Ophthalmology Department Alexandria University

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Prevention of Blindness
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• Is diabetic retinopathy a preventable disease?
• By
• Amr ElKamshoushy, MD

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Diabetic retinopathy is the leading cause of
blindness in industrialized world.
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• Diabetic retinopathy after 20 years of DM
• Type 1 ? 99
• Type 2 ? 60
• (WESDR)

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• After 20 years of DM
• Younger onset patients (lt30 yrs at diagnosis) ?
  3.6 Legally blind
• Older onset patients (30 yrs at diagnosis) ?
  1.6 Legally blind
• (WESDR)

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• Legal blindness attributable to DR
• Younger-onset group ? 86
• Older-onset group ? 33
• (WESDR)

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• Is diabetic retinopathy a preventable disease?

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YES
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• 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.

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HOW?
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• Through simple yet very important health
  messages

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• It is mandatory to have a fundus examination of
  every diabetic patient taken every year with
  proper referral

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Where?
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• Screening examination in the office of the GP
  or the diabetologist where the patient already
  goes regularly.

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Timing of first dilated ophthalmologic
examination
First examination Age of onset of diabetes
By 5 years after onset Not before puberty 0-30 yrs
Once diagnosed Over 30 yrs
During first trimester While pregnant
Following AAO preferred practice pattern
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Recommended follow up schedule
Follow up Findings on first examination
Annual None to minimal retinopathy
6-12 m Mild-to-moderate NPDR / no macular edema
4-6 m Mild-to-moderate NPDR / early macular edema
3-4 m Mod-to-severe NPDR
Each trimester During pregnancy
Consider treatment Very severe NPDR or early PDR
Recommend treatment High-risk PDR or CSME
Following AAO preferred practice pattern
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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.

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• Prevention of diabetic retinopathy is
  attainable once the diagnosis of diabetes
  mellitus is made and intensive treatment
  instituted

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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.

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• Treat associated hypertension tightly

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United Kingdom Prospective Diabetes Study (UKDPS)

• After 7.5 years, the group with tight control
  of hypertension (lt105/85 mmHg) showed a 34
  reduction in the risk of progression of
  retinopathy compared to the less tight control
  group (lt180/105 mmHg).

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Is it feasible?
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The Iceland experience
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• 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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