WHO/Europe is helping countries to prevent vision loss and impairment in people with diabetes. World Diabetes Day, observed on 14 November 2020, marks a week of focus in the WHO European Region on preventing blindness and vision impairment among people with diabetes.
About 64 million people, or about 7% of the population of the Region, have diabetes, and almost a third of them have vision impairment or blindness because of a condition called diabetic retinopathy. Diabetic retinopathy screening can identify patients at higher risk so that early treatment or intervention can be offered.
Across the Region, countries are building and improving their diabetic retinopathy screening programmes, as three case studies illustrate. On 18 November 2020 WHO/Europe will host a webinar for policy-makers, senior clinicians and public health leaders at which a new guide will be launched.
Diabetic retinopathy screening: a short guide is an operational handbook on how to design an effective and systematic diabetic retinopathy screening programme. Diabetic retinopathy is a condition caused by raised blood glucose that damages the blood vessels in the retina and can result in vision impairment and blindness.
This condition is common. A high-quality, equitable and systematic screening service is essential to reach everyone with diabetes before their vision is affected.
“We know that diabetic retinopathy is a leading cause of preventable vision impairment and blindness in the European Region”, said Dr Jill Farrington. “We encourage countries to introduce a new diabetic retinopathy screening programme, or revisit and improve their current approach. Well-planned screening programmes are cost-effective and can save thousands of people with diabetes from vision impairment.”
The situation is currently patchy. Many countries already have a form of eye exams for people with diabetes, but these are often not organized systematically with a screening pathway for everyone with diabetes, and they are not adequately resourced. The most effective screening method involves digital retinal photography, but if this is not affordable, trained and skilled practitioners can screen patients using other methods. Many countries do not even maintain a list or register of people with diabetes, which means some may not be invited for a screening. Sometimes systems are fragmented and there is no established pathway, so even in high-income countries people with diabetes fall through the cracks of the network of family doctors, endocrinology/diabetology, ophthalmology and hospital care, at different levels and localities.
Screening works. It helps detect early changes in the eye, at a stage when treatment can be effective as part of a screening pathway. Preventing and slowing the progression of diabetic retinopathy depends on good diabetes management, including patient education, supporting self-care, and facilitating the control of blood sugar, blood pressure and blood lipids through healthy lifestyles and appropriate treatment. If the retinopathy does progress to an advanced form, treatment can be provided with laser and, if available, intraocular drug injections.
More about the guide:
The guide supports policy-makers, public health leaders and senior clinicians to critically examine their current approach to diabetic retinopathy screening, and challenges them, irrespective of their current position, to take steps to improve their approach and make diabetic retinopathy screening systematic, more effective and ultimately equitable for all people with diabetes.
The guide covers principles and essential background information on screening, designing an effective screening programme, developing an improvement strategy, resources and infrastructure and designing a model, strengthening the pathway, operating a high-quality programme, addressing equity of access, managing the change process and identifying those who should be screened. It answers questions on issues ranging from diagnosis, who should be screened, which tests to use, what staff can conduct them, what protocols to follow, where the screening should be performed and what technology to use, to governance, financing, follow-up, and reporting. It also provides common country scenarios and specific examples of good practice.