1. OUT OF SIGHT
The Rise and Rise of Diabetes and the Need for a Nationwide Retinopathy Screening Program
Dr Mohamed Dirani
Health Services and Evaluative Research
Centre for Eye Research Australia

2. Presentation Outline Diabetes and its Complications
The Epidemic of Diabetes
Diabetic Eye Disease (diabetic retinopathy)
How common is it?
Disease progression
The causes and risk factors?
Indigenous community
Current Treatment
Prevention
Future Challenges and Take Home Messages

3. 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”

4. The Epidemic of Diabetes
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

7. 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

8. 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

9. Progression of Diabetic Eye Disease
moderate NPDR
severe NPDR

10. Diabetic retinopathy may progress to advanced stages without any symptoms
Regular eye tests and timely treatment are essential for people with diabetes

11. 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

13. 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

14. Current Treatment 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

15. 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

16. 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

17. 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

18. 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