Ensuring diabetics in Africa have their yearly eye exam should sound like a major challenge given that according to the International Diabetes Federation, at least 78% of diabetics in sub Saharan Africa don’t even know they have diabetes.
Among patients with known diabetes, the percentage that eventually complies with the recommendation for a yearly dilated examination of the retina is very low as studies in countries such as Nigeria and Tanzania have shown.
Combinations of the following and other approaches have shown varying degrees of success in improving access to eye examination:
– Training primary care physicians to perform dilated fundus examination with a direct ophthalmoscope
– Honing indirect ophthalmoscopy skills of general ophthalmologists
– Integrated management of the diabetic patient by a team comprised of an endocrinologist, ophthalmologist, nutritionist, podiatrist etc.
– Offering free eye consultations
– Education about eye diseases by a dedicated nurse counselor in the diabetes clinic
– Availability of laser centres to treat diabetic retinopathy etc.
Because of the lack of ophthalmologists and laser centres, as well as various barriers to access these, when they do exist, some bridging strategies between the communities, where diabetics live and the laser centres are needed.
Upper Hill Medical and Laser Centre (UHEAL) in Nairobi, Kenya has put in place such a strategy, based on the experience of increasing access to cataract surgery in Africa. UHEAL has a 4×4 van, well equipped with eye examination equipment as well as laser equipment to treat vision threatening diabetic retinopathy. Patients with advanced retinopathy are referred to their Nairobi clinic for surgery.
On a regular basis, the UHEAL team, lead by Dr Kibata, a vitreo-retinal surgeon, conducts outreach visits in public health institutions, schools and community centres in three intervention regions. This affords diabetics, who may live far from Nairobi at least one comprehensive eye examination a year as well as laser treatment for diabetic retinopathy, if needed. These visits are also an opportunity for the UHEAL team to create awareness of diabetic retinopathy among primary health care professionals, patients and the general population.
The UHEAL approach and others that have been tested in India may need to be tested and adapted in Central African countries such as Cameroon, Gabon, the Congos, Central African Republic and Chad, which have an acute shortage of ophthalmologists and of laser centres for diabetic retinopathy, but which are projected to see a very significant rise in the number of diabetics by 2030.