Diabetic Retinopathy – silently blinding millions of people world-wide

Nick Kourgialis - Hellen Keller International

GBM roundelIncreased urbanization, the consumption of less-nutritious foods, more sedentary lifestyles and resulting obesity have all contributed to the dramatic rise in the global prevalence of diabetes, particularly in resource-poor countries.

In 2014, approximately 422 million people – or 8.5% of adults world-wide – were living with diabetes, compared to 108 million in 1980 . 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 this disease.

The scale of the problem

Currently, South East Asia and the Western Pacific account for more than half of adults with diabetes world-wide. Efforts to reduce its prevalence and more effectively manage its health consequences are further undermined by the fact that roughly half of all people with diabetes are currently undiagnosed.

Every person living with diabetes is at risk of developing Diabetic Retinopathy (DR). Poorly controlled blood sugars, high blood pressure and high cholesterol increase the likelihood of vision loss due to DR, along with the risk of associated vision disorders such as Cataract or Glaucoma.

DR is the leading cause of vision loss in working-age adults (20 to 65 years) so it has profound economic consequences from lost productivity and the cost of ongoing care. Approximately one in three people living with diabetes have some degree of DR and one in 10 will develop a vision-threatening form of the disease . Over time, poor glycemic control can result in improper growth or blockage of blood vessels that nourish the retina and lead to leakage of blood, fluids and the formation of lipid deposits in the eye. In more advanced forms of DR, new abnormal vessel growth occurs due to reduced oxygen flow caused by damaged or blocked vessels. The resulting retinal scarring, retinal detachment, along with fluid build-up and swelling in the central part of the retina (the macula), lead to impaired vision. Damage to the retina is often irreversible in the later stages of the disease and results in blindness.

The scale of the world-wide Diabetic Retinopathy problem

1. IDF Diabetes Atlas Sixth Edition, International Diabetes Federation, 2013, pg. 12-13
2. WHO Global Report on Diabetes, 2016

The Raw Facts

The Vision Loss Expert Group estimated that in 2015 , some 1.07% of blindness world-wide could be attributed to Diabetic Retinopathy; this is predicted to increase as the global prevalence of diabetes continues to rise. Although early identification and treatment can prevent almost all blindness from DR, people living with diabetes are often unaware that they should have their vision examined annually, are asymptomatic during the early stages of DR, and fail to access timely care. In most resource-poor countries, the clinicians, medical technology and systems of care needed to identify and effectively treat DR are often lacking, so significant investment will be required in order to forestall the inevitable rise in vision loss to DR.

Global prevalence of people with diabetes and Diabetic Retinopathy

Global Prevalence of People with Diabetes and DR

Diabetes prevention and treatment can play a vital role in reducing vision loss from DR. Although more than 75% of people with diabetes will develop some retinopathy after 15 years, recent studies have determined that intensive glucose therapy achieved through diet and/or medication can reduce the onset of Diabetic Retinopathy by 76% and the progression of the disease by 54%.

The most effective Diabetic Retinopathy programmes 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. Increased co-operation between the diabetes care and ophthalmic communities is essential to prevent the impending epidemic of vision loss due to Diabetic Retinopathy.

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 this disease

Diabetic Retinopathy