©Tilganga Institute of Ophthalmology
Advocacy Meaningful and sustainable integration of eye health and diabetes care as well as improved accessibility and affordability of DR services will only become operational if an enabling environment is in place. Advocating for and influencing health policy change and development of adequate plans is critical to ensure that DR is in cross-sectoral responses to diabetes and non-communicable diseases. This includes adequate allocations of funds to eye health within health budgets, adequate planning and training for eye health workforce as part of national health and noncommunicable diseases plans, development and implementation of
Healthcare workers use teleophthalmology to assist in the diagnosis of diabetic retinopathy ©Michael Amendolia
screening by health professionals other than eye health specialists. Treatment for advanced DR typically consists of multiple laser surgeries, eye injections, and increasingly both. However, in low- and middle-income countries lasers are often not available, and injections are prohibitively expensive. Having to return to the specialists for multiple laser sessions and injections and the high costs involved are all barriers to completing treatment. The limited data available suggests that more than a quarter of people who need DR treatment don’t initiate this, and 15 to 20 per cent of those who commence treatment do not complete it. This is problematic because the effectiveness of DR treatment is dependent on the timely initiation and completion of the prescribed treatment course. Innovative approaches are needed to increase the accessibility and affordability of DR treatment, ultimately increasing adherence in low- and middleincome countries. There has been great interest in developing sustained delivery platforms for the drugs that are normally injected in the eyes of people with advanced DR. If successfully developed, these ‘slow release’ drug delivery devices would eliminate the need for patients to travel to eye care specialists multiple times to receive injections. However, these innovations are still in their seminal phase, so patients will continue requiring the current treatment for the foreseeable future.
The Fred Hollows Foundation is using artificial intelligence software to detect diabetic retinopathy
diabetes registries and health information systems that include eye health, and inclusion of DR treatment within essential medicines and technology lists as well as health insurance schemes in countries where it makes sense to do so. For example, The Foundation also played a central role in the development of the first National Diabetic Retinopathy Strategy and Action Plan in Bangladesh, which have now been endorsed by the Government. DR is already a significant public health problem in the Middle East and North Africa, and unfortunately, it’s likely to continue to grow. Tackling this problem will require a coordinated and integrated response by the diabetes, DR, and health sectors, which should include stepping up
evidence-based health promotion efforts, safely shifting DR screening closer to people with diabetes, and promoting take up of and adherence to DR treatment by improving accessibility and affordability of DR care. This cannot happen without creating an enabling environment nor without investment in research and innovation to identify and pilot new approaches to DR care. The Fred Hollows Foundation is an international development organization working to eliminate avoidable blindness in more than 25 countries. Visit: www.hollows.org
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