Social Approach to Diabetic Retinopathy in Nigeria

This essay discusses the social approach to diabetic retinopathy in Nigeria, including its

symptoms, potential complications, and treatments. Diabetic Retinopathy is the damage to blood

vessels in the retina caused by diabetes, the effect of diabetic retinopathy can lead to several

other complications such as eye floaters, blurred vision, challenges with colour differentiation,

and if it is not managed properly it can result into blindness (Agweye et al., 2021). Recently

diabetic retinopathy is known to be one of the major causes of loss of sight especially among

diabetic patients. Although people with diabetic retinopathy may not exhibit early clinical

manifestations, conducting an extensive dilated eye exam every year can assist in detecting the

disorder early and prevent further complications. Preventing diabetic retinopathy is most

efficient when diabetes is controlled and initial symptoms are managed (Assem et al., 2020).

Nigeria is widely considered the diabetes centre in the region, with a diabetic community

estimated to reach 69.9 million by 2025 (Kashim, Newton & Ojo, 2018). Diabetes can begin as

early as 25 years of age in Nigeria. Diabetic retinopathy (DR) occurs in nearly everybody with

type 1 diabetes and in 77% of people with type 2 diabetes who seem to have the ailment for more

than 20 years (Hussain et al., 2020). In 2006, the World Health Organization (WHO) established

recommendations describing DR as "a major cause of early-onset visual impairment and an

increasingly common cause of vision problems in middle-income countries (Assem et al.,

2020)." All around the globe, approximately 1.8 million people are losing their sight each year as

a result of DR. 2% of diabetics who still have the disease for 15 years become blind, and 10%
experience severe vision loss that impairs their capacity to work productively (Bosun-Arije e al.,

2019). The issue is that patients frequently develop symptoms only after the disease has

progressed and become more resistant to treatment. The condition's risk of complications is

highly preventable. If the disorder is diagnosed and treated promptly, that is, before it progresses

to the early proliferative stage, the rate of vision problems decreases from 50percentage points to

5percent after five years (Khair et al., 2020). Not only is it more efficient in terms of trial results,

but it is less costly if forced to treat during the background phase. To make sure that the illness is

detected early, it is critical for patients with diabetes to have their eyes examined once a year. In

both urban and rural populations, inadequate knowledge is very prevalent.

The Barbados eye study BES (1988–1992), which was financially backed by the American

Optometric Association, enrolled 4709 individuals who were identified through a simple random

sample of Barbadian-born citizens aged 40 to 84 years. 84 per cent of respondents participated,

and the changing demographics of BES respondents were very similar to that of the survey

community.

The survey's design and methodology have already been broadly discussed somewhere else.

In summary, the test procedure included a question-and-answer session, various

ocularanthropometric, and pulse rate measurement systems, an ophthalmologic investigation, and

30° colour audio fundus photograph of the disc and choroidal (standard fields 1 and 2 of the

diabetic Retinopathy Study). For 374, or 81 per cent of the respondents, articles of total

glycosylated haemoglobin (GHb) were also obtainable (Khair et al., 2020). A random selection

of lab assessments reproduced well, with an intraclass coefficient of correlation of 0.89.

Individuals with screening test findings, such as intraocular higher pressure than 21 mmHg,

abnormal measurements, or a positive ocular background, as well as a structured 10% sample,

were made a reference for an extensive ophthalmologic examination with dilation. Of the choose

from referred respondents, 93 per cent completed this assessment, which also included

ophthalmoscopy and stereoscopic perforated biomicroscopy with a 78-diopter lens or a three-

mirror lens or both, all conducted by the very same expert ophthalmologist (A.M.S.C.) (Assem et

al., 2020). Diabetes was defined as a self-reported history of medical professional type-2

diabetes and/or GHb levels greater than 10% (i.e., more than 2 standard deviations [SD] above

the population proportion of individuals without the need for a history of diabetes.  The

remaining participants were categorized as indeterminate (i.e., no historical background of

diabetes and GHb respectively 7.1 and 10% or GHb missing) or as having no diabetes (i.e., no

history of diabetes and GHb 7.1 per cent) (Kashim, Newton & Ojo, 2018). Respondents were

further classified into younger-onset (30 years of age) or older onset (30 years) diabetes based on

their age at self-reported diabetes diagnosis. Respondents with the younger onset of diabetes

were taken into account to have Type I diabetes mellitus if they also received medication.

Respondents with a history of Type-II type-2 Diabetes and those recently diagnosed by the

survey (i.e., those with no diabetes history but with elevated GHb) have been included in the

older age group (10 per cent) (Khair et al., 2020). Completely separate data on adults with

diabetes and risk factors associated will be provided. Diabetes prevalence was examined in this

report by age, sex, and race. For initial BES respondents who did not have GHb metrics, the

occurrence was determined solely on the basis of diabetes history. The modification was also

made to the inadequate GHb data for this premature group regarding the age, gender, and race-

specific rates for respondents with GHB.

At the Fundus Photography Reading Center, photos of fields 1 & 2 were evaluated for diabetic

modifications that used an altered version of the modified Early Treatment Diabetic Retinopathy
Study (ETDRS) Airlie House classification. As specified in the ETDRS Handbook of

Techniques, standard fundus photographs were also used to predict the existence of diabetic

modifications. At least two or three microaneurysms, retinal haemorrhages, hard and delicate

secretions, intraretinal microvascular anomalies (IRMA), new vessels within 1 disc diameter

(NVD), and new vessels arising somewhere else were identified (NVE). Other disorders included

clinically relevant macular oedema (CSME), venous inlays, focal shrinking, and venous loops.

Supplemental rating system of pictures of all respondents with diabetic shifts, and also a small

randomly selected of someone without such alteration, provided significant comprehensive

information on CSME, NVD, and NVE. Each image was autonomously evaluated by two

graders, and disagreements were resolved through consensus. When consensus could not be

managed to reach, the final grading was ascertained by a retinal specialist (A.P.S.). Quality

management was established through the recurring assessment of 120 sets of photographs from

60 respondents by two distinct classification workgroups composed of many different grader

pairs. The same set of photographs was used repeatedly all across the study to improve the

consistency in gradings. Reliability and validity analyses revealed considerable overlap for

diabetic modifications between assessment and evaluation teams in both field 1 (kappa, 0.57–

0.81) and field 2 (kappa, 0.62–0.77) (Ezaka et al., 2022). There has been no scientific proof of

grading deflections over time. The photographic gradings were used to evaluate the incidence of

retinopathy in at least one eye. To take full responsibility for inadequate or seriously lacking

images, projections were altered by comparing those with pictorial data to those instead of using

the age–gender-specific rates for those with digital image data. To begin, we showed that the

incidence of all types of retinopathies in the sample population as a whole, irrespectively of

diabetes standing. Second, we found that the prevalence of diabetic retinopathy, abbreviated as
DR. The dispersion of predominance was analysed by age, gender, and other factors such as

CSME, magnitude, age at diagnosis, and history of diabetes. Due to the fact that prolonged

retinopathy classifications necessitate seven photo-graphs, we used a simplified classification

that classified DR into minimal, reasonable, or severe in the affected eye. Reasonable level

retinopathy was defined as the existence of additional or more microaneurysms, solid or hollow

secretions, or haemorrhages in the retina; modest retinopathy was characterised by the presence

of IRMA or venous beading.

Diabetic retinopathy is an optical disease that develops as a result of diabetes, it can arise as a

consequence of much sugar in the blood. Over time, elevated blood sugar levels can cause

severe damage to the body's blood vessels including those in the retina (Bashir, A. A., 2021).

The retina is the layer of tissue that lines the back of the eye, it senses light and transmits

information to the brain via the optic nerve. Sugar can cause the tiny blood vessels that supply

the retina to leak or spill if it obstructs them, the eye could then develop new blood vessels that

are thinner and more prone to spillage or bleeding (Bosun-Arije e al., 2019). If somehow the eye

begins to grow new blood vessels, this is referred to as proliferative diabetic retinopathy; the

initial stage is referred to as non-proliferative diabetic retinopathy. During prolonged periods of

high blood sugar, the eye may absorb fluid, this fluid buildup alters the structure and curve of the

lens, resulting in eye disorders (Ezaka et al., 2022). After a person regains regulation of sugar

levels in the blood, the lens typically returns to its normal shape and sight improves. In Nigeria,

more than two out of every five people with diabetes have some stage of diabetic retinopathy.

Additionally, diabetes raises the risk of generating other eye problems, such as cataracts and

open-angle glaucoma (Hussain et al., 2020).

Typically, diabetic retinopathy does not manifest clinical signs in its initial phases. Symptoms

typically become apparent as the condition progresses (Kashim, Newton & Ojo, 2018).

Typically, diabetic retinopathy affects both eyes. Among the signs and symptoms of this ailment

are the following: hazy vision, colour vision impairment, Eye floaters or transparent spots and

dark strings that float in the visual field of a person and change the direction in which the person

is looking, blotches or spots that obstruct an individual's vision, night vision impairment, a

gloomy or vacant spot in the vision's centre, a complete and unexpected loss of sight (Khair et

al., 2020).

if Diabetic retinopathy is left untreated it can result in a variety of problems. Vitreous

haemorrhage occurs when blood vessels are bleeding in the main jelly that fills the eye Long et

al., 2020). In minor cases, floaters may occur, but more extreme conditions may lead to

blindness due to the vitreous blood blocking light entering the eye. If the retina is not

compromised, vitreous bleeding may resolve spontaneously (Mwangi et al., 2018). Sometimes

diabetic retinopathy may result in a disconnected retina, which occurs when scar tissue manages

to pull the retina apart from the back of the eye (Odigie & Akinlabi, 2022). However, it

manifests as floating spots in the field of vision, bright flashes, and extreme eye problems, if a

separated retina is not treated a person faces a huge risk of total blindness. Glaucoma occurs

when the normal flowrate in the eye becomes closed due to the formation of new blood vessels

the blockage results in an increase in intraocular pressure, raising the risk of damage to the optic

nerve and loss of vision (Onyiaorah, Kizor & Nwosu, 2020). Diabetes is a risk factor in the

development of diabetic retinopathy. Moreover, the risk is increased if the individual: seems to

have blood sugar levels that are out of regulation, has hypertension, has an elevated cholesterol
level, is expecting a child, smoking regularly, and has always had diabetes for an extended

period (Piyasena et al., 2019).

Diabetic retinopathy typically begins without even any observable vision changes. However, an

ophthalmologist, or eye specialist, can diagnose the signs (Samuel, 2018). Diabetes patients must

have an eye test at least once every year or as recommended by their optician. Diagnosis of

diabetic retinopathy can be aided by having a dilated eye exam which is performed by an

optometrist who inserts drops into the patient's eyes, these droplets elongate the pupils, allowing

the physician to examine inside the eye (Steinmetz et al., 2021). They will take photos inside the

eye to detect abnormalities in the blood vessels, optic nerve, or retina, cataracts, shifts in the

intraocular pressure, newly formed blood vessels, retinal abrasion, and fibroblastic tissue (Tan et

al., 2019). These eye drops, combined with the flashing lights of the photos taken can be quite

unpleasant, the eye drops may cause increased intraocular pressure in high-risk individuals.

Fluorescein angiography is performed by an optician who dilates the pupils and injects a pigment

called fluorescein into a vein in the patient's arm (Thirunavukkarasu et al., 2021). They will then

photograph the eyes as the dye reverberates, if the blood vessels are irregular the dye may flow

freely into the retina or discolour them. This test can assist the physician in determining which

blood vessels are leaking fluid, have deteriorated, or have now become Obstructed (Umaefulam,

2019). This knowledge provides more precise insight for laser treatments of any type, it may

occasionally appear to suggest the need for an eye injection of medication. For a few days after

the dye leaves the body, individuals may start noticing they have yellowish skin or dark orange

bodily fluids (Unung et al., 2020).

Optical coherence tomography (OCT) is an imaging techniques technique that produces high-

resolution cross-sectional pictures of the retina, showing its texture and letting optometrists look
for cysts or bulging (Thirunavukkarasu et al., 2021). Oncologists can undertake scans prior to

and following treatment options to determine the treatment's effectiveness. OCT is comparable

to ultrasound screening in that it generates pictures using light instead of sound. Additionally, the

scan can aid in the diagnosis of optic nerve chronic conditions (Steinmetz et al., 2021).

The treatment of diabetic retinopathy is determined by a number of considerations, including the

nature of the condition and its response to standard therapy (Onyiaorah, Kizor & Nwosu, 2020).

In the initial phases, a physician may choose to continuously evaluate the patient's eyes without

meddling, this is referred to as watchful waiting. Sometimes in certain situations, a thorough

dilated eye assessment may be required every 2 to 4 months (Mwangi et al., 2018). Participants

will first need to collaborate with their physician to maintain control of their diabetes, controlling

blood sugar levels effectively can remarkably slow the progression of diabetic retinopathy. In the

majority of cases of sophisticated diabetic retinopathy, the patient will require surgery (Bosun-

Arije e al., 2019).

Scatter laser surgery, or pan-retinal photocoagulation occurs in a doctor’s office or an eye clinic.

A doctor uses focused lasers to reduce blood vessels in the retina and seal the leaks from

abnormal blood vessels (Ezaka et al., 2022). These therapies can either halt or slow blood

breaches and fluid buildup in the eye. Individuals may require more than one session. The doctor

numbs the eye and then uses a special lens to direct a strong beam of light into it (Odigie &

Akinlabi, 2022). The bright light can sting or make you feel uneasy, and it's not uncommon to

experience dizzy spells for the remainder of the day. For a few weeks following treatment, small

spots may show up in the visual field (Onyiaorah, Kizor & Nwosu, 2020). There are some risks

associated with laser treatment, including loss of peripheral vision, colour vision, and night
vision. A patient can discuss the relative benefits and risks of this treatment with their physician

(Hussain et al., 2020).

Certain medications can help simultaneously lowering and blood vessel leakage in the eyes.

Medications may include anti-VEGF agents and corticosteroids (Onyiaorah, Kizor & Nwosu,

2020). The following steps are required by the physician during eye injections: sedating the eye

with a numbing medication, washing the eye to help to prevent infectious diseases, and injecting

the medicine into the eye with a very tiny needle (Thirunavukkarasu et al., 2021). Patients may

require regular injections at first, but typically require infusions less regularly over the moment.

A vitrectomy may be beneficial if a patient has difficulties with the retina or vitreous. This

technique involves extracting a portion of the vitreous from the eye (Odigie & Akinlabi, 2022).

This procedure is conducted in a health centre under general or supervised anaesthesia by a

surgeon. The purpose of this step is to start replacing cloudy vitreous or blood in terms of

improving vision and to assist the doctor in identifying and repairing any supplies of retinal

haemorrhage (Samuel, 2018). Following the removal of the cloudy or bloody vitreous, the

surgeon will replace it with a clear liquid or gas. Over time, the body will absorb the liquid or

gas and replace it with new vitreous. Following surgery, the individual will typically be expected

to wear an eye mask for approximately one day and use eye drops to simultaneously lowering

and prevent contamination (Unung et al., 2020). If the primary care physician inserts a gas

bubble into the eye, the patient must maintain a certain location for a few days or even weeks to

ensure that the bubble remains in the proper location (Steinmetz et al., 2021). Additionally, they

will need to abstain from flying and taking trips at high elevations until the bubble dissipates

(Onyiaorah, Kizor & Nwosu, 2020). Although the surgical procedure does not heal diabetic

retinopathy, it may be used to halt or slow the progression of symptoms. Diabetes is a chronic
condition, and after initial treatment, successive retinal destruction and eye problems may

happen (Bosun-Arije e al., 2019).

Productive blood sugar control will aid in the prevention of diabetic retinopathy. Early detection

of symptoms improves the treatment's efficiency, some other component is high blood pressure

(Agweye et al., 2021). Individuals with diabetes can control their cardiac output in a variety of

ways, including the following: consuming a nutritious and balanced diet, getting regular

exercise, achieving or maintaining healthy body weight, stopping smoking, ameliorating their

alcohol consumption, adhering to any antihypertensive measures recommended by their

physician, and attending regular medical checkups (Mwangi et al., 2018). Diabetic retinopathy is

a condition of the eyes that occurs in people who have diabetes. If left untreated, it can lead to

further complications such as vision loss (Abdulsalam et al., 2018). At least once a year, an

extensive dilated eye exam can help individuals detect the situation early and avoid difficulties.

In conclusion, diabetic retinopathy in Nigeria is a prevalent problem among adults and especially

among patients with diabetes. The high sugar level in the blood is a known factor for initiating

the disease, and it is a major cause of other eye complications such as eye floaters, blurred

vision, challenges with colour differentiation, and if it is not managed properly it can result into

blindness. To mitigate this ailment patient is advised to take regular eye tests and take

medications that will help control the rise of sugar levels in the body, consume a nutritious and

balanced diet, get regular exercise, achieve or maintain healthy body weight, quit smoking,

ameliorating their alcohol consumption, adhering to any antihypertensive measures

recommended by their physician, and attending regular medical checkups. At least once a year a

patient having an extensive dilated eye exam can help him/her detect the situation early and

avoid difficulties.
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