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ICO Leader Letter

December 2010, Volume 7, Number 12

1. Diabetic Retinopathy–An Emerging Challenge

According to VISION 2020, at least 171 million people worldwide have diabetes, a figure that is likely to more than double by the year 2030. After 15 years of having the disease, about two percent with diabetes become blind, and about 10 percent develop severe visual loss. After 20 years, more than 75 percent of diabetic patients will have some form of diabetic retinopathy (DR), which will compromise their ability to work and live productive lives.

Diabetic retinopathy is now responsible for 4.8 percent of the 40 million cases of blindness due to eye diseases throughout the world (i.e., 1.8 million persons) and diabetic retinopathy is now emerging as one of the fastest growing causes of visual loss.

What more can international ophthalmology do to address diabetic retinopathy? In this issue of the Leader Letter, we share with you approaches being taken in China, India, and Algeria, in the hope it may stimulate ideas and spur efforts to prepare us to address this growing challenge.

What other models and methods are you aware of? How should ophthalmology address diabetic retinopathy? The ICO is interested in hearing from you at info@icoph.org.

– Rubens Belfort, Jr., MD, ICO Director for Communications

2. Screening and Treatment for Diabetic Eye Disease in China

With 40 million diabetics and millions more on the verge of developing the disease, China is now home to more cases of diabetes than any other country in the world. The Peking University Eli Lilly Diabetic Eye Disease Center (PUEC) was established in 2007 to help address the growing diabetes and retinopathy crisis in China.

The Center’s primary purpose is to preserve and restore vision by detecting and treating diabetic retinopathy and other diabetes related eye disease in urban and rural areas of China through a network of provincial eye hospitals. The PUEC strategy encompasses diabetes health education, diabetic eye disease awareness, community eye care services in urban and rural areas, tertiary eye care, and training programs for physicians and health care workers.

The PUEC has created awareness of DR through newspapers, television programs and abundant public education materials. However, China has a population of 1.2 billion with a great variation of social structure, economic status, and educational levels. To treat diabetic retinopathy effectively in such a large, diverse population requires a holistic approach with attention to social structure, economics, education, government advocacy, improved clinical management, and eye care in the rural provinces.

We believe it is only with such a multi-channel approach that we can effectively treat the millions of DR patients in China. For more details and information on the Peking University Eli Lilly Diabetic Eye Disease Center network and how it addresses diabetic eye disease in China, please download: www.icoph.org/downloads/NetworkforDRinChina.pdf (PDF – 33 KB).

–Mark O.M. Tso, MD, DSc, ICO Director for Education

3. Improving DR Management in India

In India, the estimate of people with diabetes currently hovers around 35 million (three percent of the population) and is projected to double by 2030. Like China, there is also a large rural population requiring treatment. Ideally, each one of those affected should be monitored annually and the estimated seven million (20 percent) with diabetic retinopathy would require more involved management.

Recognizing this, the government of India’s national plan to control blindness includes DR as one of the country’s disease priorities (part of the VISION 2020 initiative), with budgetary allocation to allow DR diagnostic and laser treatment facilities at the local district level (areas of two million in population).

In addition, the Indian government is offering a subsidy to private practioners and voluntary organizations to provide free laser treatment to low income patients. The official government document relating to this and other eye care initiatives can be seen at http://npcb.nic.in/writereaddata/mainlinkFile/File99.pdf (PDF – 98 KB).

In the recent years the major non-governmental organizations like Sightsavers, ORBIS, and Lions have made DR a priority in India. Their innovative approaches to DR, along with the strong support of the Indian government and VISION 2020, are laying the foundation for the effective management of DR in India.

– Thulasiraj Ravilla, Executive Director, LAICO – Aravind Eye Care System

4. Lions Foundation SightFirst DR Program in Algeria

Like many other developing countries, Algeria is undergoing a transition in its disease profile. The emergence of non-communicable diseases, such as type II diabetes, which currently affects 4.1 percent of the population (roughly 1.4 million people), is forcing a shift in the healthcare policy towards the prevention and effective management of chronic conditions.

Lions’ interest in diabetes led us to initiate our first diabetic center in Algiers, the success of which impacted the Ministry of Health’s (MOH) decision to expand the diabetic center with the support of the Ministry of Social Affairs and Solidarity (MSAS). Together the two ministries have established similar centers all over the country. These centers offer a comprehensive approach to the disease by providing a wide range of medical services: cardiology, neurology, ophthalmology, nephrology, and psychology.

The MSAS builds and manages the centers, which are staffed by the MOH. This Lions project links diabetes systems through the diabetic centers,” helps integrate eye care into comprehensive diabetes care, provides high-quality eye care services, creates sustainable diabetic retinopathy services, and engages Lions as volunteers and advocates.

For more information on the Lions Clubs Foundation’s position on diabetic retinopathy, see http://lionsclubs.org/EN/common/pdfs/LCIF_diabetic_retinopathy.pdf (PDF – 41 KB).

– Lions Clubs International Foundation

5. How Will We Meet the DR Challenge? Innovation is Key

Diabetic retinopathy is now one of the fastest growing eye diseases, but with timely and appropriate treatment, more than 90 percent of blindness due to diabetic retinopathy (DR) can be prevented.

Some rough calculations based on the expected increase of people with diabetes (to 366 million in 2040), compared to the expected number of ophthalmologists, tells us that soon ophthalmologists will be overloaded with diabetic retinopathy patients alone. To properly address the soaring prevalence of DR, we will need to find new and innovative ways to screen, examine, and treat patients.

One promising approach is development of teams of ophthalmologists, optometrists, allied health personnel and community eye health workers, in ways that meet the specific needs of each local situation. The ultimate goal of such a team approach is to optimize the use of resources and ensure an efficient flow of patients to provide treatment in a timely manner, carefully considering regulatory and epidemiological issues in each location.

Another innovative approach for addressing diabetes and diabetic retinopathy is a "peer to peer approach." Peers for Progress (www.peersforprogress.org) is one such program that supports patients in self-management of diabetes by helping connect them with their peers around the world to provide support for self care.

Embracing new technology to identify and screen patients more efficiently, continuously improving and developing medication, and enhancing training, are also strategies that can and should be utilized if we are going to meet the incredible challenge diabetic retinopathy will present in the coming years.

– Serge Resnikoff, MD, PhD, ICO Director for Advocacy

6. More Resources and Information on Diabetic Retinopathy

• WHO report on diabetes mellitus: www.icoph.org/downloads/WHOPreventionofBlindnessfromDiabetesMellitus.pdf (PDF–401 KB)
• WHO Global report on preventing chronic diseases: www.who.int/topics/chronic_diseases/en
• WHO “global epidemic” of obesity maps: www.icoph.org/downloads/WHOStatisticsObesity.pdf (PDF–1.1 MB)
• International Diabetes Federation: www.idf.org
• Helen Keller International’s diabetic retinopathy programs: www.hki.org/preventing-blindness/other-programs/diabetic-retinopathy-treatment
• Sightsavers study on DR in Pakistan: www.sightsavers.org/in_depth/policy_and_research/health/13182_Diabetic retinopathy study in Pakistan - research.pdf (PDF – 274 KB)
• ORBIS International’s DR programs: www.orbis.org/Default.aspx?cid=5611&lang=1

7. WOC 2012 Abstract Submission Opens, Important Dates

Abstract submission for 2012 World Ophthalmology Congress (WOC), February 16 – 20 in Abu Dhabi, is now available at www.woc2012.org/call_for_papers.html and will be open until June 1, 2011.

Please mark your calendar with these important WOC dates in 2011:

January 25:    List of hotels available
February 1:     Early bird registration for participants and speakers
February 1:     Hotel reservations open
March 1:         Advance program (subjects of symposia) available
March 15:       Early bird deadline for sponsorship and commercial exhibition
June 1:           Abstract submission deadline
July 15:          Notification on abstract submission to first author
July 15:          Invited program completed and speakers informed
September 1: Scientific program schedule and details available (topics and dates)
November 1:  Final program announced

8. Next ICO Meetings and World Ophthalmology Congress

• ICO Board of Trustees: March 17 – 18, 2011, Sydney, Australia
• ICO General Assembly: February 16, 2012, Abu Dhabi, United Arab Emirates
• World Ophthalmology Congress®: February 16 – 20, 2012, Abu Dhabi, United Arab Emirates (www.woc2012.org)

Upcoming ICO Meetings and World Ophthalmology Congresses

Conference for Ophthalmic Educators, Busan, Korea, April 12:
New Techniques to Enhance Teaching and Learning

• Register online to attend: icoph.org/rsvp/Busan

World Ophthalmology Congress Meetings

• WOC2014: Tokyo, Japan, April 2-6, 2014, www.woc2014.org
• WOC2016: Guadalajara, Mexico, February 5–9, 2016
• WOC2018: Barcelona, Spain (provisional selection, dates to be announced)

More News

For more news of the ICO and international ophthalmology and resources for ophthalmologic leaders, see the ICO Web site at www.icoph.org.

Request for Other News and Resources

Do you have other news of international ophthalmology or know resources (particularly on the Web) that would be valuable to ophthalmologic leaders? Please let us know at leader@icoph.org.

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