It has been reported in the literature from the developed world that 20 years after the onset of diabetes, nearly all patients with type I diabetes (insulin-dependent) and more than 60% of those with type II diabetes (non-insulin dependent) will have some degree of retinopathy. Studies over the last three decades show a rising prevalence of non-insulin-dependent diabetes, which affects Indians earlier than in the West. Diabetic retinopathy is a leading cause of blindness amongst the working class (<55 years old) in the industrialized countries.
Globally Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years). It is estimated that globally every 10 seconds 2 people develop diabetes and 1 person dies because of diabetes related causes. More than 2.5 million people worldwide are affected by diabetic retinopathy a potential blinding disease.
The emerging scenario in the developing world suggests that diabetes and blindness (due secondary to diabetic retinopathy is becoming a major problem in this part of the world as well. However, many people with diabetic retinopathy remain completely asymptomatic and unaware that their vision is under threat well beyond the optimal stage of treatment. Lack of knowledge concerning the need for screening, especially in the absence of symptoms, is a major barrier to regular screening for many people with diabetics. Issues related to utilization of services also remain a major challenge. A study from south reported that only one fourth of persons identified with moderate to severe retinopathy in a screening program returned for follow-up examination to the hospital within two months.
Unfortunately India houses the highest number of diabetic patients of the world. The National Programme for Control of Blindness would have severe implication with the estimated 57 million [Table - 1] persons with diabetes in by 2025.
Table- 1 Population with Diabetes in India
* Estimates
The challenge posed to the eye care programme in India is under severe threat when one considers that approximately one-fifth to one-third of all persons with diabetes will have retinopathy - there may be approximately 11-20 million persons with diabetic retinopathy by 2025 in India, including approximately 5.7 million people with severe retinopathy who require either laser or surgical intervention to preserve vision. Current treatment modalities are effective in preventing as much as 98% of vision loss and blindness due to severe retinopathy, if treatment is provided at the appropriate time (Namperumalsamy et. al. 2004) However, issues related to utilization of services remain a major challenge. A study reported that only one-fourth of persons identified with moderate to severe retinopathy in a screening program returned for follow-up examinations to the hospital within two months.
Hence in order to shrink the existing blindness burden in ; community eye care programmes should be able to attract and examine all the potential 57 million persons with diabetes. This will require that persons with diabetes are aware of the sight-threatening potential of diabetes and the need for regular eye examinations. Appropriate eye health information, education and communication may encourage people at risk to seek timely and appropriate care. This will require developing a holistic behaviour change approach based on understanding of current knowledge, attitudes and practices in the community.
Diabetic patients require routine eye examinations so that related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by endocrinologists who in turn have to work closely with the ophthalmologist. People with diabetes and their health care providers often do not have access to critical information about the disease, treatment facilities and importance of follow-up check-up etc.
Appropriate eye health education may encourage people at risk to seek timely and appropriate care. Diabetic retinopathy has only recently become a priority of the National Program for Control of Blindness (NPCB). Though Government of India and few INGOs have initiated some diabetic retinopathy control programs with dedicated effort to develop behaviour change communication materials that are regionally, linguistcally and culturally appropriate to increase awareness and knowledge of diabetic eye disease and to encourage actions. Also with the limited available training facilities for ophthalmic services, there has been continuous gap between the knowledge update of ophthalmologists and paramedics for ophthalmic services.
In response to the above, there is need to conceptualize organised efforts to increase public awareness of diabetes and diabetic retinopathy in particular. And to advocate for highlighting the issue among policymakers and service providers.
Jamal Siddiqui
(Project Manager, Micro Insurance Academy)
Reference:
National Eye Health Education Program, November 2004,
Communication Plan: A Diabetic Eye Disease Education Program for People with Diabetes, National Eye Institute, Website: www.nei.nih.gov
IJO, A pilot study on awareness of diabetic retinopathy among non-medical persons in . Year: 2004, Volume: 52, Issue: 3, Page: 247-51http://www.ijo.in/text.asp?2004/52/3/247/14579]
International Diabetes Federation weblink: http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A
Press Release WHO/63, 14th Sep 1998 weblink: http://www.who.int/inf-pr-1998/en/pr98-63.html
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