Bradley R. Straatsma MD, JDBradley R. Straatsma MD, JDJules Stein Eye InstituteJules Stein Eye Institute
The Challenge of Diabetic The Challenge of Diabetic RetinopathyRetinopathy
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 (A1c ≤ 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. iPhone has computer processing power > 1970s 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
SightBook™
• Free application on iPhone, iPad and Mac computer
• Provides a secure Internet channel of communication and data for a diabetic patient and designated physicians
SightBook™
• Patient- Sends visual acuity test results - Receives Hbg A1c, serum lipids and
blood pressure reports- Receives fundus photographs - Receives treatment
recommendations
SightBook™
• Diabetes Physician - Sends Hbg A1c, serum lipids and blood
pressure reports - Sends treatment recommendations
• Ophthalmologist- Sends fundus photos and
interpretation- Sends recommendations
Personalized Medicine
• SightBook™ 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