Diabetic Retinopathy. Pankaj Vishwakarma Head of Programme Development, Sightsavers, India Regional Office

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1 Diabetic Retinopathy Pankaj Vishwakarma Head of Programme Development, Sightsavers, India Regional Office

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3 Disease Burden: Overall View 20 year ago Diabetic Retinopathy (DR) was17th Cause of Blindness & now its 6th position It affects 170 million persons world wide and 366 m. by 2030 India 31.7m persons have been affected by DR in year 2000 and its set to rise to 79.4 m by % of patients who have Diabetes Mellitus for more than 20 years will have some form of DR 15 to 25 % of diabetic population have DR and every one has the potential to develop it Diabetes Prevalence: Urban: 10 14% & Rural: 4 6 %

4 Strategies for Screening, case finding in community, networking with providers in community

5 DR Services at different levels Primary Level Screening Secondary Level Medical Tertiary level Surgical Detection All levels

6 DR screening BASE HOSPITAL IF KNOWN DIABETIC DR SCREENING IF SUSPECTED FOR DIABETIC DIABETIC SCREENING CAMP (Community Place & Vision Centres) Step 1 Diabetes screening Step 2 Diabetic retinopathy screening Registration Vision test Preliminary eye examination DR screening Counselling

7 Networking Purpose Information dissemination, venues for display of IEC materials, organizational assistance & volunteer staff Partners Rural areas Medical officers, Paramedical personnel, NGO, PHC Staff Teachers & SHG Urban areas Media (Press), Lions / Rotary Clubs, Diabetologist, Medical Associations, General Medical Practitioners, Paramedical Workers, Labs, Industries,

8 Awareness Generation KAP Studies (Knowledge, Attitude & Practice) Training of general physicians to detect / refer patients Seminars for physicians, diabetologist, senior citizens etc. Display of awareness posters at PHC s & other clinics Drug distribution day at PHC Health education programme is community

9 Counselling strategies for diabetic and diabetic retinopathy patients Counseling of Diabetic Patients General Education about Diabetes Effect of diabetes on eye Diet Exercise Counseling of Diabetic Retinopathy Patients General Education about Diabetic Retinopathy How DR affects the eye Symptoms of DR Treatments available Need for follow visits

10 Facilitating treatment of those with sight threatening conditions Two types of DR Non Proliferative and Proliferative Eye Evaluation of DR Recording Patients history Vision Diagnosing DR Fluorescein angiography Laser treatment Vitrectomy

11 Training (HR capacity building) of physicians, technicians, social workers 7 8% of ophthalmologist have been trained in DR in India; some countries have none. Primary level Diabetologists / physicians, technicians and counsellor at Vision Centre Secondary Level General ophthalmologists, nurse, technicians/optometrist, Field Coordinator and Counsellor Tertiary Level Ophthalmologists Medical and Surgical Retina Specialists Ophthalmologists, Medical and Surgical Retina Specialists, Technicians/optometrist, Nurse, Counsellor, Project Manager, Field Coordinator, Administrative Assistant

12 Establishment of infrastructure Level Equipments $ Human Resource $ Primary Secondary Tertiary Low Medium Optimum OP Examined Laser Cost OP Examined $ 7000 HR+Eq related Fix. Cost for Laser $ OP Exam $ 3.4 $ 3 $ 2.5 Laser Procedure $ 35 $ 18 $ 9

13 Follow up, compliance strategies, quality indicators All DR patients should have periodic examination Standardized Clinical protocols Patient flow system Initial exam history Initial physical examination Diagnosis Follow up history Follow up physical examination Patient Education International clinical DR disease severity scale General Management Recommendations

14 India XIth Five year plan Reimbursement for the laser 1000/laser treatment Scope for developing DR clinic in the grant for eye hospitals (Rs. 30,00,000) Development of DR clinics in Government Medical Colleges Special programme for control of Diabetes under NRHM (National Rural Health Mission)

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