Blind-siding costs & treatment for diabetic retinopathy


Our eyesight is so precious, that in a recent survey released by Environics, a revealing seven out of ten Canadians would rather lose a limb than lose their eyesight. Yet, for many Canadians, losing their vision through blindness is a fearful, and costly reality.

It is estimated that Canadians spend well over $1 billion annually on blindness treatments and rehabilitation. Canada does lag behind other G8 nations in its funding of research and prevention, and is currently experiencing a significant surge in age-related blindness with one in four Canadians over 75 developing irreversible vision loss.

People with diabetes have a strong chance of developing diabetic retinopathy and should have an annual eye exam to determine any onset, or care for the chronic condition thereof. If diabetic retinopathy is diagnosed early enough, the loss of vision may be prevented or at least delayed.

“We can’t cure it, but we can delay the onset and slow down the progression,” says Dr. Carol Schwartz, Staff Ophthalmologist, Sunnybrook & Women’s Health Sciences Centre. “Diabetic retinopathy is definitely the leading cause of vision loss in younger onset patients, who are working Canadians. You are about 25 times more likely to go blind if you’re diabetic. (It accounts for about 5,000 new cases of blindness per year in the US, or about six per cent of the US population is diabetic.) It is the type 2 diabetes that we are seeing a huge increase in because of the obesity.”

The Canadian Diabetic Association indicates that type 2 diabetes blinds approximately 400 Canadians each and every year. Right now, there are more than two million Canadians who have diabetes and the number is expected to increase dramatically along with Canada’s aging population. Factor into this, that in the year 2000, the World Health Organization (WHO) estimated that over 177 million people have diabetes and by 2025, this figure will reach an epidemic proportion of 300 million. If you have diabetes, then blindness caused by diabetic retinopathy is one of the biggest complications and costs you could be facing.

“You need to be screened for diabetic retinopathy when your diagnosis is made,” adds Dr. Schwartz. “The screening guidelines are that if a patient is a type 2 diabetic, whether on a controlled diet, medication controlled, or insulin dependent, it does make a difference.” Schwartz indicated that even if patients have no symptoms, they should be screened. The frequency of screening will depend on what is seen during the initial examination.

Depending on the initial eye examination, the risk of developing diabetic retinopathy is dependent on how long you’ve had the diabetes for. There are a few other factors, such as blood pressure and cholesterol. “Those factors are all important,” continued Schwartz, ” but the number one factor is the duration of the disease.” A type 2 diabetic who has been diabetic for fifteen years, Schwartz pointed out, has a 75-80 per cent chance of having some evidence of diabetic retinopathy. If no retinopathy is seen at the first screening examination, the ophthalmologist may just recommend a yearly screening.

Schwartz, who receives fifty to sixty patient referrals every week, expressed how improved access to treatment for diabetic retinopathy could prevent many diabetics from losing their eyesight. Most of her referrals are new patients for retinol disease, and almost half are diabetic. “Screening needs to be done as often as is necessary, and it has to be tied into the systemic control of the patient,” concludes Schwartz. “We are hoping that with appropriate screening, timely treatment when necessary, combined with good systemic control of blood sugar, and blood cholesterol, that blindness and diabetes can be prevented.”

Could funds be better spent to preserve the vision of Canadians? In this province of Ontario, with a population of twelve million, there are not even thirty retina specialists in the province. It may take at least four to six months for a patient to get in to see a retina specialist. As most retina specialists are in the southern Ontario corridor, Schwartz adds that seventy per cent of her patients are diabetic and come from as far away as Sault Ste. Marie and Thunder Bay.

To further exacerbate the problem, the recent announcement that the Ontario government will no longer cover routine eye exams as of November 1, 2004 (except for seniors and children) is even more dangerous given the fact that many serious eye conditions prevail during the forties and fifties, at a time when effective treatment can be undertaken. “The results could be disastrous, the cost will be enormous,” said Dr. Judith Parks, president of the Ontario Association of Optometrists. “Many of the most serious diseases do not present with symptoms before the damage is done. You can slow the pace or reduce the damage, but not if you don’t detect them early.”