Early in 2021, the IAPB Diabetic Retinopathy Work Group surveyed professionals in its networks to gain insights into the impact of the pandemic on diabetic retinopathy initiatives around the world and to help the sector’s advocacy efforts.
The survey attracted responses from low- and middle-income countries across all regions and it confirmed that the pandemic affected virtually all types of diabetic retinopathy initiatives, everywhere. So, unfortunately, COVID-19 has been a truly global event that negatively impacted diabetic retinopathy initiatives across geographies, sectors, and levels of care.
Notably, survey respondents indicated that preventive services such as diabetic retinopathy screening were particularly affected. All respondents reported a reduction in services and more than 70% reported that screening had either greatly reduced or stopped completely. This is problematic as the reduction in number of people screened may be creating a huge backlog and it is increasing the likelihood that people will seek care for diabetic retinopathy too late, when the conditions has already advanced.
The survey also indicated that COVID-19 did not impact everyone equally. Sadly, older patients with comorbidities and people from more disadvantaged backgrounds were disproportionately affected in their ability to access much needed diabetic retinopathy services.
The impact of COVID-19 on the wellbeing of healthcare providers cannot be underestimated. Survey respondents indicated that the pandemic created anxiety and a sense of hopelessness in many health care providers involved in the delivery of diabetic retinopathy initiatives; this is partly because of fears of catching and spreading the virus and in part because of the inability to adequately care for patients. It wasn’t all doom and gloom, though. The survey demonstrated that the pandemic is playing a crucial role in accelerating the uptake of technology and innovative approaches to delivering diabetic retinopathy care. For example, many respondents resorted to setting up teleophthalmology consults, to introducing risk stratification approaches to ensure that high priority patients still received care, and in some cases task-sharing was introduced to provide diabetic retinopathy services closer to the community and reduce the need for travel. There is no doubt that the COVID-19 pandemic has largely caught us unprepared.
Findings from the IAPB survey are corroborated by evidence from the published literature. A recent study from Greece demonstrated that during a period of lockdown there was a statistically significant decrease in patients with diabetic retinopathy and macular oedema as compared to the same period in the previous year. Another study highlighted an alarming link between diabetic retinopathy and outcomes in patients with COVID-19 , with a 5-fold increase in the risk of intubation in patients with diabetic retinopathy.
Now is the time to leverage the learnings from the last 18 months and the positive changes made to how we deliver diabetic retinopathy services, so that we can future proof diabetic retinopathy initiatives from future pandemics.
Photo credit: Fabrizio D’Esposito