Diabetes epidemic puts strain on eye screening

Diabetes is a major cause of blindness but some sufferers face a long wait for retinal checks. Photo / Thinkstock

Auckland health authorities are struggling to cope with New Zealand's rapidly increasing number of diabetics and is unable to check the eyes of some quickly enough.

This is potentially putting some patients at risk of blindness. Diabetes is New Zealand's commonest cause of blindness in adults until the age of 65.

The Auckland District Health Board's retinal screening service is one example of the inadequate and worsening hospital services provided for diabetics by a number of health boards, say Diabetes NZ and the Society for the Study of Diabetes.

Diabetes prevalence is rising by 8 to 9 per cent a year nationally, and nearly 15 per cent in Central Auckland and Counties Manukau.

Nationally it was estimated last year that 184,000 people had been diagnosed with diabetes, mainly type 2.

Society medical director Dr Paul Drury, who also heads the Auckland DHB's diabetes centre at Greenlane, said yesterday that because of insufficient capacity to meet the increasing demand, newly referred patients at the DHB typically had to wait six months to have their retinas screened.

The retina is the light-sensitive part of the back of the eye. It transmits visual information via nerves to the brain and can be damaged by diabetes.

Dr Drury said patients on the recall list were typically having five months added to their waiting times. This meant patients with the beginnings of diabetic eye disease but not yet needing the attention of an eye specialist were likely to wait 11 months, rather than six.

"What we are concerned about is there will be preventable loss of sight as a result."

Diabetic eye disease could be prevented by good diabetes management and treated if detected early.

"It doesn't affect your health until you have had a catastrophe and at that point you have probably lost some vision for good."

Dr Drury said although New Zealand had a good rate of diabetes detection in primary care, it was a poor performer internationally in management of the disease.

"The recent independent OECD report shows New Zealand is second worst among nations studied for life years lost to diabetes."

The health board's funding manager, Gael Humphrey, said it intended to increase screening capacity by developing new computer programs for viewing the screening photographs, contracting more private screening providers and, temporarily, providing a mobile screening service.

Health Minister Tony Ryall said he had ordered a review of diabetes programmes, "because they don't seem to be delivering for diabetes patients".

His ministry said it and Health Workforce NZ had initiated or were planning several pilot programmes to reduce the incidence and effects of diabetes, including allowing diabetes nurses to prescribe some drugs and having nurses work closely with high-risk groups to reduce diabetic kidney damage.

THE PROBLEM
* New Zealand has 0.35 fulltime-equivalent diabetes physicians for every 100,000 people.

* Britain's colleges of physicians recommend a level of 0.8 in 100,000.

* Some district health boards are trimming their specialist diabetes services, or are planning to do so.

* The prevalence of diabetes is increasing by more than 8 per cent a year.