Compiled by Dr. Mustapha Bature and Dr. Ify Monye
(Being excerpt of podcast interview with Prof. Dennis Nkanga)
Professor Dennis Nkanga is a consultant ophthalmologist and the clinical lead, Diabetes Retinopathy Screening Service at the University of Calabar Teaching Hospital.
Q: Welcome. Diabetes is one of the major health conditions the world is focusing on right now. How big of a problem is it in our environment?
Diabetes is a very big problem. It is estimated that there are about 460 million people with diabetes worldwide and the number is increasing by the day. In Nigeria, the number is also increasing. As at 2014, it was estimated that there were about 6 million people with diabetes in Nigeria. The prevalence varies from the rural communities to the urban centers but the numbers are also increasing. It is expected that in the next 20 years, we will have over 109% increase in these numbers.
And when you consider that diabetes does not just come alone, that there are a lot of associated comorbidities, it’s going to be a big problem. Unlike COVID-19, where somebody can fall ill and recover within a certain period of time, everybody who has diabetes will live with diabetes throughout their lifetime. So that demonstrate the burden of the disease. When you use just the estimate of 6 million, you know that’s more than the population of some states in Nigeria, so we can really have a situation with everybody having diabetes.
Q: Diabetes is a real burden in our society. And diabetes is known to affect almost all organs of the body. In what ways can diabetes affect the eyes?
Diabetes affects every part of the eye. From the eyelid where it can cause recurrent infections like stye, blepharitis; to conjunctivitis; to the cornea, where it causes – loss of sensitivity to the cornea, chronic bacterial infections, issues with contact lens wear and poor wound healing. The iris and pupils are also affected by diabetes via autonomic neuropathy affecting the pupillary reaction. When there is diabetic eye disease, you also have the iris affected. Diabetes is also associated with glaucoma, variable refractive outcomes, and cataracts. People who have diabetes also tend to have early age-related cataracts. It is not uncommon to have very high blood sugar and develop diabetic cataracts.
Diabetes is associated with neuropathy where the nerves that move the eye will be affected, even the optic nerve can be affected. But the big thing that we are looking at in diabetes is what we call Diabetic Retinopathy. Diabetic retinopathy is the commonest cause of vision loss and blindness in the working age group, in many communities. So it’s not just a problem of blindness. It’s also a socio-economic problem. The quality of life of patients who have diabetic retinopathy is also affected when they begin to lose vision. So it’s a major thing, and we all need to do something about it. Because when a patient who has diabetes also loses vision, the quality of life will be affected. Sometimes the life expectancy will be affected. Many of these are young people who may be the sole breadwinners of their families. So the effects of diabetes will be devastating, not just on them, but on their communities.
Q: Oh, that’s a really long list of ways in which diabetes can actually harm the eye. So how can people with diabetes protect their eyes from damage from diabetes?
So when somebody has diabetes, there is a lot the person can do to prevent the development of retinopathy. There are risk factors for the development of diabetic retinopathy. When we understand those risk factors and we work on them, then we can prevent or delay development of retinopathy. Part of it is living an active lifestyle. It has been found that retinopathy is associated with sedentary lifestyle. So if the person maintains strict good diet, which is important for the control of the blood sugar, that would help.
When there are other risk factors, including cigarette smoking and alcohol intake – with these, diabetic retinopathy comes much faster. We encourage patients who have diabetes to completely abstain from alcohol and avoid cigarette smoking. Obesity should also be handled where an appropriate Body Mass Index (BMI) can be determined for the individual, i.e. the Body Mass Index that is appropriate for the person, and we try to stick to that. It’s important that diabetes should be well controlled. Poor control is associated with development of retinopathy. It is also important for the person to have good blood pressure control. A high diastolic blood pressure or systolic blood pressure, are both risk factors for the development of not just retinopathy, but also other organ damage. So it is important for the person who already have diabetes to optimize medical treatment. But more than that, we recommend routine screening for diabetic retinopathy for everyone who has diabetes, because it is very important that diabetic retinopathy be picked up early when it is still asymptomatic, so that treatment will be able to prevent visual loss.
Q: Thank you so much for those tips. With respect to patients with diabetic retinopathy, what are the other things they can still do to prevent themselves from going blind?
Even if you have retinopathy, you don’t have to go blind. The most important thing is not just to get treatment early, but to get adequate treatment and also to stay in a system where you can be monitored within a certain facility. So the ophthalmologists will be able to determine, based on the findings, what to do for the patient. Many patients are treated with lasers, depending on the type of retinopathy. Others are treated with injections and all these kinds of treatments are readily available in Nigeria and in most places. So we can do these – maintain adequate control and get care from physicians. Actually, because of the nature of diabetes – it’s a multi systemic condition- we need a multidisciplinary team to handle the care for diabetes. But this team should be led by the patient himself. The patient should be enlightened, should get to know his or her own condition, so that he knows what to do at every point in time.
Q: Thank you very much Sir for joining us today. It’s been a real pleasure. And thank you for your wonderful insights.
Thank you for having me.
