Diabetic retinopathy screening increases from 20% to 90% in KL

“Diabetes doesn’t cause blindness; it only causes narrowing and leaking. People cause blindness.”

That is how consultant ophthalmologist Dr Kewaljit Singh likes to open his talks on diabetic retinopathy, the common eye complication of diabetes.

He does this, he says, to give the audience a bit of a shock and because it is, in a sense, true.

“The whole world knows that diabetes causes blindness, so why are so many people still going blind?” he asks.

According to him, the problem is because: “People only come to us when they have problems seeing, but the leaking or narrowing is happening before that – the vision is still normal then because the macula is not affected yet.”

The macula, which is part of the retina, is the area of the eye that gives us our sharpest vision.

The high blood sugar in uncontrolled or partially-controlled diabetes causes damage to the small blood vessels, or capillaries, within the eye.

Dr Kewaljit, who is the Wilayah Persekutuan Kuala Lumpur & Putrajaya Diabetic Retinopathy Screening Programme clinical head, says that the key thing in diabetic retinopathy screening is convenience for the patient. Photo: The Star/Sam Tham

The eye will then try to grow new blood vessels to compensate for the damaged ones, but these new capillaries are usually too fragile and abnormal, resulting in even more damage to the eye, especially the retina.

If left unchecked and untreated, this eventually results in blindness.

Getting the programme going

Because diabetic retinopathy is a common complication of diabetes, diabetic patients are suppose to get their eyes checked at least once a year.

However, as Dr Kewaljit observes, many of them don’t bother, or don’t remember, to do so regularly.

“In Seremban, I noticed that a lot of diabetics were coming from the Klinik Kesihatan (government health clinics) and private GPs (general practitioners) when they were already going blind, and were not having their annual check-ups,” he says. Dr Kewaljit served in Hospital Tuanku Ja’afar Seremban, Negri Sembilan, in 1997-98.

That was what inspired him to approach the Wilayah Persekutuan Kuala Lumpur and Putrajaya’s (WPKL&P) health department in 2003 to propose a diabetic retinopathy screening programme for their health clinics.

The programme got off the ground a year later in Klinik Kesihatan Jinjang.

As examination via ophthalmoscope was then the common method of examining the eye, Dr Kewaljit would go to the clinic regularly to conduct the screening.

“I went in there for two years and we picked up a lot of cases earlier,” he says.

Dr Kewaljit taking a photo of a diabetic patients eye using a digital fundus camera at Klinik Kesihatan Petaling Bahagia as part of the screening programme in partnership with the Lions Club and CIMB. Photo: Lions Club of Kuala Lumpur Buikit Kiara

In addition, he managed to get a fundus camera for the clinic in 2006 – the recommended tool for screening, as well as allocations for three more cameras before the programme stopped.

But in 2010, his friend and Hospital Kuala Lumpur Department of Ophthalmology head Dr Joseph Vijaya Alagaratnam called him.

Although more clinics now had fundus cameras, a new problem had arisen.

With no proper training, the nurses and medical assistants operating the cameras were referring patients to the hospital for any abnormal photo, including those caused by a dirty camera!

“They employed me to oversee all the Klinik Kesihatan,” he says, adding that with the medical staff having so many other duties, someone needs to push and remind them about diabetic eye screening, as well as coordinate the overall programme.

At that time, diabetic patients were asked to go to the clinics that had the fundus cameras to get their screening.

However, this was not effective as only about 200 out of 2,000 patients from each clinic would actually go for the screening.

“For one-two years, we told all the Klinik Kesihatan, you have to encourage your patients, you have to promote and make sure any patient who comes in goes for their eye screening,” he says.

He also helped to train medical staff in using the camera and assessing the photos, tried to create more awareness among both patients and doctors, as well as tried to get more fundus cameras.

Fundus cameras can take an image of the eye within a few minutes, with no prior preparation needed, while examination with an ophthalmoscope ideally requires dilation of the pupil first, as well as some experience and expertise in examining the eye.

Private-public partnership

When Dr Kewaljit first started the Diabetic Retinopathy Screening Programme under the hospital, only about 20% of diabetic patients in WPKL&P had had their eye checked that year.

“Then, with our education and promotion, it went up to 30%. Then, as our efforts went on, it went up very little – up to about 40% only,” he says.

Realising that it was not working and that there were a significant number of patients potentially going blind due to lack of screening, he suggested that the state health department start moving the cameras to the different clinics.

When this suggestion was not accepted, Dr Kewaljit decided to turn to the Lions Club of Kuala Lumpur Bukit Kiara in 2014.

One way to catch diabetic patients for their eye screening is while they are waiting to see the doctor or pick up their medicines, says Dr Kewaljit. Photo: Filepic

With the Club’s help, funding from the CIMB Foundation was secured for a mobile eye health screening programme.

In this programme, Dr Kewaljit and staff from his private practice managed to screen 1,000 diabetic patients at Klinik Kesihatan Petaling Bahagia with his clinic’s own fundus camera.

“Every month, we went in for four days, and in five months, we did almost 1,000 (screenings),” he shares, adding that they picked up 150 people with diabetic retinopathy during that time.

The programme also screened around 500 patients in Klinik Kesihatan Kampung Pandan, of which 75 were found to have diabetic retinopathy.

More importantly, 4% of the patients screened needed laser treatment for their retinopathy, which was also provided for by the programme.

With these successful results, Dr Kewaljit set up a meeting with the WPKL&P health director Datuk Dr Narimah Nor Yahaya, who promptly agreed with his proposal that the department’s fundus cameras should be moved around the territory’s 14 clinics, staying at each clinic for about three months at a time.

That move, in addition to the screenings supported by the Lions Club and the CIMB Foundation, resulted in around 27,000 diabetic patients (90%) in the territory getting their eyes examined last year. The territory now has four fixed cameras and three mobile ones, according to Dr Kewaljit.

With the diabetic retinopathy programme in WPKL&P running smoothly, he has now turned his sights on Selangor.

With approval received in May, he has started conducting screenings in a government clinic in Puchong, which doesn’t have a fundus camera.

“We have already started the Selangor project, so we’re just waiting for a few more screenings, then we can get the figures.

“But we’ve already picked up a number of bad cases – when you go to a new place, you will always get the bad cases,” he says.

Source : Star2.com