Diabetic retinopathy could become the world’s leading cause of blindness in the future. Thanks to changing diets and lifestyles, diabetes is becoming a global problem.
What is diabetic retinopathy?
Diabetic retinopathy is a diabetes-related complication that affects the back of the eye, and is one of many related eye diseases that threatens vision. When someone has high blood sugar levels, the blood vessels in the retina can become irreversibly damaged.
Diabetic retinopathy commonly occurs in both eyes and starts with no visual symptoms. In the early stages, the walls of the blood vessels in the retina weaken. This can cause fluid and blood to leak into the eye (called the non-proliferative stage), which sometimes results in blurred vision. It can progress, with fragile new blood vessels growing within the retina (now the proliferative stage), which can rupture easily and bleed. This can cause a catastrophic drop in vision.
Early detection of these changes in the blood vessels through an annual eye examination, offers the chance to prevent vision loss. Prevention methods can include treating the retina with LASER (Light Amplification by Stimulated Emission of Radiation), and, where resources permit, the injection of certain medications into the eye.
If left untreated, scar tissue stimulated by the growth of new blood vessels can cause the retina to detach from the back of the eye. This is very serious, because even if treated promptly through highly specialised and expensive surgery, vision may never be completely restored in the affected eye.
Who suffers from it?
Everyone who develops diabetes, over the subsequent five to twenty years, is at risk of developing diabetic retinopathy.
Across the world, changes to diet and an inactive lifestyle contribute to the increasing numbers of people that develop diabetes and its complications. The International Diabetes Federation estimates by 2030, the number of people with diabetes will have increased to 552 million. We know almost half the people that have diabetes are ‘undiagnosed’; that is, they don’t know they have the disease. This is extremely worrying, especially in developing countries, where there’s already limited access to quality heath and eye care. Vision loss from diabetic retinopathy will put a huge strain on already stretched and under-resourced health systems.
Diabetic retinopathy will affect people living in poverty the most – already 80% of people with diabetes live in low and middle income countries.
- The International Diabetes Federation
Can diabetic retinopathy be prevented?
The advancement of retinopathy can be slowed down before it causes vision loss. Progression of the disease depends on a number of factors:
The duration of diabetes: the longer someone has had the disease, the more likely they are to get diabetic retinopathy. Once present, the disease worsens over time.
Blood sugar levels: when control of blood sugar levels is poor, the chances that diabetic retinopathy will develop are high. Once diabetic retinopathy starts, tight control of sugars can slow down progression to vision loss.
Controlling other risk factors: monitoring cholesterol and blood pressure is also important in delaying the progression of diabetic retinopathy. Behavioural change through lifestyle choices – like healthy eating, weight control, regular exercise and quitting smoking – help control these risk factors.
Can it be treated?
People with diabetes should have an eye examination at the time their diabetes is diagnosed. This should be followed by annual comprehensive eye examinations, or, when screening for retinopathy is a part of diabetes care, to have the tests as scheduled. The early detection of sight-threatening diabetic retinopathy is the most important and cost effective way of treating the disease and preventing blindness.
LASER is the most common treatment for diabetic retinopathy, and it’s something The Foundation supports (both in the providing of equipment and training) in Indigenous Australia. LASER stops leaking blood vessels and reduces new vessel growth, helping prevent vision loss. Repeat treatments are usually needed. If the diabetic retinopathy is advanced (known as proliferative retinopathy), laser treatment may not help and the disease will continue to progress. Surgical treatment is an option for complicated cases, where there is a massive bleed or the retina detaches. Surgery can correct structural damage, but once lost, visual function can’t be restored.
How can we fix the problem of diabetic retinopathy?
The good news is, we still have time before the burden of vision loss from diabetic retinopathy becomes critical, so it’s essential we take action. To help bring this issue to the global stage, we’ve partnered with the International Diabetes Federation to raise the profile of diabetic retinopathy as a largely avoidable complication of diabetes. Developing countries will be the hardest hit, so we must put equipment, systems, processes and people in place to cope with the potential burden of vision loss due to diabetes and we must simultaneously make a concerted effort to prevent that loss.
Most people with diabetic retinopathy do not have to go blind, however for early detection and treatment to be successful, regular screening for diabetic retinopathy must be integrated into diabetes care, where timely detection, management and referral of diabetic retinopathy are facilitated. Ensuring all people with diabetes have access to these important health care services requires a new approach in service provision and cross-sectoral collaboration.
We need to make eye health part of the comprehensive care received by every person with diabetes.
We must also encourage people to work with health providers to manage their disease. Primary health workers are at the frontline of providing services to people with diabetes, and this must include screening for and monitoring diabetic eye health, and timely referral to eye specialists for further examination and treatment.
Finally, we have to create awareness about the potential for vision loss and the need for lifestyle changes as a key to prevention.