The Three H’s: Delaying Onset and Preventing Diabetic Retinopathy

 In Retina Labs Blog

In our February 1, 2019 blog post, we talked about the American Diabetes Association’s 2019 guidelines as they relate to screening (and specifically  teleretinal screening) for diabetic retinopathy (DR). In this post, we’ll take a closer look at the ADA’s recommendations for preventing the onset and slowing the progression of DR, and some expert opinion on educating patients about how to best protect their vision.

Risk factors for DR are sometimes referred to as the 3 H’s: hyperglycemiahypertension, and hypercholesterolemia. Accordingly, the ADA guidelines recommend that glycemic, blood pressure, and serum lipid control should all be optimized to reduce the risk or slow the progression of DR. The importance of this systemic control of diabetes was highlighted in a discussion on Medscape Ophthalmology between two ophthalmologists at the New York Eye and Ear Infirmary of Mount Sinai in New York City: Dr. John Aljian (an anterior segment surgeon and Clinical Associate Professor of Ophthalmology) and Dr. Ron Gentile (Director of the Ocular Trauma Service and Surgeon Director). They stressed the need to “get to patients before they have diabetic retinopathy. If a patient comes in to the office with no diabetic retinopathy, we don’t want to forget to mention the importance of the 3 H’s.” Because DR can take years to develop, each clinical encounter is an opportunity to stress to the patient the importance of striving to meet his or her individual treatment targets. In fact, as summed up by Dr. Aljian  “there is nothing more powerful—no medication, injectable, laser, whatever—to prevent a vision loss from diabetic retinopathy than control of the blood sugar, the blood pressure, and the lipid profile.”

You can watch Dr. Aljian’s interview of Dr. Gentile here:


(note: you will need a free Medscape account to access this video).

ADA stresses that while high-quality evidence supports many interventions to improve diabetes outcomes, diabetes remains a “complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications.”

Primary care physicians, through their regular contact with patients with diabetes, are ideally positioned to reinforce these messages and to help patients make the connection between their overall diabetes management and their gift of sight.

Aljian JM, Gentile RC. Three Keys to Delaying and Preventing Diabetic Retinopathy. Medscape Ophthalmology. August 28, 2017. Available at:
American Diabetes Association. 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019 Jan; 42(Supplement 1): S124-S138.