14 November 2022
“Chirag”, a Public Health Awareness initiative of Grewal Eye Institute, Chandigarh conducted an enlightening program for common people on World Diabetic Day.
The session was led by a panel of eminent Ophthalmologists from Grewal Eye Institute, Chandigarh viz., Dr. Jagat Ram (former Director – PGI), Dr. M R Dogra (former Head of Eye Department), and Dr. SPS Grewal (CEO, GEI). The aim of the program was to provide the general public an overview of diabetes affecting the vision that leads to partial or total blindness. Great emphasis was laid on the significance of regular and detailed fundus examination. First fundus examination should be done when a person is diagnosed with diabetes for the first time.
The session started with a welcome note from Dr. SPS Grewal, the CEO & MD – Grewal Eye Institute, Chandigarh highlighting how awareness about disease can change a patient’s life. After diabetes for 25 years, practically everyone is likely to have diabetic retinopathy. He pointed out that Diabetes is increasing dramatically in India due to longer life span, change in lifestyle and sedentary work. Two types of diabetes are encountered. Type 1 diabetes (juvenile) is uncommon, starts before 30 years of age and requires insulin for treatment and survival. Type 2 diabetes (adult onset) is common, starts after 30 years of age and is managed with lifestyle changes and/or oral drugs/ insulin. Nearly 95% of people with diabetes have type 2 diabetes. Most affected are between 35 and 64 years. Type 1 diabetes is rare but its prevalence is also rising. Diabetic retinopathy, especially in Type 2 diabetes is the leading cause of blindness in the USA and the same is happening in India.
During this session, Dr. Mangat Ram Dogra, Director – Retina Services, Grewal Eye Institute talked on “The Diabetic Scene in India & World” and mentioned that there are estimated 463 million adults worldwide with diabetes, expected to grow to 578 million by 2030. India has nearly 77 million Indians affected by Diabetes as per the latest reports and expected to increase to 134 million by 2045. Diabetic retinopathy affects an estimated one-third of all people with diabetes. One-fifth with diabetes would develop vision threatening diabetic retinopathy (VTDR). There are approximately 3 – 4.5 million patients with VTDR in India. Recent National Diabetes and Diabetic retinopathy Survey by Dr RP Centre (AIIMS) New Delhi reported more than 20% prevalence of diabetes in the districts of Thrissur, North Goa, Kapurthala and Vridhunagar. Prevalence of diabetic retinopathy more than 20% was seen in disticts of Kaddapa, Thrissur and Bilaspur. 90% were never screened for diabetic retinopathy in this survey. Burden of disease is immense with limited infrastructure and manpower avalable in our country.
Dr. Manpreet Brar, Dr. Mansi Sharma and Dr. Sartaj Grewal emphasized that problem with diabetic retinopathy is that no visual symptoms are present in early stages. Treatable stage is usually missed which leads to permanent visual impairment. 50% to 90% are never examined for diabetic retinopathy due to lack of awareness among physicians, ophthalmologists, and patients. Identification of high-risk diabetic retinopathy is missed by general ophthalmologist. Errors in diagnosis increases the risk of visual loss.
Detailed retina examination after putting dilating drops should be norm for every diabetic at a time when diabetes is first diagnosed. This helps in early detection of diabetic retinopathy and timely intervention to preserve good vision. Timely intravitreal anti VEGF /steroids injections with or without laser treatment offer best treatment options and prevent moderate visual loss. Vitreous surgery may be required for advanced cases of diabetic retinopathy to prevent severe visual loss. Delayed detection and presentation of diabetic retinopathy leads to permanent visual impairment or blindness despite undertaking all kinds of treatment.
Dr. Jagat Ram further opined about “Cataract Surgery in Diabetes.” He emphasized to achieve good control of diabetes before cataract surgery. Progression of diabetic retinopathy after cataract surgery is well known. It is a much more complicated procedure. In view of these facts, there is a need for experienced cataract surgeon to perform excellent surgery in these cases. Multifocal intraocular lenses should be avoided in patients with diabetic retinopathy. Always inform the patient of the likely decrease in vision after cataract surgery especially if there is moderate to severe diabetic retinopathy. Treatment of diabetic retinopathy before and after cataract surgery aggressively with anti-VEGF / steroid / laser improves visual outcome and prevents visual loss. Post-op treatment should also be more aggressive and prolonged.
Dr. Sachin Mittal, Diabetologist, talked about diabetes as a chronic disease which involves multiple organs and requires a multi-modal approach with long term strategies. Management of diabetic retinopathy in addition to eye treatment requires comprehensive control of blood sugar levels, normalizing blood pressure, reducing serum lipids, treating proteinuria and anemia.
Dr. S D Mehta, Dermatologist shared his opinion on the effects of diabetes on a patient’s skin.
The talks were interspersed with very interactive question answer session. World Diabetes Day is an opportunity to raise awareness of the severe nature and high diabetic rates, discuss prevention and treatment, and ensure better care and support for patients. Additionally, this day is also a chance to advocate for action at all levels so that steps are taken to control diabetes and its associated effects on different organs especially the vision impairment, access to appropriate treatment, and prevention measures.