Diabetic Retinopathy

Diabetic retinopathy is a well-recognized complication of diabetes mellitus. Well-conducted clinical trials have shown that good control of diabetes and hypertension significantly reduces the risk for diabetic retinopathy, and there is evidence from studies spanning more than 30 years that treatment of established retinopathy can reduce the risk for visual loss by more than 90%. Once vision has been lost due to diabetic retinopathy, it usually cannot be restored, although some forms of retinopathy can be treated by complex vitreo-retinal surgery. Screening programmes for detecting diabetic retinopathy at a stage at which treatment can prevent visual loss and health education programmes are the mainstay of prevention of blindness due to diabetic retinopathy. Care for diabetic retinopathy is relatively expensive and requires properly trained eye-care professionals. The decisions made by each country are adapted to their resources, social expectations and available
health-care infrastructure. Effective services for prevention and treatment of diabetic retinopathy can be provided only if adequate medical services for patients with diabetes mellitus are in place.

Current situation
Diabetic retinopathy is responsible for 4.8% of the 37 million cases of blindness due to eye diseases throughout the world (i.e. 1.8 million persons). The proportion of blindness due to diabetic retinopathy ranges from close to 0% in most of Africa, to 3–7% in much of South-East Asia and the Western Pacific, to 15–17% in the wealthier regions of the Americas, Europe and the Western Pacific (6).

At least 171 million people worldwide have diabetes, and this figure is likely to more than double by the year 2030, to 366 million (33). About 50% of persons with diabetes are unaware that they have the condition, although about 2 million deaths every year are attributable to complications of diabetes.After 15 years, about 2% of persons with diabetes become blind, and about 10% develop severe visual loss. After 20 years, more than 75% of patients will have some form of diabetic retinopathy (34).

Overall, the direct health-care costs of diabetes range from 2.5% to 15% of annual health-care budgets, depending on the prevalence of diabetes and the sophistication of the services available. The costs of lost production can be as much as five times the direct health-care cost according to estimates derived from 25 Latin American countries (35, 36). In some countries, persons known to have diabetes are registered, so that screening programmes can be set up or the coverage of existing programmes be improved.

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