New frontiers for screening and follow-up therapy
La Diabetic Retinopathy (DR) is the most common microvascular complication of Diabetes Mellitus (DM) and is the leading cause of non-traumatic working-age blindness in adults aged 20-74.
In April 2016, the NCD Risk Factor Collaboration published in the Lancet the results of the largest epidemiological survey ever conducted on diabetes, based on 751 population studies covering 146 different countries with 4.4 million participants over a period of 34 years (1980-2014). An alarming trend emerged: between 1980 and 2014, the number of diabetics quadrupled from 108 million in 1980 to 422 million in 2014. As for theItaly the growth has been from 2.4 million diabetics in 1980 to 4.3 million of 2014.
In Italy, there is no national register of individuals with DR and no data are available on the prevalence and incidence in diabetic patients of legal blindness (visual residue of no more than 1/20 in the better eye). Epidemiological findings show, however, that RD occurs in about one third of diabetic individuals, and about 2% of patients with diabetes develop a severe form of this complication, including Diabetic Macular Oedema (EMD), which can lead to loss of central vision. Furthermore, the SOI (Italian Ophthalmological Society) and the SID (Italian Diabetology Society) have reported data showing that when DM is diagnosed beyond the age of 30 years, the prevalence of DR varies between 21% in individuals with diabetes that has been present for less than 10 years and 76% in those with more than 20 years since the diagnosis of diabetes: on average, 30-50% of the diabetic population is affected by retinopathy with visual changes of varying severity.
This demonstrates the urgency and importance of promoting activities aimed at early diagnosis and effective control of diabetic disease in order to prevent the development of complications.
In this area, important support could come from the telemedicine. It was in March 2017 that Jama Internal Medicine of the study by American researchers, coordinated by Lauren Daskivich of the Los Angeles County Department of Health Services, which proposes a screening programme of large-scale DR, carried out in primary care and based on telemedicine, to reduce waiting times and improve timeliness of care.
The authors started from the situation in Los Angeles County where more than 200 primary care practices refer patients to 6 optometry clinics and 4 ophthalmology clinics, with waiting times for retinal examinations of up to 8 months. With this in mind, a telehealth programme was organised involving 15 large primary care practices, managed by the Los Angeles County Department of Health Services, in which doctors and professional nurses were trained to take pictures of the ocular fundus, which were then sent and read remotely by optometrists and ophthalmologists. The results were very good: the programme eliminated the need for more than 14,000 face-to-face visits and also increased the volume of diabetic retinopathy screening by 16.3% and reduced waiting times by 89.2%.
Dr. Carmelo Chines
Direttore responsabile
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