Diabetes is increasing worldwide. As diabetes becomes more prevalent so do associated complications such as Diabetic Retinopathy. Of 415 million people worldwide living with diabetes in 2015, over one third will develop some form of diabetic retinopathy in their lifetime. Diabetic retinopathy (DR) is a complication of diabetes that can cause visual impairment and blindness.
Diabetes and DR are intrinsically linked with DR affecting an estimated 33% of people with diabetes, of which around 10% have an advanced, vision-threatening form of the disease. DR is currently the leading cause of vision loss in working-age adults and as the global prevalence of diabetes increases, so too will the numbers of people with DR. DR is asymptomatic – you don’t feel anything - until an advanced stage and then it is often too late for effective treatment.
Prevention and early detection of DR are imperative. A comprehensive eye exam which leads to early detection is the most effective way to identify DR and treat it before it results in vision impairment.
If the current trend continues, it is estimated that by the year 2040 the number of people living with diabetes will increase to 642 million or 1 out of 10 adults. The most significant growth in diabetes prevalence will occur in low and middle income countries. This poses a significant risk for the health systems and economies of these countries as they will carry the majority of the disease burden for treating diabetes and its complications. This has the potential to cripple health budgets and stretch health systems.
A comprehensive eye exam which leads to early detection is the most effective way to identify DR and treat it before it results in vision impairment. Most people with DR do not have to go blind, howeverfor early detection and treatment to be successful, regular ongoing screening for DR in people with diabetes must be integrated into comprehensive diabetes care, where timely detection, management and referral of DR are facilitated.
Regular eye screening begins with primary health workers. There are only about 200,000 ophthalmologists worldwide (20 in Rwanda) and it would be impossible for them to undertake all the screening eye examinations required to detect those at risk of vision loss and in need of treatment. Screening for diabetic eye disease should become an integral part of the primarycare of those with diabetes.
In Rwanda, the Fred Hollows Foundation has been investing in modern ophthalmic equipment for the treatment of DR in the Northern and Eastern provinces, where there are specialist ophthalmologists available in the public hospitals. The Laser machine for photocoagulation, specific for the treatment of DR, is now available in both Musanze and Rwamagana Hospitals, beyond those already available in Kigali. The Foundation will continue to help with such equipment as new ophthalmologists finish their training abroad (also supported by The Foundation), and are assigned to the remaining provinces by the Ministry of Health.
Managing diabetes goes a long way to managing diabetic retinopathy. People whose diabetes is not well controlled are more likely to develop complications of the disease, including retinopathy. Diabetes management includes controlling blood pressure, blood glucose and lipid levels, and this can be achieved by encouraging a healthy lifestyle and medication as required. Improved control can slow the progression of eye disease, especially when initiated soon after diabetes is diagnosed.
“Everyone with diabetes is at risk of losing vision and to become blind. Timely treatment can prevent almost all vision loss associated with diabetes and so regular eye exams become essential for all those living with diabetes…” Hugh R. Taylor AC MD, President - International Council of Ophthalmology.
Image 1: graphical representation (if needed for the composition of the page).
Image 2: patient with health worker
Image 3: Dr. John Nkurikiye of the Rwanda International Institute of Ophthalmology examines the eye of a patient.
Image 4: FHF logo to be used.
Image 5: Prof Fred Hollows, 1929 – 1993 (to be used next to the logo)