According to the report by the World Health Organization (WHO), diabetic retinopathy is the result of long-term accumulated damage caused by diabetes mellitus to the small blood vessels of the retina, and is one of the major causes of blindness and visual impairment in the world. In 2014, 400,000 Singaporeans were recorded to have diabetes, 30 percent of them have diabetic retinopathy, and 10 percent have severe or vision-threatening diabetic retinopathy.

“The effects of diabetes on the eyes is that of a micro-angiometry. It causes two main pathological problems: haemorrhage or bleeding within eye, and oedema or swelling within the tissues of the eye. [These problems] lead to secondary complications such as glaucoma, and retinal detachments,” explained A/Prof Wong Hon Tym, Senior Consultant at the Department of Ophthalmology at Tan Tock Seng  Hospital and Hospital Medical Director of the NHG Eye Institute, during the Singapore Health and Biomedical Congress 2017.

In order to address the potential implication of diabetic retinopathy to Singapore’s overall population, the Singapore National Eye Centre (SNEC), and the National Healthcare Group Eye Institute (NHGEI), together with local polyclinics, have conceptualised the Singapore Integrated Diabetic Retinopathy Screening Programme (SiDRP) – a tele-ophthalmology screening network to detect and monitor eye diseases in diabetic patients such as retinopathy and maculopathy.

Improved screening system

Prior to SiDRP’s conceptualization in 2011, Singapore had a flawed screening system, Wong lamented. “Previously, photographs were taken by polyclinic nurses and then family physicians will take turns to read all the photos produced.” The family physician-based system, according to Wong, was not sustainable and had led to turnaround time of at least two weeks due to the doctors’ time constraints.

“The new system is cloud-based, all the photos are now sent online, and they are reported by the two reading centres at SNEC, NHGEI. Reports are read in a very systematic way by our technical readers, and accessed by polyclinics,” said Wong.

SiDRP boasts an improvement on the patient waiting time to at least one hour—patients may choose to wait at the polyclinics for an hour or so for their results, as well as the decision as to whether they will be referred to a specialist or not.

The new system also helps reduce work from family physicians as the photographs are now being read by qualified technical readers and optometrists.

Health economic impacts of the disease

Dr Owen Hee Kim on the underlying effects of diabetic eye diseases to Singapore’s health economics.
Dr Owen Hee Kim on the underlying effects of diabetic eye diseases to Singapore’s health economics.

In a separate discussion, Dr Owen Hee Kim, Ophthalmology Consultant at Tan Tock Seng Hospital, emphasized the underlying effects of diabetic eye diseases to Singapore’s overall health economics.

“If you have diabetic eye disease, all ancillary costs – be it inpatient, outpatient, or A&E cost – will all go up (See Table 1),” said Kim. “Ophthalmic complications in and of itself is actually a significant burden in the society, in our country because of the cost.”

In addition to this, the total economic costs for the entire working-age population is expected to increase by 2.4-fold from USD 787 million in 2010 to USD 1,867 million in 2050.

“This is not just about the numbers, it is also about the whole demographic shift we are looking at,” warned Kim. “We are looking at 2.4 increased in burden that is going to be shouldered by a 2.3-fold reduction in the working adult population [due to Singapore’s greying population].”

Kim called for increased collaborative work between healthcare professionals in Singapore as the presence of diabetic eye disease correlates with the presence of other diabetic comorbidities.

“There is a need to act now. We need to address some socioeconomic determinants of health because this is a lifestyle disease. It is not just about blood sugar, it is about all the factors that contribute to high blood sugar.” MIMS

Health economic impacts of the disease