“Prevention of Blindness”

Is diabetic retinopathy a preventable disease? By Amr ElKamshoushy, MD

Diabetic retinopathy is the leading cause of blindness in industrialized world.

Diabetic retinopathy after 20 years of DM:Diabetic retinopathy after 20 years of DM: Type 1  99% Type 2  60% (WESDR)

After 20 years of DM:After 20 years of DM: Younger onset patients (<30 yrs at diagnosis)  3.6% Legally blind Older onset patients (≥30 yrs at diagnosis)  1.6% Legally blind (WESDR)

Legal blindness attributable to DR: Younger-onset group  86% Older-onset group  33% (WESDR)

Is diabetic retinopathy a preventable disease?

YES

With early detection and timely applied laser treatment we can intervene in the natural course of diabetic retinopathy and prevent % of the vision loss due to diabetes.

HOW?

Through simple yet very important health messages

First Message

“It is mandatory to have a fundus examination of every diabetic patient taken every year with proper referral”

Where?

Screening examination in the office of the GP or the diabetologist where the patient already goes regularly.

Timing of first dilated ophthalmologic examination: First examination Age of onset of diabetes By 5 years after onset Not before puberty 0-30 yrs Once diagnosedOver 30 yrs During first trimesterWhile pregnant Following AAO preferred practice pattern

Recommended follow up schedule: Follow upFindings on first examination Annual None to minimal retinopathy 6-12 m Mild-to-moderate NPDR / no macular edema 4-6 m Mild-to-moderate NPDR / early macular edema 3-4 m Mod-to-severe NPDR Each trimester During pregnancy Consider treatment Very severe NPDR or early PDR Recommend treatment High-risk PDR or CSME Following AAO preferred practice pattern

A fully dilated examination * Sensitivity decreases by 50% if the eyes are undilated. Photography through dilated or (undilated) pupils * Easy – Acceptable – Mobile teams * Offers twice the utilization as a usual referral based system of care. Method of examination:

Second Message

“Prevention of diabetic retinopathy is attainable once the diagnosis of diabetes mellitus is made and intensive treatment instituted”

Diabetes Control and Complication Trial (DCCT) In 9 years, a 76% reduction of diabetic retinopathy progression was found in intensive group compared with the conventional treatment group.

Third Message

“Treat associated hypertension tightly”

United Kingdom Prospective Diabetes Study (UKDPS) After 7.5 years, the group with tight control of hypertension (<105/85 mmHg) showed a 34% reduction in the risk of progression of retinopathy compared to the less tight control group (<180/105 mmHg).

Is it feasible?

Yes it is possible to greatly reduce the incidence of blindness from diabetic retinopathy through: 1.Early detection of DR 2.A tighter control of diabetes 3.A tight control of associated hypertension 4.Patient education and compliance