The importance of integrating diabetic eye care with diabetes management
Dr Elizabeth Wilkinson
Consultant Ophthalmologist
Clinical Lead, North and East Devon Diabetic Screening Programme
Dr Elizabeth Wilkinson, ex president of the Ophthalmology Section at the Royal Society of Medicine knows that managing diabetes is a complex issue. She is the Clinical Lead for the North and East Devon Diabetic Screening Programme and argues for better integration of diabetic eye care with wider diabetes management.
Despite the tremendous success of the National Diabetic Eye Screening service launched in 2003 (over 2 million people were invited for photographic diabetic eye screening locally during 2016 – All Type 1 and Type 2 diabetics over the age of 12 are eligible) and the emergence of pharmaceutical options in addition to laser treatment, pressures are increasing on the patient, their supporting family, hospital eye services and NHS budgets. All drugs now available are very expensive and cost the NHS at least £1,000 to deliver each time. Patients may need monthly injections and follow ups. The dawn of injectable drugs for retinal disease has had a huge impact on hospital eye services and it’s expensive in both time and money.
So, one of the solutions to this situation might be to recognize that the problem with diabetes is that it is a blood vessel disease, a whole body disease and symptom-free until late and not just an eye disease. Therefore it could be argued that the current pathways for patients with diabetes are focusing too much on the eye disease itself and in addition are not sufficiently integrated. Improvements in Diabetic screening must continue such as including length of diagnosis, type of diabetes, HbA1c (sugar level), blood pressure and blood fats so that the screening service can be optimized to reflect an individual’s risk.
Also Healthcare in the UK actually needs to increase patients’ awareness of the risks and impress on people the importance of bringing about wholesale changes in lifestyle, improving self-management and taking responsibility for their condition among people with diabetes and improve access to integrated diabetic care services.
In other words, prevention of diabetic eye disease is surely a better option than simply monitoring for the progression of eye disease. This should also be placed firmly back into diabetic care where for example foot checks, BMI, blood and urine tests are conducted at the same time as diabetic eye screening which are shown in some trials to reduce the number of appointments for the patient and release GPs to plan other forms of healthcare.
Perhaps we now have good enough evidence that advice from consultant ophthalmologists like Dr Elizabeth Wilkinson to diabetic eye patients regarding the fact that their high blood sugars were affecting the blood vessels at the back of the eyes causing them to leak and bleed and narrow and that images showing where the blood, fluid and fats had leaked into the macula have had a real impact on improving patients’ lifestyles and encouraged them to take greater control of their diabetes thus reducing the risk of further diabetes related complications in the eye.