Program for Diabetes Eye Care

SEKWA QUALITY ASSURANCE FOR DIAGNOSIS OF DIABETIC EYE DISEASE

Supporting the development of quality clinical services for persons diagnosed with Diabetes will be the major focus of this initiative.  The modality will be the organization of a demand driven quality assurance programs for lower level institutions. This will be primarily undertaken through the MedLink platform supported by the Sekwa Reading Centre to be develop under the auspicees of world’s leading Ophthalmic Fundus Imaging Reading Centre,  Department of Ophthalmology and Visual Sciences, University of Wisconsin- Madison. The immediate main focus of this initiative will be the quality assurance for diagnosis of eye complications of Diabetes.

Diabetic retinopathy is the most common complication of diabetes and a major cause of visual loss. Damage (maculopathy) to the area of the retina used for fine and central vision (the macular area around the fovea) is the most significant problem in people with type 2 diabetes, though classical retinopathy with new vessels and consequent problems is also important.  Interventions to control blood glucose, blood pressure can help to prevent or delay the onset of retinopathy and slow its progression, but most people with retinopathy will be asymptomatic until the damage is advanced.

With the development of imaging and laser technologies improved early detection by regular surveillance is thus essential if people with sight threatening retinopathy are to be identified in time to offer laser treatment to prevent visual loss. New therapies are being developed for retinopathy although current and improved laser photocoagulation and vitrectomy will continue as essential interventions to reduce severe visual loss from focal and diffuse diabetic macular oedema and proliferative diabetic retinopathy.

More recently with the latest progress in imaging technology  [e.g . the modern easy-to-use high-resolution non-interventional non-mydriatic (no dilation of the pupil) digital fundus camera] all Diabetes care providers, including those at the community and general practice  level,  are now in a position to undertake regular exams of the inner eye [retina] and thereby can monitor the development of retinal microvascular abnormalties –  these  abnormalities being  the key markers for the early detection of  the microvascular  complication of Diabetes.

Diabetic Retinopathy (DR) should not be considered simply as an eye problem but is one of the important microvascular complications of Diabetes from the disease management   point of view.

If left undiagnosed and untreated these early signs of diabetic disease will lead to serious late stage organ tissue destruction with ultimate vision loss, renal failure, neorological complications. Unfortunately, in most societies, the clinical implications of the microvascular changes of retina has received little attention by the general diabetes care settings that unil recently lacked appropriate technologies and supporting systems for monitoring diabetes patients.  By incorporating such technology into the community we will be able to detect and monitor the diabetic microvascular complications in the primary care showing to patients the observable evidence of the insults  (i.e., the injuries or damages) of diabetes. Quantitative and qualitative grading scale systems of diabetic retinopathy are now available to be used by a third-party independent service provider and can be integrated into the clinical practice for both ophthalmologists and general practitioners. The crucial issue is that these systems includes fundus photograph reading systems that adhere to a rigid standard and is under a continuous quality control framework.   

With available technologies local healthcare professionals (doctors and nurses) can gain the skills for detecting diabetic eye changes.  By empowering community health workers to detect pathological changes of the eye related to diabetic disease    it is our belief that the community health service will gain in local trust and that both unknown diabetes and  undiagnosed diabetes related disease will be more readily detected. It should also ultimately lead the local population to more readily utilize community services for both detection and management of diabetes and other chronic diseases.