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Diabetic eye disease

Diabetic eye disease often begins without symptoms, but because it it often left unmanaged, it has become a leading cause of vision loss and blindness.

Featured around diabetic eye disease

Treatment and successes

People with diabetic retinopathy 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.

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.

Access the fundus camera equipment specifications for diabetic retinopathy screening, produced in collaboration between the IAPB Valued Supplier Scheme, the IAPB Diabetic Retinopathy Working Group, and international diabetic retinopathy experts.

As discussed in the Lancet Global Health Commission on Global Eye Health, screening for diabetic retinopathy depends on close partnership with general medical services to identify people with diabetes. Delivery of diabetic retinopathy screening is being transformed by increasing availability of lower-cost retinal cameras operated by non-specialists, acquiring images for remote grading.

In high-income countries, established diabetic retinopathy screening and treatment programmes deploy technicians to community settings to collect images for remote grading and referral decision. In the UK, for example, the proportion of blindness in the working-age population caused by DR has declined, due to both improved diabetes control and the national DR screening programme (Liew et al., 2014).

Programmes are also being developed in low- and middle-income settings. For example, in India multiple pilot programmes have been developed in the public health system under the Ministry of Health, demonstrating substantial increases in people screened at NCD clinics and community health centres (Murthy et al, 2020). In Sub-Saharan Africa and the Caribbean multiple countries have developed regional or national DR screening programmes following similar patterns of embedding DR service within general NCD clinical services (Poore et al., 2015).

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, behaviour 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 diabetes care and ophthalmic communities is essential to preventing the impending epidemic of vision loss due to diabetic retinopathy.

For the period of 2022-2025, The World Diabetes Foundation (WDF) and IAPB have been collaborating on an ambitious initiative to develop and secure adoption of a target on diabetic retinopathy (DR). Funded by WDF, this three-year project aimed to raise the profile of DR within global health agendas. Through strategic advocacy, regional stakeholder engagement, collaboration with WHO departments, and development of national-level tools and pilots, the project has been able to integrate DR prevention discussions and management into broader diabetes care frameworks. Notable successes from this project has included the DR included in the WHO Global Diabetes Compact, with an IAPB representative joining, the development of the joint policy brief with the International Diabetes Federation, successful Southeast-Asia regional meeting with DR screening targets included and reaffirmed commitment from Commonwealth Ministers.

To support continued advocacy efforts, a range of toolkits developed through the project are now available to empower stakeholders in advancing the DR agenda worldwide.

The IAPB/IDF Policy Brief can be accessed here:
Diabetic Retinopathy: A Call for Global Action – The International Agency for the Prevention of Blindness

 

Click Here to download the Advocacy Presentation & Country level Template.

Click Here to download Papa New Guinea as an exemplary country.

Photo Credits

Rajesh Pandey