OUT OF SIGHT

1. OUT OF SIGHT The Rise and Rise of Diabetes and the Need for a Nationwide Retinopathy Screening Program Dr Mohamed Dirani Health Services and Evaluative Research Centre for Eye Research Australia

2. Presentation Outline • Diabetesand its Complications • The Epidemic of Diabetes • Diabetic Eye Disease (diabetic retinopathy) • How common is it? • Disease progression • The causes and risk factors? • Indigenous community • Current Treatment • Prevention • Future Challenges and Take Home Messages

3. Diabetes and its Complications? • Diabetes is a common chronic disease • There are 2 main types of diabetes • Type 1: Failure of insulin production • Type 2: Insulin resistance • Complications of diabetes • Heart disease, peripheral vascular disease and stroke • Kidney disease • Neuropathy • Diabetic eye disease – “diabetic retinopathy”

4. The Epidemic of Diabetes • Worldwide in 2013 • 382 million people were living with diabetes • A further 316 million had impaired glucose tolerance (“pre-diabetes”) • 5.1 million deaths were caused by diabetes • The number of people with diabetes is expected to rise to almost half a billion (471 million) by 2035 • In Australia in the year 2000 • Approximately 1 million adults had diabetes • The number is expected to double to in excess of 2million in the next ten years • It is estimated that up to 50% of people with diabetes have not yet been diagnosed with the disease

7. How Common is Diabetic Eye Disease? • Leading cause of blindness • 1 in 3 Australians have diabetic retinopathy • Of those people who have had diabetes for more than 20 years • almost 100% of those with type 1 diabetes and more than 60% of those with type 2 diabetes will develop diabetic retinopathy

8. Progression of Diabetic Eye Disease • Retinopathy can be classified as either: • non-proliferative diabetic retinopathy: earlier in the disease process • proliferative diabetic retinopathy: later in the disease process; characterised by new blood vessel growth and a high risk of vision loss • The leakage of fluid from blood vessels in the area of the retina responsible for detailed vision ( the macula) is known as diabetic macular oedema • this is the leading cause of vision loss in diabetes

9. Progression of Diabetic Eye Disease severe NPDR moderate NPDR

10. Diabetic retinopathy may progress to advanced stages without any symptoms • Regular eye tests and timely treatment are essential for people with diabetes

11. The Causes and Risk Factors • Complex disease: • contributions from genetic and environmental factors • The single most important risk factor for retinopathy is suboptimal blood glucose control • large studies have shown that careful blood sugar control can dramatically reduce the risk of retinopathy • Other important risk factors for retinopathy include • high blood pressure • high blood cholesterol (lipid) levels • Modifiable risk factors – diet and physical activity

13. Diabetic Eye Disease in Indigenous Australians • Indigenous Australians are at least 4 times more likely than non-Indigenous Australians to develop diabetes • NIEHS: 37.9% of Indigenous Australians reported to have diabetes • Much higher proportion of sight-threatening diabetic retinopathy, such as macular oedema (10%). • Progression of disease at earlier stages of diabetes

14. Current Treatment • Who needs treatment? People with: • proliferative retinopathy • macular oedema • Main aim is to reduce the risk of further vision • Treatments • improve control of blood glucose, blood pressure and cholesterol • retinal laser therapy • injections into the eye • Surgery • Combination of treatments

15. PREVENTION is key • Optimise control of: • blood glucose • blood pressure • cholesterol • body weight • Eat a healthy diet that is appropriate for people with diabetes • consult your doctor or a dietician • Regular, moderate physical activity • Almost all cases of sight-threatening diabetic retinopathy can be prevented! • Have your eyes checked regularly • by an optometrist or ophthalmologist

16. The need for a Nationwide Diabetic Eye Screening Program • Up to 50% do not get regular diabetic eye checks • Diabetes related blindness on the rise • No nation wide screening program in Australia • Proven screening models overseas, including Poland, Iceland, France and the UK • Recent UK reports that diabetic retinopathy is no longer the leading cause of blindness in working age adults • We are 20 years behind • We need your support to STOP avoidable blindness

17. Take Home Messages • Diabetic retinopathy is a leading cause of vision loss and blindness in Australian adults • It is on the rise and Australia still has no nationwide retinopathy screening program • Most vision loss from diabetes is avoidable through: • optimal control of: • blood glucose • blood pressure • cholesterol levels • AND regular eye examinations The establishment of a CRE; develop and implement a diabetic eye screening program

18. Acknowledgements • FRIENDS OF CERA • Novartis Pharmaceuticals • BakerIDI Heart and Diabetes Institute • Associate Professor Jonathan Shaw • Glen Cormick • Centre for Eye Research Australia • Professor Jonathan Crowston • Dr Peter van Wijngaarden • Stuart Galbraith • Emily Woodhams