of Medicine, University of Missouri, Columbia.

It seems to me that they have succeeded wonderfully. I know how much I prefer not to read about the awful complications of diabetes. The threat of losing my vision is not something that I prefer to dwell upon.

But this case study is fascinating. The patient is called Andrew Cole. To protect his privacy that's not his real name and the pictures supposedly of him are actually of an actor.

But the patient is real and not a composite. He is, in fact, a chiropractor practicing in a rural Missouri community, according to Dr. Ormerod. The real Dr. Cole had been diagnosed 19 years earlier with type 2 diabetes.

Now all of a sudden it was hard for him to treat patients, to drive, and to take care of himself. "I figured that I would become totally blind," Dr. Cole said. Believing that his professional life was over and that he faced financial and personal hardships, it's not surprising that he was depressed.

His vision went down to 20/4000 in his right eye and 20/300 in his left eye. It was a case of advanced diabetic retinopathy.

The goals of his treatment were first to stabilize his diabetic retinopathy and then to limit additional vision loss and minimize the effects of his retinopathy. Finally, the multidisciplinary team of low vision specialists who treated him wanted to restore his visual independence.

The case is well organized in about two dozen Web pages of manageable length. "We put a lot of effort into the site to make it accessible to visually disability individuals," Dr. Ormerod says. "We used clear text, sans serif fonts, high contrast, removed clutter, and structured it for screen readers that read text on the page in audio form to make it easy for them to work."

The case is supplemented by an audio summary. This is, of course, especially important because many of the people that it's trying to reach could read it only with difficulty, if at all.

There is a lot of detail on rehabilitation on the site. It also has several links.

While Dr. Cole says that in general he was pleased with the quality of the services he received, he was frustrated with how long it took.

The site points out that visual rehabilitation is not a "quick fix." There are many different parts of the solution.

What's best, they emphasize is prevention. The site says that one of the most important aspects of prevention is an annual diabetic eye examination.

This is in line with the American Diabetes Association's position statement on "Standards of Medical Care for Patients with Diabetes Mellitus." Specifically, an experienced ophthalmologist or optometrist who knows about diabetic retinopathy needs to examine everyone with either type 1 or type 2 diabetes at least annually. If the retinopathy is progressing, the exams should be even more frequent.

Personally, ever since I was diagnosed with diabetes I have always gotten an annual eye exam. If anything, reading about all that Dr. Cole has had to go through strengthens my resolve. I hope that you'll have your eyes examined every year too. 

The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.

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