2. Prevalence of Diabetes in Adults (20-79 years), 2015 415 million adults with diabetes worldwide, or 1 in 11 adults

3. 35.8% of cases are undiagnosed in high-income countries, 50% in low / middle income countries. 87-91% of cases are type 2 diabetes Type 2 diabetes factors: Lifestyle, culture, industrialisation, urbanisation, availability & affordability of processed foods, genetics.

5. Impacts of Vision Loss on the Poor Less access to health support services Loss of earning capacity Loss of dependence and dignity Need for greater social support Women and girls suffer most

6. Work: going to work, continued employment in current job Daily necessities: preparing meals, shopping, recognizing faces Fear of total blindness, feeling isolated and helpless, depression Forced to rely on caregivers, guilt More difficult to care for self, increased risk of injury due to falls IMPACT OF VISION LOSS Mitchell J, Bradley C. Health Qual Life Outcomes 2006 Wysong A et al. Arch Ophthalmol 2009 Effects of Vision Loss on a Person Work & social Integration Physical well-being Psychological well-being Lost independance

7. Health Related Quality of Life ComplicationMean Mild stroke 0.70 Diabetic neuropathy 0.66 Angina 0.64 Diabetic nephropathy 0.64 Amputation 0.55 Diabetic retinopathy 0.53 Blindness 0.38 End-stage renal disease 0.35 Major stroke 0.31 Huang S et al. Diabetes Care 2007 0 = death, 1 = life in perfect health

9. Diabetes Eye Health Produced by The Fred Hollows Foundation and the International Diabetes Federation Co-written by a working group of professionals from the diabetes and eye health sectors A practical Guide for health professionals

10. Builds on Existing Diabetic Retinopathy Guidelines Existing DR Guidelines available for eye health professionals Audience for the Guide are those at the frontline caring for people with diabetes Guide highlights right time and right place for eye health interventions provided by a range of healthcare professionals

12. Timing of Eye Screening Type 1 DiabetesType 2 DiabetesGestational Diabetes Initial Five years after diagnosis of diabetes As soon as possible after diagnosis of diabetes Ongoing Every one to two years If diabetes resolves after pregnancy, no further screening needed

13. Screening and photo grading services, Indonesia. Photo: Dwi Ananta, HKI. CC BY-NC 2.0 CEHJ Eye Examination Ideally all people with diabetes should have at least an initial comprehensive eye examination by an eye care professional If this is not possible, then eye screening should be performed consisting of visual acuity test and retinal examination

14. Retinal Examination Non-mydriatic retinal photography Binocular indirect ophthalmoscopy Mydriatic retinal photography Slit-lamp biomicroscopy A photographer working with a mobile clinic team takes fundus images in a rural hospital. Photo: Cristóvão Matsinhe. CC BY-NC 2.0 CEHJ

15. Normal retinaDiabetic retinopathy Macula Fovea Optic Disc Retinal Arterioles Central Retinal Vein Central Retinal Artery Retinal Venules Macula Aneurysm Hard Exudates Hard Exudates Haemorrhages Abnormal growth of blood vessels “Cotton wool” spots Venous beading Haemorrhages “Cotton wool” spots Optic Disc Normal retina Severe non-proliferative diabetic retinopathy with severe diabetic macular edema Source: Singapore Eye Research Institute

16. Grading of Diabetic Retinopathy (DR) No apparent DRNo abnormalities Mild non-proliferative DR Microaneurysms only Moderate non-proliferative DR More than just microaneurysms, less than severe non-proliferative DR No signs of proliferative DR Severe non-proliferative DR Any: Intraretinal haemorrhages Venous beating Intra-retinal microvascular abnormalities Proliferative DR Any: Intraretinal haemorrhages Venous beating Intra-retinal microvascular abnormalities One or more: Neovascularisation Vitreous/pre-retinal haemorrhage

17. Examination of the eye. Mozambique. Photo: Riccardo Gangale/Sightsavers. CC BY-NC 2.0 CEHJ Referral Criteria No problems detected = REGULAR SCREENING DR detected = REFERRAL

18. Ophthalmic Assessment of Diabetic Eye Disease Record of medical history Assessment of visual acuity Slit-lamp biomicroscopy Measurement of intraocular pressure Gonioscopy (in certain cases) Fundus examination

19. Treatment Options Laser photocoagulation Intravitreal anti VEGF Intreavitreal steroids Vitrectomy Ophthalmic staff preparing to see patients, Ethiopia. Photo: Lance Bellers/Sight Savers. CC BY-NC 2.0 CEHJ

20. Post Treatment Support Discuss clinical findings using patient’s own retinal images Communicate eye exam results to other health professionals Provide education and support on controlling blood glucose, blood pressure, and lipid levels

21. Managing Diabetes Social support Nutritional support Medication Medical examinations and treatment

22. Managing Diabetes to Manage Eye Health Communicate need for ongoing eye screening Encourage lifestyle modification Develop individual plans Provide support for ongoing self-management Ensure regular contact with health professionals Ensure access to education programmes, including education on eye health

23. www.idf.org/eyehealth

24. Supported by Supporters had no influence on the scope or the content of this publication