Diabetic Retinopathy and eliminating blindness in Iceland
by means of screening for diabetic retinopathy, laser, and better diabetic control, Iceland has reduced its blindness from retinopathy to 0.5% (graph error..reduction started 1983 as program begun) enlarge
Iceland has 300,000 population, with 5000 patients, all screened with slitlamp biomicroscopy, with photographs recording findings. In 1980 2.4% of all diabetics were blind from diabetic retinopathy, but many others had reduced sight, and needed laser.
Laser treatment was shown to be effective in 1973, and in 1983 Iceland started its screening program. All diabetics were screened and laser carried out when needed. Over the next 14 years the percent of blindness from retinopathy was reduced to 0.5%. Of these, about 1 in 5 represented patients where everything possible had been done, with really good diabetic contral, 100% attendance, and appropriate laser. The other 4 reperesented patients who were unable to attend clinics etc (this group of patients may have mental health problems etc).
ES showed that 95% of type 1 patients developed retinopathy over 25 years, and 80% of type 2 patients.
Figures for patients becoming diabetic in 2007 will be greatly improved .
ES reported those not attending the screening programs had a much, much, greater risk of blindness from diabetic retinopathy.
- ES reported screening every 2 years, for those without any retinopathy, did not miss a single case of sight-threatening retinopathy.
- As soon as any retinopathy develops, screening was made more frequent
- Most screening programs use a 1 yearly interval...but now all are computerised, screening every 2 years would save many visits.
ES reported that sight-treatening retinopathy affects 50% of type 2 patients, 33% of type 2. This retinopathy is maculopathy or proliferative retinopathy.
Notes .. David Kinshuck .. lecture: Professor Einar Stefansson, Professor of Ophthalmology, Iceland, 2007 ES has been a member of the Iceland team preventing and treating diabetic retinopathy for ~25years. He has published definitive data on diabetic retinopathy. See