Preventing diabetic blindness: A priority for South Africa

Abstract

The prevalence of diabetes in South Africa is increasing rapidly, and diabetes is a significant cause of blindness. Diabetic complications can induce a cycle of poverty for affected families. Early detection of retinopathy and appropriate management can prevent blindness. Screening for retinopathy using a mobile retinal camera is highly cost-effective, with costs of screening and follow-up treatment being less than the expense of one year of a disability grant. Such a programme is a prime example of a 'best buy' that should be part of the national diabetes care package. has been established in Iceland for over 30 years. In 1980, 2.4% of Iceland's population was legally blind, but by 2005 the prevalence had dropped to 0.5%. [16] Similarly, Israel's prevalence of preventable blindness dropped by half from 33.8/100 000 in 1999 to 16.6/100 000 in 2008.[17] These declines can be attributed to the availability of treatment and preventive measures and illustrate the importance of implementing treatment guidelines for diabetic vision impairment.In sub-Saharan Africa, countries have utilised other alternatives by task-shifting cataract operations from ophthalmologists to nonphysician cataract surgeons (NPCSs). NPCSs in Kenya, Tanzania and Ethiopia, for example, performed over 77 000 operations in 2000 -2004. [18] Results showed no difference between specialised ophthalmologists and NPCSs in respect of the quality of surgeries conducted. [19] Although the use of NPCSs is not widely accepted, they represent a cost-effective alternative solution. Laser treatment for diabetic retinopathy by appropriately trained doctors at secondary level and district hospitals would be a feasible solution to deal with diabetic retinopathy-related blindness in SA. 'Best buys' for policy makersUnder the current economic circumstances, every ZAR must work more effectively, efficiently and equitably. In order for the SA government to discern a 'best buy' among cost-effective options, it needs access to valid, reliable and comparable information on costs and consequences of policy alternatives. International examples do provide useful information, but this must be complemented by local context-specific evidence. Prevention interventions offer particularly good value, as they produce the largest gain. ConclusionThe use of mobile fundus cameras to screen for diabetic vision impairment is a paradigm of an innovative approach to achieve economies of scale to reduce preventable blindness effectively on a national level. The use of mobile fundus cameras would interface well with the screening strategy recommended by the Ophthalmology Society of South Africa. One of the challenges for the evolving NHI is how value for money and affordability can be balanced across competing priorities. This approach is one example of a 'best buy' that could potentially be incorporated in a diabetes care package. Over the past 18 years Candy has worked on developing information resources in the field of public health. The current focus of her work includes monitoring ...

Compliance with local diabetic guidelines at a district hospital in KwaZulu-Natal, South Africa

“…3,7,10 A 2010 survey conducted in Cape Town showed that diabetic retinopathy was responsible for 8% of blindness and 11% of severe visual impairment. 15 Loss of vision in patients with diabetes is disabling as it may impair their ability to selfmonitor blood glucose and administer insulin. In addition, it puts them at greater risk of falling and leads to loss of independence.…”

“…5,7 Early identification of retinopathy and appropriate management has been shown to prevent or slow the progression to visual impairment and blindness. 7,15 Only 13.6% of patients received an annual eye examination. This finding is unexpected as there is an on-site eye clinic with a senior medical officer in ophthalmology.…”

Decreasing the Burden of Type 2 Diabetes in South Africa: The Impact of Taxing Sugar-Sweetened Beverages

“…We estimate that the size of this underestimation is modest, however, as it would be dwarfed by the effects on life-years lost, and to a lesser extent also because the potential loss of quality of life is reduced by the effect of the disability weight for T2DM. With approximately 8 000 new cases of diabetes-related blindness each year [ 10 ] and a disability grant of about R12 120 per blind person per year [ 53 ], the SSB tax may potentially save an additional R97 million (USD 8 million) in T2DM-related costs every year.…”

Outcomes of vitrectomy for advanced diabetic retinopathy at Groote Schuur Hospital, Cape Town, South Africa

“…Digital fundus photography screening is established in many developed countries, and Khan et al [2] have suggested that this is cost-effective in SA. We are pleased to note the recent efforts of Cook and others to highlight and promote screening in SA, [5,6] including quality assurance assessment of the graders of fundus photographs. [7] Unfortunately there are currently virtually no established screening programmes, and patients' systemic control is often poor.…”