November marks Diabetes Awareness Month and the Canadian Ophthalmological Society (COS) wants to educate Canadians on one of the various complications that are associated with diabetes, specifically diabetic retinopathy (DR), an eye disease that can lead to vision loss.

According to recent data, the number of adults living with diabetes worldwide is projected to soar to a staggering 642 million by 2040, underscoring the urgent need for improved diagnosis and management of DR.

“If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision,” says Dr. Phil Hooper, president of the Canadian Ophthalmological Society. “Nearly 60 per cent of patients with type 2 diabetes (T2D) in Canada will develop DR within two decades of diagnosis. Therefore, the key to prevention is annual screening for early detection and intervening when necessary.”     

Diabetic retinopathy produces few symptoms until serious complications emerge, which can lead to severe vision loss or even blindness. For this reason, just testing visual acuity during an eye examination does not detect disease. Direct retinal examination by a trained professional, or where this is not possible then systematic evaluation of retinal photographs, is necessary to detect asymptomatic disease when it is most treatable.

To reduce the risk of DR, people with diabetes should regularly take the following actions:

• Keep blood pressure, blood sugar, and cholesterol within the specified target ranges.
• Book a comprehensive eye exam every year, as early detection is the best way to prevent vision loss.
• Follow the specified diabetes regime set by your healthcare team and discuss the barriers that exist to find the best way to take care for yourself.

Diabetic retinopathy is a condition that develops when the blood vessels in the retina become damaged due to diabetes. The different stages and types of diabetic retinopathy include:

• Nonproliferative Diabetic Retinopathy (NPDR): This early stage may lead to retinal swelling, retinal deposits, and minor blood vessel leakage in the retina.
• Macular Edema: This condition refers to the swelling of the macula, the central area of the retina responsible for sharp, detailed vision, due to fluid leakage from retinal blood vessels. It is the most common cause of visual impairment in diabetes.
• Macular Ischemia: Vision blurs as small blood vessels in the retina close, depriving the macula of adequate blood supply to function correctly.
• Proliferative Diabetic Retinopathy: In this severe stage, abnormal blood vessels grow from the surface of the retina, potentially leading to bleeding, vision obstruction, scar tissue formation, and retinal detachment.

The economic burden of diabetes care in Canada is predicted to reach $5 billion by 2025, with $228 million allocated to indirect costs.

To address this challenge, it is imperative to enhance the efficiency of diabetes care and establish patient-centered, comprehensive models for diabetes management.

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The Centre for Ocular Research & Education (CORE) has published a resource collection to promote greater understanding among the global eye care community and their patients. Issue 74 of Contact Lens Update expands on the Tear Film & Ocular Surface Society (TFOS) Lifestyle Reports that were published earlier this year. The issue is available by visiting ContactLensUpdate.com.

“Multiple factors may affect the patient sitting in front of you. The World Health Organization has recognized that eye problems can be a result of our lifestyle choices,” said Lyndon Jones, director of CORE and a member of the TFOS Board of Directors. “The TFOS Lifestyle Workshop was created to address how different aspects of our modern lifestyles can affect the health of the ocular surface. The broad range of reports address topics including the impact of contact lenses, the type of eye makeup they are wearing, to the state of their mental health. Our work to increase practitioner awareness of these issues will improve patients’ lives.”

The TFOS Lifestyle Reports also provides information on digital eye strain and digital device use, and discusses how food, beverages, and elective procedures can affect the integrity of the ocular surface.

Jennifer Craig, professor at the University of Auckland and Chair of the TFOS Lifestyle Workshop, provides an introduction to the reports in the issue’s editorial. Her overview summarizes some of the key clinical findings from the eight topic reports, which span contact lenses, cosmetics, the digital environment, elective medications and procedures, environmental conditions, lifestyle challenges, nutrition, and societal challenges. The summary helps practitioners narrow down important points of discussion that could be affecting the health of their patient’s ocular surface. 

The feature article features a series of eight informative infographics that condense the TFOS findings into an easily accessible visual format. This provides eye care practitioners with a synopsis of the important findings from each report, before they delve into the full details found within the comprehensive reports.

This issue’s clinical insight is a two-page patient handout provides take-home messages from each of the TFOS Lifestyle Reports. This serves as a way for practitioners to open the conversation into how lifestyle impacts our eyes and empowers patients to take a proactive role in managing the health of their ocular surface.

Himal Kandel, a Kornhauser Research Fellow at the Save Sight Institute, The University of Sydney, contributes the conference highlight. First presented as a poster at the Association for Research in Vision and Ophthalmology 2023 annual meeting, his study describes use of an international registry to examine factors that affect the quality of life in people with different types of dry eye disease and corneal neuropathic pain. 

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The Centre for Ocular Research & Education (CORE) has published a series of infographics in 25 diverse languages that encourage responsible contact lens recycling and disposal. The initiative resulted from widespread positive feedback about four English-only versions released earlier this year.

The series is now available for download and use by the global eye care community at https://contactlensupdate.com/2023/10/31/contact-lens-sustainability-infographics/

Languages now include Afrikaans, Arabic, Croatian, Danish, Dutch, English, Finnish, French, German, Greek, Hindi, Indonesian, Italian, Japanese, Malay, Norwegian, Persian, Polish, Portuguese, Russian, Serbian, Slovak, Spanish, Swedish, and Vietnamese. CORE plans to distribute additional languages over the coming months.

The four separate designs are intended for professional and consumer educational purposes, as sustainable practices and programs are becoming more established within the contact lens sector. One infographic helps communicate with wearers about relative impact, putting contact lens-related waste into context with other common products and lifestyle habits. Two others explain the best routes for ideal contact lens disposal, while a fourth reminds wearers not to place their contacts into wastewater systems.

These can be provided to patients directly as printed resources, sent via email or text, or used on social media and practice websites to make consumers aware of available options.

“Several contact lens manufacturers have demonstrated sustainability commitments by preventing waste and inspiring reuse, recycling, recovery, and responsible disposal. Helping patients grasp that they can enjoy their contacts while remaining environmentally responsible is something we should all be reinforcing,” said Daddi Fadel, DOptom, clinical scientist with CORE and the coordinator of the translation initiative.

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