Prevention of Blindness and Visual Impairment

Priority eye diseases


Diabetic retinopathy

Definition

Diabetic retinopathy is composed of a characteristic group of lesions found in the retina of individuals having had diabetes mellitus for several years. The abnormalities that characterise diabetic retinopathy occur in predictable progression with minor variations in the order of their appearance. Diabetic retinopathy is considered to be the result of vascular changes in the retinal circulation. In the early stages vascular occlusion and dilations occur. It progresses into a proliferative retinopathy with the growth of new blood vessels. Macular oedema (the thickening of the central part of the retina) can significantly decrease visual acuity.

Magnitude

There are important differences over the past few decades in diagnosis, medical care, socioeconomic factors and other risk factors that influence the prevalence and geographic distribution of diabetes and retinopathy as well. It is estimated that in 2002 diabetic retinopathy accounted for about 5% of world blindness, representing almost 5 million blind. As the incidence of diabetes gradually increases, there is the possibility that more individuals will suffer from eye complications which, if not properly managed, may lead to permanent eye damage.

Prevention and treatment

Risk factors for diabetic retinopathy include duration of diabetes, level of glycemia, presence of high blood pressure, dependence on insulin, pregnancy, levels of selected serum lipids, nutritional and genetic factors. Medical interventions can decrease some of the risk to vision caused by diabetic retinopathy. The control of glycemia decreases the risk of the incidence and the progression of the retinopathy. If sight-threatening retinopathy is present, timely laser photocoagulation of the retina decreases the risk of a subsequent severe visual lesion.

VISION 2020 role

Diabetic retinopathy is on the priority list of eye conditions which can be partly prevented and treated. It is recommended that eye care services for diabetic patients be incorporated into strategic VISION 2020 national plans. In diabetic patients, regular examination of the fundus is essential, followed by appropriate laser treatment if required. Well tested international guidelines for management of diabetic retinopathy should be followed.

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