Diabetic retinopathy: A growing cause of blindness in Bangladesh

 Lal Miah, a 66-year-old former employee of Sadharan Bima Corporation and a resident of Dhaka's North Badda, is completely blind in his right eye and has only 30% vision in the left. He was diagnosed with diabetes in 2006 and is now suffering from diabetic retinopathy, an eye condition that can cause vision loss and blindness in people with diabetes.

Lal Miah describes his vision in his left eye as "like a light, but I cannot understand what or who I am seeing".

On the morning of 19 October, Lal Miah, who also has heart problems, came to the National Institute of Ophthalmology Hospital to receive laser treatment on his left eye.

"I have been living with diabetes for 17 years, and I had never seen an eye doctor until a month and a half ago. At that time, I consulted an eye doctor at this hospital, who prescribed laser treatment," he told The Business Standard.

Another man named Anwar Hossain, 57, an accountant at a private company in Dhaka, suddenly lost vision in his left eye while working in the office on 18 October.

The next day, he saw a doctor at the National Institute of Ophthalmology, who recommended laser treatment. Anwar has had diabetes since 2008 and underwent laser surgery on his right eye at Bashundhara Eye Hospital and Research Institute in 2020. He also has heart and kidney problems due to his diabetes.

A growing number of people in Bangladesh are going blind, like Lal Mia and Anwar Hossain because of diabetes. In fact, half of the patients who visit the retina department of the National Institute of Ophthalmology each day are suffering from diabetic retinopathy, according to the hospital authorities.

The hospital provides laser treatment to an average of 12 patients every day, but the demand is high, and patients often have to wait one to two months for an appointment.

According to physicians, more than 1.3 crore people in Bangladesh are currently affected by diabetes, which increases the risk of a range of eye diseases. The main cause of blindness associated with diabetes is diabetic retinopathy.

Diabetic retinopathy damages blood vessels in the retina, the light-sensitive tissue at the back of the eye. It commonly affects both eyes and can lead to vision loss if left untreated. Poor blood sugar control, high blood pressure, and high cholesterol increase the risk of developing diabetic retinopathy.

According to Orbis, an organisation dedicated to saving people's sight worldwide, diabetic retinopathy affects an estimated one-third of people with diabetes and is the leading cause of blindness and vision loss in adults between 35 and 50 years old.

According to figures from the International Agency for the Prevention of Blindness (IAPB), around 1.85 million Bangladeshi adults live with diabetic retinopathy.

To reduce the risk of blindness, doctors recommend yearly retinal examinations for all people with diabetes.

Dr Atiqul Haq, a long-term fellow at the National Institute of Ophthalmology, told The Business Standard, "The risk of developing diabetic retinopathy begins 10 years after the diagnosis of diabetes. Early detection and treatment can reduce the risk of blindness."

However, most patients who come to the hospital for laser treatment are already in the advanced stages of the disease. While laser treatment can help to preserve some vision, it cannot completely eliminate the risk of blindness. But it can delay the onset of blindness for several years, he said.

To prevent diabetic retinopathy, patients should have their retinas examined once a year after diabetes diagnosis. Additionally, keeping blood sugar, blood pressure, and cholesterol levels under control can help reduce the risk of developing diabetic retinopathy, Atiqul Haq added.

While there is no specific data on the number of diabetic retinopathy patients in Bangladesh, studies have shown that the number is increasing.

A new study published in January 2023 found that the prevalence of diabetic retinopathy among type 2 diabetes patients in Bangladesh was 18.8%. The study was conducted among 489 type 2 diabetes patients attending the outpatient department of BIHS General Hospital, an enterprise of the Diabetic Association of Bangladesh.

According to the study "Prevalence and factors associated with diabetic retinopathy among type 2 diabetic patients in Bangladesh: A hospital-based cross-sectional study," the prevalence of diabetic retinopathy rose to 40% among patients with a known duration of diabetes of 15 years or more.

Another study, titled "Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living with Diabetes in a Fundus Photograph–Based Diabetic Retinopathy Screening Program in Bangladesh," was conducted over a seven-year period at one diabetic and two eye hospitals in Bangladesh and involved 49,264 patients with diabetes. 

The study, published in November 2019, found that the diabetic retinopathy prevalence rate across all three sites was 33%, with male patients at higher risk of prevalent diabetic retinopathy than female patients across all age groups.

Dr Mohammad Afzal Mahfuzullah, an associate professor in the Department of Ophthalmology at Bangabandhu Sheikh Mujib Medical University, told TBS that diabetic retinopathy is one of the leading causes of blindness in the world. It is a chronic condition that cannot be cured, but it can be managed with regular eye exams and treatment. 

"If diabetic retinopathy is severe, surgery or laser therapy may be necessary, Dr Mahfuzullah said, emphasising the importance of yearly retinal exams for people with diabetes to prevent vision loss.

Bangabandhu Sheikh Mujib Medical University is conducting a nationwide study to determine the prevalence of diabetic retinopathy in Bangladesh. 

Dr Mohammad Afzal Mahfuzullah, a researcher on the study, said that data from several upazilas in Jamalpur, Sherpur, Trangail, Gopalganj, Cox's Bazar and other districts have been collected.

The study aims to understand the prevalence of diabetic retinopathy in the country, identify preventive measures, and develop interventions for those who have already developed the disease, he added.