South Africa is caught up in the midst of a
diabetic epidemic. There are currently approximately 6.5 million people with
diabetes countrywide. The highest prevalence of diabetes is among the Indian
population in South Africa (11-13%) as this group has a strong genetic
predisposition for diabetes. This is followed by 8-10% in the coloured
community, 5-8% among the black population and 4% among the white population.
The medical complications of diabetes are
related to a number of risk factors, most importantly, blood sugar control and
blood pressure control. In general there is a lack of knowledge as to the
long-term effects of uncontrolled diabetes. The medical complications affect
the eyes, heart, peripheral circulation, nervous system and the kidneys.
cause of blindness
“Diabetic related eye disease is a major
cause of irreversible blindness and is the leading cause of blindness in the
working age group. Recent advances in technology and drug treatments have meant
that ophthalmologists have been able to treat blinding conditions more
effectively than ever before, however prevention is better than cure,” says Dr
Stephen Cook, an ophthalmologist from East London with a special interest in
Countries that have a screening programme
for diabetic retinopathy have shown a decrease over time in the level of sight
threatening diabetic retinopathy (STDR). South Africa has not had a screening
programme until this year.
The Ophthalmological Society of Southern
Africa (OSSA) has developed and implemented a screening system that is designed
to work in South African conditions. The system was developed from insights
gained from the pilot project in the Buffalo City area. The system makes use of
the internet to facilitate a database and patient tracking capability. This
makes the results accessible to healthcare providers wherever the person with
diabetes may choose to go.
Diabetic eye disease has been shown to
correlate with other organ damage and to be predictive of the future risk of
serious events, such as stroke and heart attack. This makes it important for
healthcare providers to have the full picture and know the ‘” score” when
advising their patients.
“The key to the screening system is to
empower the person living with diabetes to know their “score” in the fight
against diabetic disease related eye damage,” says Dr Cook.
He explains that a patient held record has
been developed for the programme that acts as a communication tool to all
parties involved, for example the patient, their family, their GP etc.
The record contains the grading system for
the level of retinopathy: (R) and Maculopathy: (M), with numeric scores
increasing with severity. This makes it really easy to understand. It also
incorporates a risk calculator for future disease. This has been developed by
Prof E. Steffanson from Iceland. This calculator is available at
www.riskafrica.co.za . The patient held record contains all of the definitions
necessary to understand the grading system for diabetic and hypertensive retinopathy.
The “score” and systemic risk provide a
great incentive to modify the lifestyle factors in order to reduce the chance
of eye disease and systemic disease.
Workshops have been held to train
Optometrists, GP’s and Ophthalmologists to use the system. This means that
there are places that you can go to get your score and find out about future
Symptoms of diabetic retinopathy can
or double vision
lights, which can indicate a retinal detachment
veil, cloud, or streaks of red in the field of vision, or dark or floating
spots in one or both eyes, which can indicate bleeding
or blank spots in the field of vision
If you know a person with diabetes, help
them to know their score by downloading the calculator and speaking to their
optometrist, GP or ophthalmologist regarding the results, and how to best
manage their condition to avoid any loss of vision.
For more information or to find an
ophthalmologist near you, go to the OSSA (Ophthalmological Society of South
Africa) website at www.ossa.co.za or call 012 343 8920.