The Observatory

Growing diabetes epidemic means more people are at risk of blindness

On 7 April—World Health Day—the World Health Organisation (WHO) is shining a light on the rise of diabetes worldwide. While the epidemic is increasing rapidly in low and middle-income countries, Australia is not immune. Approximately 1.7 million Australians currently live with diabetes and this number is expected to increase to 2.45 million by 2030. The WHO projects that diabetes will be the seventh leading cause of death by 2030.

Diabetes can also be a risk factor for other diseases including diabetic retinopathy, which can lead to blindness. Diabetic retinopathy may have no symptoms or cause only mild vision problems, which means it can be overlooked by people living with diabetes and their health specialists. But it is vital that diabetic retinopathy is put back on the agenda of diabetes management. Diabetic retinopathy is already the leading cause of blindness in working-age Australians. People with diabetes are 25 times more likely to experience vision loss than people without diabetes.

Along with the social and emotional costs, diabetic retinopathy also has very real economic costs. In Australia in 2015, the total indirect cost of vision loss associated with Diabetic Macular Oedema (DME), just one form of diabetic retinopathy, was estimated to be $2.07 billion, which corresponds to $28,729 per person with DME.

Like diabetes itself, a large proportion of the cases of blindness caused by diabetic retinopathy are preventable. Managing diabetes with a good diet, regular exercise and an eye exam upon diagnosis and at least every two years afterwards can reduce the risk of vision loss due to diabetic retinopathy.

In an ideal world, GPs and patients would manage diabetes and its associated illnesses through integrated general practice with optometrists, pharmacists and other health professionals. But the current approach to eye examinations for Australians with diabetes is not systematic. According to Medicare data, 80 per cent of Indigenous and 50 per cent of non-Indigenous Australians with diabetes do not have an eye exam at the frequency recommended by the National Health and Medical Research Council.

Aboriginal Elder Aunty Mary is a Bundjalung woman from Taree who knows the importance of education. When we spoke to her in 2014 she was adamant more information needed to be made available to Indigenous communities about how to prevent diabetes and blindness. “The young ones really listen to me. We teach them about healthy eating, why it’s important to look after yourself, and what can happen if you don’t—like what has happened to me.

“We teach them about the different eye conditions and what it’s like to be blind, so they can help anyone in their own family who has low vision.

 “Things are slowly changing—in the schools, they get healthy food to eat now. We have even started the Aunty Mary program, which is about healthy eating and exercise. I’m doing it for our future generations.”

Aunty Mary gradually lost her sight, first in the left eye, then in the right, until she was declared legally blind. This may be because diabetic eye disease is often asymptomatic until it reaches an advanced stage and outcomes of late treatment are usually inferior to early intervention. But evidence shows that early detection and timely treatment can prevent the majority of diabetes-related vision loss. The implementation of systematic programs that include retinal photography in the UK, Iceland, Poland and Sweden has dramatically decreased the incidence of blindness from diabetes.

As access to timely information and resources becomes more important for future populations of Australians with diabetes, Vision 2020 Australia, together with experts from the diabetes, eye health and vision care sectors is proposing the introduction of an innovative approach to prevent blindness from diabetes through systematic early detection, early intervention and e-health optimised coordination.

This proposal forms part of our policy platform which addresses the need to better plan and act, close the gap, improve the integration of care and support, facilitating greater collaboration in our region and building a sustainable future for eye health and vision care beyond 2020. Read our platform here.

Enacting our vision will ensure people with diabetes are put in control of their care, and with regular review and timely treatment we can prevent the majority of diabetes-related blindness.

On World Health Day, it’s more important than ever to realise despite the spread of this insidious illness, with a more systematic approach the majority of diabetes-related blindness can be prevented.

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About the Author

Jennifer Gersbeck

Jennifer Gersbeck is Director of Global Partnerships and Advocacy at The Fred Hollows Foundation, and previously CEO of Vision 2020 Australia. Jennifer has been involved in a wide range of social marketing campaigns aimed at raising awareness, changing behaviour and influencing key decision makers. Jennifer has qualifications in Political Science and Business Marketing, is a graduate of the Australian Institute of Company Directors, and has worked extensively in the health and community services sector.View author's posts
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