The
Health Ministry has introduced new clinical guidelines for the monitoring of
diabetic retinopathy.
DOES it surprise you to know that the most
common cause of visual loss, including blindness, among working adults in
Malaysia is actually preventable?
And as it is a condition that arises as a
consequence of having another disease, it is actually preventable on two
levels.
The medical condition we are talking about is
diabetic retinopathy, which is one of the leading complications from having
diabetes mellitus, or more commonly known as just diabetes. As a
non-communicable disease, caused by mainly lifestyle factors, diabetes is
preventable by living a healthy lifestyle.
However, as it stands at the moment, the Third
National Health and Morbidity Survey in 2006 estimated that 14.9% of Malaysians
aged 30 and above have diabetes. This means that in a group of around seven
adults, one is likely to be diabetic.
And this number is only expected to increase,
with the International Diabetes Federation predicting that the number of
diabetes patients in Southeast Asia will double by 2025.
If that was not bad enough, the 2007 Diabetic
Eye Registry Malaysia reported that over one third of diabetic patients (36.8%)
have diabetic retinopathy. Of these, 15.6% had sight-threatening retinopathy,
with 9% practically blind already.
Catch it early
Now, there are two important things to bear in
mind concerning diabetic retinopathy.
Firstly, it is an almost inevitable
consequence of having diabetes. The longer you are diabetic, the more likely
you are to develop diabetic retinopathy.
According to the World Health Organisation
(WHO), around half of diabetic patients will have some sort of diabetic
retinopathy after 10 years, while almost all patients with type 1 diabetes
mellitus and over 60% of patients with type 2 diabetes mellitus (the more
common variety) will have some degree of retinopathy after 20 years of having
diabetes.
Secondly, diabetic retinopathy can be reversed
in the early stages of the condition.
However, there are no symptoms during that
early stage, and by the time the patient starts having symptoms of the condition
— like floaters (dark spots that float across your field of vision), blurred
vision, missing areas of vision, and trouble seeing at night — it is already
too late to reverse the damage.
That is why it is essential that diabetic
patients go for regular eye check-ups once they have been diagnosed, so that
any problem with the eyes can be caught at the stage when it is still
reversible.
According to Health director-general Datuk Dr
Hasan Abdul Rahman, “Late presentation with irreversible blindness continues to
be a major challenge in the management of diabetic retinopathy in Malaysia.”
Looking at the numbers from the 2007 Diabetic
Eye Registry, around 70.9% of diabetic patients have never gone for an eye
examination before.
And this is despite the recommendation that
all type 2 diabetes patients (comprising 92% of the entries in the registry)
should get their eyes examined as soon as they are diagnosed.
Bigger and better
Dr Hasan made the statement in conjunction
with the launch of the Clinical Practice Guidelines (CPG) for the Screening of
Diabetic Retinopathy at Hospital Selayang recently.
As can be inferred from its name, the CPG is
the latest and most updated set of guidelines for healthcare professionals on
the best screening procedure for diabetic retinopathy.
As diabetic patients are followed up by
general practitioners and non-eye specialists, it is crucial that these
healthcare professionals are aware of the proper method to monitor for diabetic
retinopathy.
According to Hospital Selayang consultant
ophthalmologist, and head of the committee that put together the CPG, Dr Nor
Fariza Ngah, this edition of the CPG contains far more information than its
predecessor.
“The 1996 CPG was a simple one. Now, we have a
new classification, new scheduling for follow-ups, and it is very
evidence-based, from both local and international resources,” she said.
The contents of this CPG include the risk
factors for diabetic retinopathy; a standardised grading for the severity of
the disease; recommendations on screening methods, including sample fundus
images; the recommended examination and follow-up schedules, including when to
refer to an ophthalmologist; and treatment options.
Also included is a list of the 107 government
clinics that have a fundus camera — the recommended screening tool for diabetic
retinopathy.
A slim booklet of 35 pages, the CPG is aimed
at all frontline healthcare professionals, including nurses, assistant medical
officers, optometrists, general practitioners and family medicine specialists.
Dr Hasan said during his speech: “I ask two
things: number one, to make sure these guidelines are internalised and
institutionalised by all our personnel.”
He added that he expects the CPG to be treated
as a “bible” in the monitoring of diabetic patients for retinopathy.
“Number two, another thing towards
institutionalisation is that we must incorporate this CPG into all our teaching
hospitals; put it into the curriculum,” he said, adding that he is taking the
implementation of the guidelines very seriously.
“There is no point having a guideline if it is
not practised,” he said.
The CPG is also meant for private
practitioners.
Dr Hasan said that doctors in the private
sector can get it for free from the ministry’s Health Technology Assessment
Section in Putrajaya, or download it from the ministry’s website (http://www.moh.gov.my/v/op).
TAN SHIOW CHIN
starhealth@thestar.com.my
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