Diabetic Retinopathy: An Important Cause Of Vision Impairment Among Diabetic

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Pune, 14th November 2021: November 14 is observed as World Diabetes Day. The day was created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to growing concerns about the escalating health threat posed by diabetes.

14 November is the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. Diabetes Mellitus (DM) is a global epidemic.

According to the International Diabetes Federation’s 9th edition of Diabetes Atlas, 463 million adults (1-in-11) were living with diabetes in 2019. The number is expected to rise to 578 million by 2030 and 700 million by 2045. 1 in 2 adults with diabetes remains undiagnosed (232 million). The majority have type 2 diabetes. More than 3 in 4 people with diabetes live in low and middle-income countries.

According to WHO, diabetes is a growing challenge in India with an estimated 8.7% diabetic population in the age group of 20 and 70 years. The rising prevalence of diabetes and other non-communicable diseases is driven by a combination of factors – rapid urbanization, sedentary lifestyles, unhealthy diets, tobacco use, and increasing life expectancy.

As per the National Rapid Assessment of Avoidable Blindness (RAAB) Survey (2015-19), Maharashtra population above 50 years is 1,92,00,000, of which DM is estimated to be 23 lakhs, Diabetic Retinopathy (DR) is around 4 lakhs and sight-threatening diabetic retinopathy (STDR) is estimated around 83,000.

Col Dr Madan Deshpande, Chief Medical Director at PBMA’s HV Desai Eye Hospital, a non – profit working to serve the community says, “Diabetic Retinopathy (DR) is an important cause of visual impairment among persons with diabetes. The risk of DR increases with increasing duration of diabetes and poor control of blood glucose, cholesterol and high blood pressure.”

The other strongly associated disease with diabetes is both microvascular and macrovascular complications, including nephropathy, neuropathy (microvascular), ischemic heart disease, peripheral vascular disease, and cerebrovascular disease (macrovascular), resulting in organ and tissue damage.

In India, Diabetic Retinopathy in the population, aged 50 years and above is 16.9%. This is as per a nationwide survey in 2015 -19 funded by the National Program for Control of Blindness and Visual Impairment of the Government of India and implemented by Dr RP Centre for Ophthalmic Sciences, AIIMS.

This current study also reported a higher prevalence of DR among the urban population than in the rural population (20.7% vs. 15.5%).

According to a (RAAB + DR) survey by the HV Desai Eye Hospital, Pune, findings of which were published in 2018, one in five people aged above 50 are diabetic in the city. In 3,600 people, it was found that over 22 per cent of people in the age group suffered from diabetes and nearly 13 per cent (more than one in 10) had diabetic retinopathy.

“Diabetic Retinopathy cannot be entirely prevented, but the severe stages which are sight-threatening can be reduced by improved control of risk factors. Visual loss can be controlled by early detection and treatment,” says Dr Sucheta Kulkarni, Retina specialist at PBMAs HV Desai Eye Hospital.

Since visual loss may not be present in the earlier stages of retinopathy, regular screening of persons with diabetes is essential to enable early intervention.

“We at HV Desai Eye Hospital have initiated DR screening through a well–equipped ‘Mobile Vision Care Van’ which will provide comprehensive eye screening services at urban slums of Pune, says Dr GV Rao, CEO, PBMAs HV Desai Eye Hospital.

An initiative of INGO Sightsavers, the Amrita Drishti Urban Eye Health Programme was launched in March 2021. The services will include refractive error, DR screening, prescription of spectacles and referral for secondary or tertiary eye care treatment at the base hospital. The project’s aim is to reach out to the poor & marginalised population where eye care services are not available.

Noncompliance for undergoing periodic DR screening as well as recommended eye treatment in diabetic eye patients is high. This was the conclusion of a survey by Pune based PBMAs HV Desai Eye Hospital in 2018 to study patient compliance.

Dr Kuldeep Dole, Medical Director at PBMA’s HV Desai Eye Hospital says that lack of knowledge, cost of intervention and distance of eye care services from the patient residence were the main perceived barriers. The rate of noncompliance for DR screening in this study was found to be (64%) and treatment for DR (56%) matched rates reported in other regions of India and other developing countries.

“A patient might not have any signs of diabetic retinopathy until it becomes serious, warns Dr Rahul Deshpande, Medical Director, PBMA’s HV Desai Eye Hospital.

Some of the common symptoms are:
• Loss of central vision, which is used when you read or drive
• Not being able to see colours
• Blurry vision
• Holes or black spots in your vision
• Floaters, or small spots in your vision caused by bleeding