Opinion
Video
Challenges in Diabetes Therapy Adherence: Impact on Early Intervention and Long-Term Visual Outcomes
Joseph M. Coney, MD, FACS, discusses the challenges physicians encounter when treating diabetic macular edema and the impact of the disease on patients’ quality of life.
Joseph M. Coney, MD, FACS: The burden of therapy affects everyone. It doesn’t make a difference if you are Hispanic,… Caucasian, or African American. I think the burden of therapy, to see a physician, is great. I think it is greater in populations which are underserved, those that are underinsured because [the] disease is much more progressed. I think we have to be cognizant of the amount of time that patients are in our office for their therapies, not just [their] 30-, 40-, 50-minute trip to the office. Oftentimes [when] they need a health care provider, there may be only 1 car in the community or the household that allows them to come in, so they may be limited by their transportation. We also know that individuals, particularly if they live more than an hour away from a clinic, find it really difficult to keep their appointments. There are associated costs with transportation when it comes to parking and maybe when it comes to co-pays. All of these [issues] will have an effect on a patient trying to adhere to their therapy.
The day of the injection, I think, causes a lot of anxiety. Patients often receive these injections and go home [with their eyes] sometimes irritated. We know that this can go on for the next 12 to 24 hours. This is not just a onetime visit to the office. This can really impact them, particularly if they are still working. Oftentimes, employers will have a hard time letting patients go every 4 to 6 weeks to see an eye doctor. I can’t tell you how many patients I’ve seen where their employer threatens them about missing so much time and the possibility of being replaced. Sometimes they may or may not have the flexibility to take time off work to go see an eye doctor, especially if they are first-line workers. Unfortunately, the majority of the individuals tend to be people of color from underserved populations who need that job to take care of their family. They are very frightened of taking time off. If we can find a way to maximize therapy early on, I really think that we can make a lot of headway with that therapy [in the] long term.
All of our studies show that the most important time in terms of diabetes is the first 6 months to a year. After year 2, year 3, although these individuals still require follow-up, they may not need it as intensively. I think this has to do with the fact that if we catch the disease early, not only can we treat their diabetic macular edema, but we can also control the disease process. Over time, they will require less therapy.
The problem with patients not being able to keep appointments or have timely appointments where they can come in every 4 to 6 weeks until we get them stable and have the ability to extend out their therapy is that they may experience a waxing and waning of their diabetic edema where one month there may be no swelling, but 6 weeks later, the swelling comes back. This break in therapy or this unexpected extension of therapy will unfortunately lead to chronic swelling over time. Over years, this may have an impact on vision. Some of our trials show that even individuals who have been stable but have recurrent swelling experience an overall decrease in vision over 5 years compared to other studies that may show a long-acting medication. If you decrease the ups and downs of swelling or the fluctuation of swelling where individuals have peaks and troughs, these individuals actually have an improvement in vision. I do think that over time, this waxing and waning, not being able to maximize therapy early on, will have a negative impact on someone’s overall visual acuity and, unfortunately, their quality of life.
This transcript is AI generated and reviewed by an AJMC® editor.
