Preventable visual loss and diabetes

Diabetes is one of the leading causes of blindness in the Philippines and in the working age group globally.

Diabetic eye disease has been shown to ultimately affect nearly all individuals with diabetes.

The number of people with diabetes is expected to nearly double in the next 20 years with the greatest increases in developing countries and in the population over 60. This rise in the diabetes population will be associated with an increase in the incidence and prevalence of diabetic complications, including those of the kidney, nerve and, most commonly, the retina.

Diabetic retinopathy ( eye disease) results in visual loss through two main mechanisms, diabetic macular edema and proliferative diabetic retinopathy.

In diabetic macular edema, the small blood vessels of the retina leak fluid into the part of the retina called the macula which is responsible for central and sharp vision. This leakage of fluid commonly results in impaired central vision.

In proliferative diabetic retinopathy, blood vessels in the retina grow where they should not. The newly formed blood vessels are fragile and may break easily or may cause scar tissue formation which results in substantial loss of vision.

However, visual loss from diabetic retinal complications is largely preventable with early detection, careful followup and timely treatment. Early detection is critical since it allows the identification of patients at risk for visual loss and access to appropriate levels of care.

Diabetic retinopathy is readily diagnosed by an appropriate retinal examination which entails dilation of the pupils. Alternatively, retinal imaging has been an established method for determining the presence and severity of diabetic retinopathy for decades.

The eye is unique in that its vasculature, microvasculature and neuronal systems can be visualized directly, enabling noninvasive direct evaluation of biological processes.

The retinal imaging program at St. Luke’s Medical Center-Global City allows the evaluation of diabetic retinal disease through a retinal imaging system that uses specialized cameras and computers to “take a picture” of the back of the eye. This type of digital retinal imaging as part of a comprehensive diabetes program has been shown to increase surveillance and identification rate that leads to the preservation of vision and prevention of visual loss.

The cornerstone of diabetes management and the prevention of diabetes related complications is the control of blood sugar levels and appropriate management of co- existing medical conditions.

However, educational initiatives that focus on increasing patient awareness and partnership with health care providers play an increasingly important role. Educational initiatives regarding diabetic retinal complications may ameliorate unawareness of this serious eye complication that has led to far too many individuals going blind from diabetes.

Preventing visual loss from diabetes needs to be addressed through a multidisciplinary approach that includes the patient and his physicians as partners in a comprehensive diabetes care and education effort.

Diabetic retinopathy is associated with significant personal and socioeconomic burdens, but is a treatable disease with largely preventable long- term visual complications. Firm adherence to the standards of care is an essential and well proven approach to avoid preventable vision loss.

Although physician and patient knowledge of diabetic retinal complications have increased as a result of global informational campaigns, studies have shown that patient awareness regarding appropriate recommendations for care and patient awareness of the presence of retinopathy still remain markedly inadequate. Over 43 percent of patients did not know how frequently they should follow-up with their eye care provider and over 72 percent did not know what eye treatments were available.

Every August, the Philippines celebrates “Sight Saving Month” to promote better awareness for eye health and encourage Filipinos to have their eyes checked. “Fighting Diabetes Blindness” has been designated as one of the priority messages that the Philippine Academy of Ophthalmology and the Vitreoretinal Society of the Philippines would like to promote.

This is particularly poignant in the Philippines and similarly across the Southeast Asian region where approximately 50 percent to as high as 80 percent of patients do not receive the recommended eye care.

Even in urban areas, eye care utilization among diabetes patients remains low and it is estimated that less than 20 percent of patients receive the annual recommended eye examination. Seeing an ophthalmologist experienced in diabetic retinal disease and the use of retinal imaging programs that identify eyes at risk for severe eye disease are critical to ultimately preserve vision from diabetic complications.