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HomeminewsNational Approach to Diabetic Macular Oedema Needed

National Approach to Diabetic Macular Oedema Needed

A co-ordinated national approach to encouraging people with diabetes to have eye checks could reduce the incidence of preventable blindness, help keep people in the workforce and significantly reduce the financial burden being placed on Australia’s economy.

A new Deloitte Access Economics report supported by Macular Disease Foundation Australia and Diabetes Australia identified that the entire indirect financial and wellbeing costs associated with diabetic macular oedema (DME) in 2015 will be AU$2.07 billion – with a large part due to productivity losses (approximately $570 million).1 Per person affected by the disease, that cost amounts to $28,729. The report did not include the cost of hospitalisation and other treatments.

DME is one of the leading causes of blindness for working-age Australians and can prevent people from working at full capacity or, in the worst case, from working at all. It can occur in anyone living with diabetes.2,3
Professor Greg Johnson, CEO of Diabetes Australia, said vision loss associated with diabetes is preventable. “Around 200,000 Australians with diabetes every year – one third or more of people diagnosed with diabetes – are missing out on eye checks that have been recommended by National Medical Health and Research Council Guidelines for 10 years.

He said evidence collected from other countries proves that coordinated screening programs can reduce the incidence of vision loss associated with diabetes. “Diabetic eye disease was the leading cause of vision loss in the UK’s working age population until a screening program was introduced over a decade ago. The numbers have now been significantly reduced,” he said.

“We have a government that tells us we need to work longer, and we have an increasing number of people who are unnecessarily losing their vision, and in doing so, losing their ability to continue in employment.

Numbers Escalating

The report estimates that of more than 1.7 million Australians who currently have diabetes, 72,000 have diabetic macular oedema. By 2030, without effective prevention and treatment, those numbers are predicted to escalate to 2.45 million people with diabetes, of which 103,000 will have DME. Lynne Pezzullo, report author and Lead Partner, Health Economics and Social Policy at Deloitte Access Economics said, “91 per cent of the estimated $624.30 million indirect costs of DME in 2015 is projected to be caused by lower workforce participation, absenteeism and an estimated 218 premature and preventable deaths associated with the condition because of poor vision.“With an anticipated 42 per cent rise in DME prevalence by 2030, if effective prevention and treatment were not in place, and with ongoing demographic ageing, we can expect the effects of this condition on productivity losses to be felt even more strongly in the future,” said Ms. Pezzullo.

Professor Johnson said early intervention was critical. “If we don’t intervene early, if we leave it too late to screen and treat people with vision loss as a result of diabetes, it becomes more expensive and difficult to manage. We end up clogging the hospitals with people who shouldn’t need to be there and those people end up with poorer outcomes.”

Julie Heraghty, CEO of Macular Disease Foundation Australia, said the increasing numbers of people living with diabetes was of major concern, as every person with diabetes is at risk of vision impairment. “Many Australians with diabetes don’t recognise they are at risk of blindness or the importance of maintaining regular eye tests when their risk actually increases over time – even if they are managing their diabetes well. Of concern is that only half undergo the recommended two-yearly eye examination, (or more frequently for some people) even though early detection and timely treatment can prevent vision loss.”

Systems Required

Prof. Greg Johnson said over the coming months a proposal to implement a nationally co-ordinated approach to screen people with diabetes will be released.

“This is not about educating health professionals or people with diabetes, because the information is out there. It’s about building systems. A screening program can’t be coordinated by one sector – by optometrists, or ophthalmologists, by diabetes specialists or GPs, it needs to be co-ordinated across all disciplines, which is what’s happening in screening programs for other diseases.“Australia has the technology to put the required systems in place – we have screening technology and communications technology, such as e-health, and the government is introducing Primary Care Networks in place of Medicare Locals. It is now possible to efficiently share patient records between relevant medical practitioners – it just requires a co-ordinated approach. This is what Diabetes Australia, Macular Disease Foundation and eye health professionals are working to achieve.

“If we could increase the number of people with diabetes having eye checks by 50 per cent, then approximately 4,500 additional people with DME could be identified and potentially receive earlier treatment to prevent disease progression and prevent serious vision loss,”Prof. Johnson said.

*All figures referenced to the Deloitte Access Economics ‘The Economic Impact of Diabetic Macular Oedema in Australia’ are estimates only and are based on modelling conducted by Deloitte Access Economics.
** The report does not address the direct costs of hospitalisation and other treatments.

1. Deloitte Access Economics Pty Ltd, 2015, The Economic Impact of Diabetic Macular Oedema in Australia.
2. Ciulla TA, Amador AG, Zinman B, 2003, Diabetic Retinopathy and Diabetic Macular Edema: Pathophysiology, Screening, and novel Therapies, Diabetes Care 26(9): 2653-64.
3. The Angiogenesis Foundation, 2014, A Patient Guide to Diabetes Macular Edema.