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• Diabetic Retinopathy

Diabetic Retinopathy

What is diabetic retinopathy ?

Diabetes can occur at any age, even during childhood and it becomes more common with age. It affects 3 to 4% of the population, which accounts for more than 2 million people in France.

There are two types of diabetes :
 Type 1 diabetes : insulin dependent representing 10% of diabetics.
 Type 2 diabetes : non-insulin dependent type which accounts for the remaining 90% of diabetes sufferers. Currently, type 2 diabetes is increasing to epidemic proportions. The ageing population and the increased levels of obesity are to blame for this increase.

Thus, epidemiological studies predict that by 2025 there will be 25% more diabetics in France.

The constant presence and increased quantity of sugar in the blood stream alter the small arteries in the organs, which include those in the retina of the eye. It is estimated that 30 to 40% of diabetics, some 800,000 people in France, will be affected to some degree by diabetic retinopathy. This illness has no visible signs during the beginning stages and often passes unnoticed by diabetics until severe visual impairment becomes apparent and thus it is difficult to treat (haemorrhages or the retinal blood vessels can become blocked).

The magnitude of Diabetic Retinopathy

Diabetes around the world

Diabetes is considered as an important public health problem. Diabetic retinopathy is a major cause of visual deficiency. The World Health Organisation, WHO, estimates that the number of diabetes patients worldwide reached 221 million in 2010, with a particular bias towards developing countries.

People suffering from diabetes in developing countries face a greater risk of developing complications.

Good management of blood sugar and fats as well as arterial tension reduces the risk of developing retinopathy.
It is likely that several social determinants of health such as poverty, malnutrition, limited access to healthcare and a lack of medicines go some way to explaining the increased prevalence of retinopathy in low- and middle-income countries.

The most recent meetings on diabetic retinopathy re-confirmed the enormous challenge ahead of us to deal with the burden of visual impairment and blindness caused by diabetes in future.

The diabetes prevalence will increase from currently 382 million people to 592 million people in 2035. In this period Africa will experience a 109 % increase in people with diabetes and South East Asia a 71 % increase.

These two regions combined account for less than 1 % of global health expenditure on diabetes.
By 2035 each day 3 million eyes will need to be evaluated which is 35 eye exams per second.

4 out of 5 people with diabetic blindness will live in developing countries.

Source : International Diabetes Federation [http://www.idf.org/diabetesatlas]. Data from 2013.

The OPC fights against diabetic retinopathy in Mali and Guinea.

Firstly, frontline health personnel are made aware of the need to manage diabetes to avoid the development of complications during training.
Secondly, the OPC works to :
 ensure that public awareness messages explaining the risks of sight loss linked to diabetes are broadcast via radio
 ensure that general practitioners are aware of the need to carry out a full examination of the back of the eye on their diabetic patients annually, to facilitate early diagnosis of diabetic retinopathy before any visual deterioration occurs.

In industrialised countries

Diabetic retinopathy is the main cause of blindness amongst under-60s in the active population. Globally, it is thought that after 15 years of having diabetes, 2% of sufferers become blind and a further 10% become partially sighted. This means that around 1,000 people in France go blind every year due to diabetic retinopathy and many more become partially sighted. For the most part, these complications are avoidable :
 Primarily, diabetics should maintain a good glycaemic balance and blood pressure
 Laser treatment can detect the first serious signs of diabetic retinopathy. The efficacy of this treatment has been proved over and over again by numerous studies. However, diabetic retinopathy still remains one of the leading causes of blindness in France because of the difficulty in detecting it early meaning that it is often diagnosed too late.

The problem of screening for diabetic retinopathy in France

Public health programmes and recommendations for good practice have been developed in many different countries to improve the management of diabetes and its associated complications. There is an examination that must be carried out regularly in order to diagnose diabetic retinopathy early enough to be treated. The efficacy of such systematic screening has been demonstrated in several countries. This is demonstrated in countries that have a systematic screening programme for diabetic retinopathy as they have significantly fewer cases. The cost-effectiveness of diabetic retinopathy screening has also been proven in various studies.

In France in 1999, the ALFEDIAM (Association de Langue Française pour l’étude du Diabète et des Maladies métaboliques) and ANAES (Agence Nationale d’Accréditation et d’Evaluation en Santé) strongly recommended an annual screening of the back of the eye for all diabetics. A study that was also published in 1999 showing that at least 50% of the patients studied had consulted an ophthalmologist during the course of the previous year. The ophthalmologic care of diabetics is still insufficient in France.

For several years, the screening for diabetic retinopathy uses digital scans to photograph the back of the eye and then send the image via the internet to a specialist centre where they can be interpreted elsewhere in France. This method has several advantages :

 It is as reliable as the original examination of the back of the eye carried out by an ophthalmologist.
 It is more convenient for the patient as the waiting time for a consultation is much shorter and it does not require pupil dilation which is unpleasant for the patient.
 It saves doctors a lot of time, they are not required to take the photographs of the retina and several screening centres rely on just one centre. Ophthalmologists can concentrate on the interpretation of the images and the care of the patients who have been screened. The detection of diabetic retinopathy through photographs of the back of the eye should not be considered a conclusive method of diagnosing diabetic retinopathy, but an alternative way of detecting it. It represents an appropriate response to the difficulties linked to the rise in the number of diabetics and the decreasing number of specialists.

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What do the OPC and its partners do ?

The OPHDIAT network (1), which facilitates screening for diabetic retinopathy in the Ile-de-France region, was implemented by AP-HP (2). Then it was extended across 12 centres thanks to a partnership with the OPC and the Valentin Hauÿ Organisation (AVH) (3). The AVH and the OPC next set up 5 further centres, outside of the OPHDIAT network, based on the same model. Today the 32 screening locations available enable the screening and referral of 15,000 patients each year. In general, they are located as a priority in areas with a lack of ophthalmologists.
(1) Diabetic ophthalmology telemedicine
(2) Welfare services- Paris Hospitals
(3) fights in France with and for visually impaired people

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How does diagnosis take place ?

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 1. Health centre
Screening for diabetic retinopathy is done in a health centre using non-mydriatic retinal photography. The photographs of the fondus are digitized and then sent via the internet to a reading centre. In the Ile-de-France, the images use the telemedicine network OPHDIAT created by AHP.

 2. Reading centre
The scanned images are interpreted at the reading centre by ophthalmologists. In Paris, the reading centre is managed by Professor Massin at the Lariboisière Hospital.

 3. Summary
The images are analysed and evaluated before being sent back to the health centre within 3 days.

 4. Treatment
If laser treatment or a follow-up appointment is required, the diabetic patient is consulted by an ophthalmologist of their choice.

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Where to go to be screened ?

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75-PARIS

4th arrondissement
 Hôtel Dieu, diabetes services, Professor Slama

• No immediate appointments
• Address : 1, place du Parvis Notre-Dame, 75004 Paris
• Telephone : 01 42 34 82 34
  
  5th arrondissement
   Hôpital Cochin, endocrinology service, Professor Boitard
• No immediate appointments
• Address : 27, rue du Faubourg Saint-Jacques
• Telephone : 01 58 41 41 41
  
  10th arrondissement
   Hôpital Lariboisière, medecine B, Professor Guillausseau
• Address : 2, rue Ambroise-Paré, 75010 paris
• Telephone : 01.49.95.63.69
  
   Hôpital St-Louis, endocrinology service, Professor Vexiau
• No immediate appointments
• Address : 1, avenue Claude-Vellefaux, 75010 Paris
• Telephone : 01 42 49 96 80
  
  13th arrondissement
   Hôpital Pitié-Salpétrière, endocrinology service, Professor Grimaldi
• No immediate appointments
• Address : 47-83, boulevard de l’Hôpital, 75013 Paris
• Telephone : 01 42 16 00 00
  
  15th arrondissement
   Diabetic House (MGEN, rue de Vaugirard) Dr Sokolowsky
• Address : 178, rue de Vaugirard, 75015 Paris
• Telephone : 01 44 49 28 88 / 01 44 49 28 89 / 01 44 49 28 91
  
  15th arrondissement
   Hôpital Bichat, endocrinology service, Professor Marre
• Address : 46, rue Henri-Huchard, 75877 Paris Cedex 18
   Telephone : 01 40 25 87 35
  
  19tharrondissement
   Hôpital Robert Debré, Mrs Annie ESCOT (Children’s diabetes services)
• No immediate appointments
• Address : 48, bd Sérurier, 75019 Paris
• Telephone : 01.40.03.53.08

77-SEINE et MARNE

Saint-Fargeau-Ponthierry
 CMS (Centre Médico Social)

• Address : Saint Fargeau-Ponthierry, 98 av de Fontainebleau 77310
• Telephone : 01 60 65 81 50
• Everyday except Tuesday mornings
  
  Fontainebleau
   Centre Hospitalier de Fontainebleau, Dr Christine ESTEVE - Head of Ophthalmology
• No immediate appointments
• Address : 55, Boulevard Joffre : 77300 Fontainebleau
• Telephone : 01.60.74.11.74
  
  Cannes-Ecluse
   Cabinet médical la Garenne
• Address : 11, rue de la Garenne, 77130 Cannes-Ecluse
• Telephone : 01.64.23.37.12
  
  Férolles-Attilly
   Centre médical de Forcilles, Dr Legrand’s Diabetics services
• Address : 77 150 Férolles-Attilly
• Telephone : 01 60 64 60 03

91-ESSONNES

Corbeil-Essonnes
 CH Sud-Francilien

• Address : site Gilles de Corbeil, 59 bd Henri Dunant, 91110 Corbeil-Essonnes
• Telephone : 01 60 90 30 87

92-HAUTS-de-SEINE

Gennevilliers
 CMS (Centre Médico Social), Dr Tyrode

• Address : 3, Rue de la Paix, 92230 Gennevilliers
• Telephone : 01 40 85 67 70 or 01 40 85 66 50
  
  Malakoff
   Municipal Health Centre "Maurice Ténine", Dr Limousin
• Address : 74, avenue Pierre Larousse, 92240 Malakoff
• Telephone : 01.41.17.43.50

93-SEINE-SAINT-DENIS

Aubervilliers
 CMS Dr Pesqué (Centre Médico Social), Dr Clément

• Address : 5 rue du Dr Presque, 93300 Aubervilliers
• Telephone : 01 48 11 21 87
  
  Aulnay-sous-bois
   Centre Hospitalier Intercommunal BALLANGER
• Address : Boulevard Robert Ballanger, 93602 Aulnay-sous-bois Cedex
• Telephone : 01.49.36.70.92 Monday to Friday 9:30am to 17pm
  
  Bobigny
   CES (Health Examination Centre) de Bobigny, Dr Laboulaye
• Address : 2, Avenue de la Convention, 93017 Bobigny Cedex
• Telephone : 01.72.59.55.13 - Receptionist to arrange appointments : 01.72.59.55.08
  
  Bobigny
   CH Avicenne, endocrinology service, Professor Réach
• No immediate appointments
• Address : 125, rue de Stalingrad, 93 Bobigny
• Telephone : 01 48 95 55 55
  
  Bondy
   Hôpital Jean Verdier, diabetes services, Professor Paul Valensi
• No immediate appointments
• Address : Avenue du 14 Juillet 93 Bondy
• Telephone : 01 48 02 66 66
  
  Neuilly sur Marne - CES de la CPAM du 93 - Executive doctor Dr Le Clesiau
   CES de Neuilly sur Marne : Gerontology and Diabetics
• Address : 3, Avenue Dauphiné 93330 Neuilly sur Marne
• Telephone : 01.72.59.57.04
  
  Pantin
   CMS (Centre Médico Social) ; Mr Brodart
• Address : 10-12 rue Eugène et Marie-Louise Cornet, 93500 Pantin
• Telephone : 01 49 15 45 05 (ask for Mme Lavergne)
  
  La Courneuve
   CMS Salvador Allende, Dr Bremaud
• Address : 20, avenue du Général Leclerc, 93120 La Courneuve
• Telephone : 01.49.92.60.66

94-VAL de MARNE

Champigny-sur-Marne
 CMS (Centre Médico Social) Pierre Rouquès, Dr Lopez

• Address : 5, rue de l’Abreuvoir, 94500 Champigny-sur-Marne
• Telephone : 01 45 16 81 13
  
  Choisy-le-Roi
   Centre de santé CPAM Choisy-le-Roi
• Address : 9, rue Ledru Rollin, 94600 Choisy-le-Roi
• Telephone : 01 48 53 65 91
  
  Choisy-le-Roi
   Hôpital BICETRE, Professor Chanson - endocrinology service
• No immediate appointments
• Address : 78, rue du Général Leclerc, 94 Le Kremlin-Bicêtre
• Telephone : 01 45 21 21 21
  
  Centre de détention de Fresnes
• Address : Allée des Thuyas, 94261 Fresnes Cedex
• Telephone : 01 49 84 38 00

95-VAL-D-OISE

Gonesse
 Centre Hospitalier de Gonesse, Diabetics services - Endocrinology

• No immediate appointments
• Address : 25, rue Pierre de Theilley, 95500 Gonesse
• Telephone : 01 34 53 21 21
  
  Gonesse
   Hôpital Simone Veil - Groupe hospitalier Eaubonne-Montmorency
• Address : 28, Rue du Dr Roux, 95600 Eaubonne
• Telephone : 01 34 06 60 00 standard hospital number / service number : 01 34 06 62 67 ou 62 16

28-EURE et LOIR

CHR de Dreux
 Diabetics services, Dr Charitanski

• No immediate appointments
• Address : 44, avenue du Président John Kennedy, 28102 Dreux Cedex
• Telephone : 02 37 51 53 09

61-ALENCON

Centre hospitalier d’Alençon
 DiabOrne - Diabetes Network

• Address : 25, rue du Fresnay, 61 000 Alençon
• Telephone : 02 33 32 31 42

97-GUYANE

Cayenne
 House pf Guyana Diabetes Network

• Address : 59, avenue Voltaire, 97300 Cayenne
  
   Centre Hospitalier de l’Ouest Guyanais, Service of Medecine Inter-Diabetics, Réseau DIET 973
• Address : 16 avenue de Gaulle BP 245 , 97393 Saint Laurent du Maroni cedex
• Telephone :05 94 34 88 88

REGIONS

Languedoc-Roussillon
 Montpellier

• CHU Endocrinology, Professor Bringer
• Address : 71, avenue du Doyen Gaston Giraud, 34295 MONTPELLIER cedex 5
• Telephone : 04 67 33 84 31
  
  PACA
   Marseille
• CHU Endocrinology, Professor Vialettes
• Address : Hôpital sainte-Marguerite, 270, Bd Sainte Marguerite, 13274 Marseille cedex 9
• Telephone : 04-91-38-75-72
  
   Nice
• CHU St Roch - CCAS Carrefour santé pour Tous
• Address : 2, Rue Raspail 06000 Nice
• Telephone : 04.92.26.16.50
  
  Pays de la Loire
   Angers
• CHU Endocrinology, Professor V. Rohmer
• Address : Centre Hospitalier Universitaire d’Angers, 4, rue Larrey, 49933 Angers Cedex 9
• Telephone : 02 41 35 34 31
  
  Poitou Charentes
   La Rochelle
• CHR La Rochelle, Rochefort, Jonzac, St jean d’Angely, Saintes
• Address : Rue du docteur Schweitzer, 17019 La Rochelle Cedex 01
• telephone : 05 46 45 50 50

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  To find out more about diabetic retinopathy click here