April 2016

Breaking the Vicious Cycle of Blindness in Djibouti

By Eric Craypo

Here’s the catch: a person with Diabetic Retinopathy – the leading cause of blindness in working age adults around the world – can still see well when they are in the early stages of the disease. But if they wait until visual symptoms appear to seek help, it’s often too late;and the treatment is unlikely to work. Then as vision becomes further impaired, they blame the treatment for the blindness, which discourages others from seeking treatment. It’s a vicious cycle of blindness.

The solution, explains Berkeley Optometry’s Dr. JorgeCuadros is early detection and patient engagement: “If you treat it early, 90% of people can maintain good vision. You can avoid vision impairment.” But in many places around the world – including underserved communities in this country – the screening of diabetic patients is hampered by both a dearth of equipment and clinicians trained to do the assessments. Djibouti, for example, has only two ophthalmologists for the entire country.

With this in mind, Dr. Cuadros traveled to Djibouti, an east African country of 800,000 located on the Red Sea,late last year to train a group of nurses and other clinicians to operate a digital retinal camera and to detect Diabetic Retinopathy using a free and non-proprietary software called EyePACS—a program developed by Dr. Cuadros and Dr. Wyatt Tellis of UCSF.

Dr. Ethan Chorin, founder and director of Perim Associates,the Berkeley-based international policy consultancy that helped introduce EyePACS in Djibouti, says: “EyePACS is a great example of technology in service to development. It is simple to use, responds to a widespread need, and empowers local clinicians to do their own screening and treatments, rather than relying on external aid.”

During the initial screening of 140 people, the group found that 64 had some diabetic retinal disease and will need to be counseled and monitored closely to avoid vision impairment in the future, and 20 had severe diabetic retinal disease requiring immediate treatment. For these84 people, the screenings have likely prevented blindness. But it was too late for 5 of those 20 patients—the disease had progressed so far that treatment is unlikely to help. A devastating reminder that early detection is critical. In the next phase of the project, Cuadros anticipates that newly trained health care professionals – traveling around the country—will be able to screen 50% of Djibouti’s diabetic population. That’s about 40,000 people. He thinks it can be done by the end of 2017. The program will follow the success of similar endeavors that Cuadros initiated in the U.S., Canada and Mexico. All told, over340,000 people with diabetes have been screened using the EyePACS system, saving thousands from blindness.Dr. Cuadros recently told the Huffington Post, “If we can test early and widely, we can save many from this fate. The testing technology is now there, it’s simple, portable, and it works really well.

*Originally Published in U.C. Berkeley Optometry Magazine, November, 2015