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“Prevention of Blindness”

“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: Type 1  99% Type 2  60% (WESDR).

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“Prevention of Blindness”

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  1. “Prevention of Blindness”

  2. Is diabetic retinopathy a preventable disease? By AmrElKamshoushy, MD

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

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

  5. 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)

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

  7. Is diabetic retinopathy a preventable disease?

  8. YES

  9. With early detection and timely applied laser treatment we can intervene in the natural course of diabetic retinopathy and prevent 95-98% of the vision loss due to diabetes.

  10. HOW?

  11. Through simple yet very important health messages

  12. First Message

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

  14. Where?

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

  16. Timing of first dilated ophthalmologic examination: Following AAO preferred practice pattern

  17. Recommended follow up schedule: Following AAO preferred practice pattern

  18. Method of examination: • 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.

  19. Second Message

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

  21. 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.

  22. Third Message

  23. “Treat associated hypertension tightly”

  24. 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).

  25. Is it feasible?

  26. The Iceland experience

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

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