The Challenge of Diabetic Retinopathy Bradley R Straatsma

The Challenge of Diabetic Retinopathy Bradley R. Straatsma MD, JD Jules Stein Eye Institute

Diabetes and Diabetic Retinopathy • Worldwide health problems • China. 92. 4 million diabetics • Saudi Arabia. Diabetes affecting 13. 6% of population Yang et al. 2010 World Health Organization, 2011

Diabetes and Diabetic Retinopathy • United States - 23. 5 million diabetics - 40% of diabetics have retinopathy - Diabetes is the leading cause of new blindness in adults 20 – 74 years of age Hazin et al. 2010

Randomized Clinical Trials • Control of glycemia (A 1 c ≤ 7. 2%), serum lipids and blood pressure prevent onset and retard progression of retinopathy • Treatment of proliferative retinopathy and macular edema decrease vision loss Hazen et al. 2011

ICO Response • Collaborate with WHO and ophthalmology societies • Advocate for National Health Plans that provide adequate care for diabetes and diabetic retinopathy

ICO Response • Support population-based programs that detect and treat diabetic retinopathy regardless of patient ability to pay • Admirable programs at Aravind, Peking University and other institutions Peking University

ICO Response • Encourage use of Internet and personalized medicine to improve care of diabetes and retinopathy • Recognize transformative technology of data processing, data storage and wireless communication

Transformative Technology • Data processing. i. Phone has computer processing power > 1970 s IBM Mainframe • Data storage. Internet is migrating to the “cloud” with thousands of data storage units • Wireless revolution. Enables a billion people to communicate in real time Mills and Ottino, 2012

Transformative Technology • Costs have decreased and Internet access is global • Sub-Saharan Africa population with mobile phone subscriptions 2012 – 42% 2020 – 70% Euromonitor International, 2012

Sight. Book™ • Free application on i. Phone, i. Pad and Mac computer • Provides a secure Internet channel of communication and data for a diabetic patient and designated physicians

Sight. Book™ • Patient - Sends visual acuity test results - Receives Hbg A 1 c, serum lipids and blood pressure reports - Receives fundus photographs - Receives treatment recommendations

Sight. Book™ • Diabetes Physician - Sends Hbg A 1 c, serum lipids and blood pressure reports - Sends treatment recommendations • Ophthalmologist - Sends fundus photos and interpretation - Sends recommendations

Personalized Medicine • Sight. Book™ and similar Internet applications are suitable for a limited but growing number of patients • Personalized medicine increases communication and patient motivation to improve management of diabetes and retinopathy

Summary – ICO Response • Collaborate to form National Health Plans for diabetes and retinopathy • Support population-based programs to detect and treat diabetic retinopathy • Encourage Internet programs and personalized medicine to improve management of diabetes and retinopathy