Course 3

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10GA_c3 and 12

Diabetic Retinopathy Part 1 – Evidence-based Clinical and Public Health Care

Convenors: Tien Yin Wong and Silvio Mariotti
GOC for Optometrists GOC for Therapeutic Optometrists GOC for Dispensing Opticians

Diabetic retinopathy (DR) is the leading cause of vision impairment worldwide. The epidemiology of diabetes has shown significant increase of the disease and has required a major change in the magnitude of the Diabetes Mellitus (DM) management services, with focus on primary health care level. This has, in turn, stressed the need for a corresponding upgrade in the level and quality of services provided to detect, diagnose and manage diabetic retinopathy, posing significant challenges to the eye care services in most countries. Required interventions span across the health system, involving cooperation between DM and DR care providers, policy makers, financing systems, patient support groups, vision rehabilitation providers. A newly developed tool from WHO has been used across the different regions of the world to assess the current situation and identify the top actions required to improve the access to services for DM and DR.

An emerging trend is the recognition that diabetic macular edema (DME), which affects around 6.8% of the diabetic population, is the major cause of vision loss, particularly with respect to increasing prevalence of type 2 diabetes. There is also a shift in management in DR, with increasing recognition that new intra-ocular therapies such as anti-vascular endothelial growth factor (VEGF) therapy are superior to traditional laser treatment in the management of vision-threatening DR and DME. However, while these new therapies are exciting, there continues to be significant challenges from a public health perspective as many of these therapies are expensive and require significant resources. Furthermore, many patients with DR are unaware of their condition, and many countries do not have well established screening programs. Diabetic eye care guidelines from the International Council of Ophthalmology (ICO) have been developed to prevent blindness from DR, and serve as a resource for eye care providers working in low, middle and resource rich settings of the world.

Over two sessions, this course will cover current concepts in understanding the challenges, barriers and the management of DR. The course will also present the initial results of the assessment as well as the priorities for action in the various countries and discuss the common findings which might require joint and synergistic interventions at local, regional and global level.

Tien Yin WongGlobal Epidemiology and Trends in Diabetic Retinopathy
Silvio Paolo MariottiThe WHO Tool for the Assessment of Diabetic Retinopathy and Diabetes Services
Tien Yin WongEvidence-based Management of Diabetic Retinopathy
Neeru GuptaChallenges and barriers in implementing evidence-based care of DR in Canada and Other Developed Countries
Mahi MuqitChallenges and barriers in implementing care of DR in African and Other Developing Countries
Babar QureshiImplementing the DR guidelines at a district level

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