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Diabetic Retinopathy

An Overview

Information and resources provided courtesy of The Fred Hollows Foundation (FHF) and IAPB Vision Atlas 2016 ( to be published Oct 2016)

Diabetes mellitus is becoming a global epidemic. In 2014, there were approximately 422 million people (8.5% of the world’s adult population) living with diabetes; compared to 108 million in 1980 (2016 WHO Global Report on Diabetes). [i]

Low and middle income countries account for approximately 75% of the global diabetes burden yet many are ill equipped to properly identify, treat and manage the complex and varied consequences of this disease. Currently, South East Asia and the Western Pacific account for more than half of adults with diabetes worldwide. China, India, Indonesia and Bangladesh alone represent 45% of the global burden. [ii]   Yet the highest prevalence of diabetes is found in the Eastern Mediterranean, where close to 14% of the population is afflicted.[iii] Efforts to reduce the prevalence of diabetes or to more effectively manage its health consequences are further undermined by the fact that approximately 50% of people with diabetes are currently undiagnosed. This is even more pronounced in Africa, where two thirds of people with diabetes remain undiagnosed and the greatest increase in disease burden (103%) is anticipated by 2040.[iv]

Diabetes increases the risk of a range of eye diseases, but the main cause of blindness associated with diabetes is diabetic retinopathy (DR).

DR damages blood vessels inside the retina at the back of the eye. It commonly affects both eyes and can lead to vision loss if it is not treated. Poorly controlled blood sugars, high blood pressure and high cholesterol increase the risk of developing DR.

Every person with diabetes is at risk of developing DR. Approximately 35% of people living with diabetes have some degree of DR and 1 in 10 will develop a vision threatening form of the disease.[v]

Solutions

People with DR whose sight is at risk can be treated, most commonly with laser, to prevent visual impairment and blindness. However, there is no treatment that can restore vision that has already been lost. Because DR is initially asymptomatic many people with diabetes are not aware that their condition, if left unmanaged it may affect their vision and lead to blindness. The vast majority of patients who develop DR have no symptoms until the very late stages (by which time it may be too late for effective treatment). Therefore screening and early intervention is critical. Targeting resources to the ‘front end’ of the service delivery system over time will help reduce the burden on tertiary services, which are expensive, resource- intensive and often simply unavailable.

There is good evidence, however, that making appropriate lifestyle changes can contain or even reverse the most common form of the disease (Type 2 diabetes). The relevant lifestyle changes involve a sensible lower carbohydrate diet, increased exercise plus control of blood pressure, blood sugar and cholesterol. This is the main primary health care approach that can result in lowering the incidence and ultimately the prevalence of diabetes – but community buy-in is critically important.

Therefore, the most effective diabetic retinopathy programs will take a holistic approach, focusing on patient education, behavior change, and effective disease management strategies in addition to the provision of annual vision exams and high quality, affordable treatment, when required. Increased cooperation between the diabetes care and ophthalmic communities is essential to preventing the impending epidemic of vision loss due to diabetic retinopathy.

 

Resources

  • The International Council of Ophthalmology has issued new Guidelines for Diabetic Eye Care, which are intended to serve a supportive and educational role for ophthalmologists worldwide, with the ultimate goal of improving the quality of eye care for patients with diabetes. Read more…
  • Diabetic Eye Health: A Guide for Health Professionals. http://www.idf.org/eyehealth
  • United Kingdom's National Institute for Health Research : a comprehensive review of laser treatment for DR. http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0006/148596/FullReport-hta19510.pdf
  • DR: 'Evidence Gap Maps' : Sightsavers in collaboration with the Cochrane Eyes and Vision Group - http://www.sightsavers.org/gap-maps/diabetic-retinopathy-gap-map/
  • The IAPB Essential List for Screening, Monitoring and Treatment for Diabetic Retinopathy   www.iapb.standardlist.org
  •  The Online Self Directed Diabetic Retinopathy Grading Course developed by the University of Melbourne School of Population and Global Health and the Center for Eye Research Australia is available in Mandarin and Spanish and will soon be translated into additional languages. The new versions of the course are available at http://drgrading.iehu.unimelb.edu.au.
  • The newly formedCommonwealth Eye Health Consortium (consisting of 11 leading research institutions focusing on eye health) which is working to address the growing burden of diabetes across the Commonwealth by supporting a network of hospital-based training links between multiple African and UK eye units focused on building strong diabetic retinopathy teams.” Information regarding theDiabetic Retinopathy LINKS network is available at http://cehc.lshtm.ac.uk/dr-links/
  • Community Eye Health Journal (special issue on DR )  http://www.cehjournal.org/
  • The Silver Book - Diabetic Retinopathy: Published by  The Alliance for Ageing Research        http://www.silverbook.org/publication/diabetic-retinopathy/

 

Download other useful resources and presentations below. You can also watch below video-interviews with Dr. David Friedman and Mr. Thulasiraj Ravilla at the Council meeting in Brighton, September 2013, discussing challenges and solutions for diabetic retinopathy with Ms. Kathy Spahn.

 

IAPB Diabetic Retinopathy Work Group

On 6 April 2013, a meeting was organised in Bangkok by The Fred Hollows Foundation and Helen Keller International to bring together NGOs working in DR and coordinate their efforts. The meeting led to the establishment of an IAPB Work Group. Learn more about the group and ways for members to engage at the link below.

DR Work Group


References cited:

[i] WHO Global report on Diabetes
http://www.who.int/diabetes/global-report/en/

[ii] IDF Diabetes Atlas Sixth Addition, International Diabetes Federation, 2013, pg. 12-13

[iii] WHO Global Report on Diabetes, 2016

[iv] IDF Diabetes Atlas Sixth Addition, International Diabetes Federation, 2013, pg. 12-13

[v] Yau JW, Rogers SL et al., Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012 Mar;35(3):556-64.

 

 

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