OUT OF SIGHT

The Rise and Rise of Diabetes and the Need for a Nationwide Retinopathy Screening Program

Dr Mohamed DiraniHealth Services and Evaluative Research Centre for Eye Research Australia

Presentation Outline

1. Diabetes and its Complications

2. The Epidemic of Diabetes

3. Diabetic Eye Disease (diabetic retinopathy)

A. How common is it?

B. Disease progression

C. The causes and risk factors?

D. Indigenous community

E. Current Treatment

F. Prevention

4. Future Challenges and Take Home Messages

Diabetes and its Complications?

• Diabetes is a common chronic disease

• There are 2 main types of diabetes • Type 1: Failure of insulin production • Type 2: Insulin resistance

• Complications of diabetes • Heart disease, peripheral vascular

disease and stroke• Kidney disease • Neuropathy• Diabetic eye disease – “diabetic

retinopathy”

• Worldwide in 2013• 382 million people were living with diabetes• A further 316 million had impaired glucose tolerance (“pre-diabetes”) • 5.1 million deaths were caused by diabetes

• The number of people with diabetes is expected to rise to almost half a billion (471 million) by 2035

• In Australia in the year 2000 • Approximately 1 million adults had diabetes • The number is expected to double to in excess of 2million in the next ten

years

• It is estimated that up to 50% of people with diabetes have not yet been diagnosed with the disease

The Epidemic of Diabetes

How Common is Diabetic Eye Disease?

• Leading cause of blindness

• 1 in 3 Australians have diabetic retinopathy

• Of those people who have had diabetes for more than 20 years

• almost 100% of those with type 1 diabetes and more than 60% of those with type 2 diabetes will develop diabetic retinopathy

Progression of Diabetic Eye Disease

• Retinopathy can be classified as either: non-proliferative diabetic retinopathy: earlier

in the disease process proliferative diabetic retinopathy: later in the

disease process; characterised by new blood vessel growth and a high risk of vision loss

• The leakage of fluid from blood vessels in the area of the retina responsible for detailed vision ( the macula) is known as diabetic macular oedema • this is the leading cause of vision loss in

diabetes

Progression of Diabetic Eye Disease

moderate NPDR severe NPDR

Diabetic retinopathy may progress to advanced stages without any symptoms

Regular eye tests and timely treatment are essential for people with diabetes

The Causes and Risk Factors

• Complex disease: contributions from genetic and

environmental factors • The single most important risk factor for

retinopathy is suboptimal blood glucose control large studies have shown that careful

blood sugar control can dramatically reduce the risk of retinopathy

• Other important risk factors for retinopathy include high blood pressure high blood cholesterol (lipid) levels Modifiable risk factors – diet and

physical activity

Diabetic Eye Disease in Indigenous Australians

• Indigenous Australians are at least 4 times more likely than non-Indigenous Australians to develop diabetes

• NIEHS: 37.9% of Indigenous Australians reported to have diabetes

• Much higher proportion of sight-threatening diabetic retinopathy, such as macular oedema (10%).

• Progression of disease at earlier stages of diabetes

• Who needs treatment? People with: proliferative retinopathy macular oedema

• Main aim is to reduce the risk of further vision • Treatments

improve control of blood glucose, blood pressure and cholesterol

retinal laser therapy injections into the eye Surgery Combination of treatments

Current Treatment

PREVENTION is key

• Optimise control of: blood glucose blood pressure cholesterol body weight

• Eat a healthy diet that is appropriate for people with diabetes consult your doctor or a dietician

• Regular, moderate physical activity• Almost all cases of sight-threatening

diabetic retinopathy can be prevented!• Have your eyes checked regularly

by an optometrist or ophthalmologist

The need for a Nationwide Diabetic Eye Screening Program

• Up to 50% do not get regular diabetic eye checks

• Diabetes related blindness on the rise• No nation wide screening program in

Australia • Proven screening models overseas,

including Poland, Iceland, France and the UK

• Recent UK reports that diabetic retinopathy is no longer the leading cause of blindness in working age adults

• We are 20 years behind• We need your support to STOP avoidable

blindness

Take Home Messages

• Diabetic retinopathy is a leading cause of vision loss and blindness in Australian adults

• It is on the rise and Australia still has no nationwide retinopathy screening program

• Most vision loss from diabetes is avoidable through:– optimal control of:

• blood glucose• blood pressure• cholesterol levels

– AND regular eye examinations

The establishment of a CRE; develop and implement a diabetic eye screening program

Acknowledgements

• FRIENDS OF CERA

• Novartis Pharmaceuticals

• BakerIDI Heart and Diabetes Institute• Associate Professor Jonathan Shaw• Glen Cormick

• Centre for Eye Research Australia • Professor Jonathan Crowston• Dr Peter van Wijngaarden • Stuart Galbraith • Emily Woodhams