Diabetic retinopathy, a complication of diabetes, is a leading cause of blindness but many patients do not do enough to control the risk of it developing. Professor Shahina Pardhan is collaborating with healthcare providers around the world to develop programmes that encourage patients to protect their vision.
Close your eyes and imagine that you will never see again. What would you be prepared to do to stop yourself from going blind? It’s a question that Professor Shahina Pardhan, Director of our Vision and Eye Research Institute, frequently asks diabetes patients all over the world.
Diabetes has been described as a 'modern plague' that currently affects 400 million people internationally – a figure set to double by 2030. But many people do not realise that it can also lead to diabetic retinopathy, a condition in which blood vessels in the eye are damaged, and a leading cause of blindness. “Diabetes alone isn’t the problem,” Shahina explains. “The problem is that, uncontrolled, it leads to further complications, including in our eyes.”
“Think about how much you value your vision. You could lose it forever, if you don’t control your diabetes.”
Diabetic patients cannot always control the potential risk of blindness. But they can lower it, both through good management including lifestyle measures like eating a healthy, balanced diet and, crucially, by attending diabetic eye screening appointments. Not all patients, however, realise the importance of this. “Many patients may not even be aware that they have sight-threatening retinopathy, especially if they are seeing well,” Shahina says. “The most effective way to find out is through retinal screening.”
Shahina’s research focuses on closing that awareness gap. It stems from an earlier study, in which she discovered that British Asians, a population with an unusually high risk of diabetes, develop sight-threatening diabetic retinopathy much earlier than white Caucasian patients.
Shahina wanted to know whether this was caused by genetic predisposition, or cultural and lifestyle differences within British Asian communities. To find out, she started to study diabetic retinopathy in countries where these people have their roots – India, Thailand, China and Nepal.
She soon found that regardless of the fundamental causes, people in these countries were simply not doing enough to prevent diabetes-related blindness. “In all these communities, there was a lack of awareness of how important it was to control blood sugar levels,” she says.
As a result, Shahina is now collaborating with health partners in Asia on research projects that examine why patients are not managing the danger of diabetic retinopathy, and how they might be encouraged to do so.
Typically, she begins by asking the patients themselves about what they know, especially in relation to eye care and also how they manage their diabetes, and access to local healthcare. She then works with healthcare providers to develop tailored interventions in their communities.
There is, she says, no one-size-fits-all solution. Depending on where they live, face different obstacles in managing the disease. In Nepal, Shahina has started a training programme for patients, involving videos and workshops that teach them how to manage diabetes and stress the importance of retinal screenings.
Contrastingly, in India and Thailand, patients do not attend screenings even though they may know that diabetes pose a threat to their vision. In India, taking into account cultural barriers, Shahina is working with focus groups and has introduced measures like text message reminders for patients. In Thailand, the challenge is partly linked to local healthcare resourcing, so she is working with healthcare providers to work with five regional centres to improve the uptake of retinopathy screening.
She is also continuing her efforts to address these issues in the UK. Her most recent study, carried out in Peterborough and Cambridge, found that training about diabetes and diabetic retinopathy was not available in any South Asian language, even though many older Asians in the community have difficulty speaking or understanding English. Leaflets in South Asian languages are not useful for those who cannot read or write. She is working with local community groups to rectify this.
“In all these communities, the problem is similar, but the causes can be locally specific,” Shahina adds. “Our research identifies those specific reasons, then develops suitable interventions. But the message is always the same. Think about how much you value your vision. You could lose it forever, if you don’t control your diabetes.”