South Africans at increasing risk of vision loss
With an ever-growing number of South Africans diagnosed with diabetes and an ageing population, loss of vision due to diabetic eye complications and age-related visual conditions is on the rise.
Diabetic retinopathy, a complication of diabetes that damages the blood vessels in the retina at the back of the eye, is the leading cause of vision loss globally,1 while the number of diabetics in South Africa has risen sharply from 1.3-million in 2010 to 4.5-million in 2019, and is expected to reach 6-million in 2030 – 10% of the projected population.2
As the number of people affected by vision loss due to disease, age and other causes including overexposure to damaging light from digital devices is increasing, Retina South Africa and the Ophthalmological Society of South Africa (OSSA) have joined forces to create awareness of vision loss during World Retina Week from 21 to 27 September.
Dr Gerhard Kok, President of the South African Vitreoretinal Society, a sub-society of OSSA, said that about 1.7% of diabetic patients would develop diabetic retinopathy, while improved life expectancy globally meant that worldwide incidence of age-related macular degeneration was expected to reach 288-million in 2040, from 196-million in 2020.3
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in people over 50.3 AMD is also recognised as a Prescribed Minimum Benefit (PMB) condition, which compels South African medical schemes to fund its treatment.
Dr Kok said that the COVID-19 pandemic and lockdowns had been especially difficult for the blind and vision-impaired, particularly because access to eyecare was limited, because of limited mobility during lockdown or fears of visiting doctors and healthcare facilities.
“Many ageing patients with wet age-related macular degeneration need a regular injection into the eye to combat vision loss. Skipping these treatments could lead to serious and irreversible loss of vision. Missing medical treatments could also affect people with diabetes which could lead to serious complications including damage to the retina.
“Limited access to eyecare during lockdown, combined with economic hardship in the aftermath of the lockdown, means that many patients that require routine follow-up and chronic treatments for retinal conditions have not been able to get the necessary, regular care. This will most likely pose challenges in the coming weeks and months for optimising and maintaining visual outcomes in these patients,” he said.
In addition, social distancing is almost impossible for partially sighted and blind people who rely mainly on the sense of touch to compensate for the loss of up to 80% of sensory input that comes from the eyes.
“They hold the elbow of a sighted guide, or use touch for orientation, security, and balance. The loss of this tactile sensory input leads to confusion and isolation.
“We hope that World Retina Week 2020 will contribute to raise awareness for this vulnerable part of our population and that citizens will join hands to help ease their plight. Small acts of kindness go a long way in helping partially sighted or blind people to cope during these challenging times,” Dr Kok said.
During the COVID-19 pandemic, Retina SA has conducted an outreach program to give assistance and advice to the thousands of South Africans losing vision to retinal conditions.
The program has highlighted major problems such as avoidance of doctor visits, as well as the negative impact on health of lockdowns not only causing stress but also making people less mobile, making poor dietary choices and the added risk of increased screen time resulting in overexposure to damaging light from computers, phones, devices and TV screens.
Retina SA fears that the negative impact of this pandemic could have long term and serious effects on both vision and health in the future.
The organisation also found that the bans on alcohol sales “led to the serious and unexpected consequence of desperate individuals drinking hand sanitiser”. The poisonous alcohols in hand sanitiser, such as methanol or isopropyl alcohol, can cause serious damage to the optic nerve, blindness or even death.
Retinal conditions such as AMD, Retinitis Pigmentosa, Stargardt Disease and Usher Syndrome affect thousands of South Africans and are presently incurable. Retina South Africa is appealing to people with vision to assist in the search for treatments for these blinding conditions.
For more information go to: www.retinasa.org.za
1 Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision. 2015;2:17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657234/.
2 International Diabetes Federation Diabetes Atlas. Available from: https://www.diabetesatlas.org/data/en/country/185/za.html.
3 Epidemiology of age-related macular degeneration (AMD): associations with cardiovascular disease phenotypes and lipid factors. Eye and Vision. 2016;3:34.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178091/.