Anterior segment surgeons can take steps to manage diabetic patients who need cataract surgery

Diabetes and cataract are both age-related diseases. The median age that a patient undergoes cataract surgery in the United States is now approximately 69 years, having just recently dipped under 70 years. According to the most recent National Health and Nutrition Examination Survey, 20% of Americans older than age 65 years have diabetes, 90% being type 2, and 40% have impaired glucose tolerance or so-called pre-diabetes. Thus, diabetes rivals age-related macular degeneration as the most common comorbidity that the cataract surgeon must manage every day. Many diabetic patients also suffer from hypertension and obesity, and many smoke. Each of these puts the cataract patient at increased risk for sight-threatening postoperative complications, especially diabetic macular edema.After 10 or more years of diabetes, there is damage to the pericytes lining the blood vessels, resulting in microvascular abnormalities that can lead to retinal edema and ischemia. These manifest in the eye as nonproliferative or proliferative diabetic retinopathy and/or DME. In severe cases, rubeosis iridis with the potential for secondary glaucoma can also develop.