
Diabetes mellitus is a global epidemic that currently affects 366 million people and the number is expected to increase by 54% to 552 million in 2030. Like its damaging effect on heart, kidney, blood vessel, it increases the risk of a range of eye diseases most notably 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. More than 75% of people who have diabetes for more than 20 years will have some form of DR. While DR is not currently the primary cause of avoid-able blindness, it has the capacity to become the leading cause of blindness in the next 20 years and it will affect the poorest people most — already 80% of people with diabetes live in low-middle income countries.
People with DR whose sight is at risk can be treated, most commonly with laser, to prevent visual impairment and blind-ness. 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 blind-ness. 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. 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.
Due to the prolific increase in diabetes, based on current estimates, a minimum of 3 million eyes will need to be evaluated each day by 2030 (35 exams per second). Despite a 54% increase in the diabetes population there will be less than a 2% growth in the number of ophthalmologists by 2030. The limited availability of a trained workforce at all levels limits service quality and reach.
Fortunately, because of the ten to twenty year delay in the onset of DR, we still have a small window of opportunity to put systems, equipment and people in place now to cope with, and wherever possible prevent, the epidemic of DR that is likely to affect the poorest countries a decade or so from now.
Source - The Daily Star

