Ophthalmic care in older adults with diabetes

Abstract

According to Global Health Data, among ocular conditions leading to visual impairment or blindness, diabetes ranks fifth, with cataract being the leading cause of blindness and uncorrected ametropia the primary cause of low vision.

More than 29% of individuals over the age of 65 have Diabetes Mellitus (DM), and this prevalence is expected to rise rapidly in the coming decades. In this population, screening for diabetes-related complications should be individualized, prioritizing the detection of those complications that may impair functional status or quality of life for the patient and those around them.

Beyond diabetic retinopathy itself, older adults with diabetes frequently present with other age-related ocular disorders, including cataract, glaucoma, and age-related macular degeneration, which further contribute to visual impairment and functional decline.

When adressing ophtalmological complications, international guidelines emphasize the need for a comprehensive approach in older adults. The Recomendation is an annual screening through fundus photography or dilated fundus examination, adapted to the patient’s clinical and functional situation².

In this age group, age-related ocular changes together with multiple comorbidities further increase the burden of diabetic eye diseaseThe progression of this condition is influenced by factors such as long duration of diabetes, suboptimal glycemic control, hypertension, and dyslipidemia³.

Aging entails structural changes in the retina and lens, which, in the context of chronic hyperglycemia, may exacerbate patient vulnerability in many aspects. Population-based studies have indicated that cataracts, glaucoma, and age-related macular degeneration are the main causes of visual impairment and are associated with an increased risk of falls in aging patients⁵.

Overall, diabetic ophthalmopathy in older adults requires personalized strategies that integrate scientific evidence with the particularities of aging. Early detection of visual impairment that affect quality of life is imperative, along with the implementation of interventions aimed at preserving or restoring vision. The establishment of accessible screening programs and the strengthening of interdisciplinary collaboration are key pillars to reduce the burden of avoidable blindness in this population.