Dr. Muhammad Bayu Sasongko, MD, has been officially inaugurated as a full professor in ophthalmic health sciences at the UGM Faculty of Medicine, Public Health, and Nursing.
In his inaugural speech titled “Implementation of Tele-Ophthalmology-Based Screening to Reduce the Burden of Diabetic Retinopathy and Blindness Due to Diabetes in Indonesia,” he delved into the pressing issue of diabetes in Indonesia.
“I selected this title because Indonesia ranks as the fourth most populous country grappling with diabetes globally, and over the last 1-2 decades, the prevalence of diabetes here has witnessed a significant surge,” he shared at the UGM Senate Hall on Tuesday (Dec. 12).
This surge, as explained by Professor Sasongko, is coupled with a rise in the most prevalent complications of diabetes, notably diabetic retinopathy (DR), a condition with the potential to inflict permanent blindness.
Therefore, he underscores the need for proactive measures such as early detection to halt vision deterioration leading to blindness in individuals with diabetes and DR, advocating for therapeutic interventions at the earliest stage to circumvent irreversible blindness.
The strategy for early detection involves routine screening for all individuals with diabetes, ideally conducted at primary healthcare services.
Despite its somewhat limited implementation over the past decade, diverse community-based screening models leveraging health workers and artificial intelligence continue to evolve.
“Considering the various merits and demerits of different models, it’s evident that teleophthalmology-based screening currently stands out as the most viable choice to alleviate the burden of blindness stemming from diabetes in Indonesia,” he explained.
The professor illuminated that diabetic retinopathy poses a considerable burden of blindness in Indonesia, with individuals living with diabetes susceptible to DR complications throughout their lives.
Unfortunately, many diabetes patients remain oblivious to the onset of DR as mild and moderate-stage DR often progresses without manifesting noticeable symptoms.
The prevalence of DR varies widely across several Asian countries. For instance, India reports a prevalence of 12-22 percent, China ranges from 28-43 percent, and Singapore stands at 35 percent, with China recording a 4 percent blindness rate due to DR.
In Indonesia, the reported overall prevalence of DR is 43 percent, with severe-stage DR posing a threat to vision, standing at 26 percent. The blindness rate attributed to DR itself is reported at 12 percent among all DR patients, and 7 percent of these are type 2 diabetes mellitus (DM) patients.
Highlighting that diabetic retinopathy is a progressive complication associated with various risk factors, Professor Sasongko stressed that the condition deteriorates over time or with the aggravation of systemic conditions.
The latest Indonesian data indicates an annual incidence of 38 new DR cases, 28 new severe DR cases, and five new blindness cases due to DR per 1000 people with DM.
“If we extrapolate this data to 20 million people with DM in Indonesia by 2030, there will be 760 thousand new cases of DR and 100 thousand new cases of blindness due to DR every year,” he projected.
“Addressing this challenge necessitates routine, diverse, and sustainable treatments such as retinal laser, drug injections, and surgeries conducted by specialist retina eye doctors.”
However, routine and ongoing DR treatment inevitably incurs substantial indirect costs related to DR treatment, including expenses borne by patients’ families during the treatment or DR treatment period, transportation costs to health services, loss of employment, and more.
Advanced-stage DR patients’ healthcare costs are estimated to reach IDR 20-40 million per patient, while healthcare costs for mild to severe DR range from IDR 100 thousand to 9 million per patient.
Professor Sasongko reiterated that screening is pivotal to successfully reducing the burden of DR in the community. Early and accurate diagnosis, coupled with prompt treatment, can mitigate the severity of ongoing DR.
According to him, one of the significant challenges in nationally addressing DR is the substantial number of undiagnosed DR cases that have not received appropriate eye health services.
The World Health Organization stipulates that individuals with DM should undergo eye examinations at least once a year to detect the presence or absence of DR.
Regrettably, data from several DM populations in Indonesia indicates that over 90 percent of individuals with DM have never undergone eye examinations, potentially contributing to the high rate of visual impairment and blindness in individuals with DM in Indonesia.
Numerous DR screening models are continually evolving in various countries, including Indonesia. The United Kingdom stands out as one of the pioneering countries to implement tiered DR screening at primary healthcare centers.
In Australia, DR screening services are integrated into all optometry services, eyewear service providers, and almost all clinical pathology laboratory services.
Professor Sasongko elaborated that DR screening programs in Indonesia began in 2013, initially launching in three areas: Jakarta, Bandung, and Yogyakarta.
With support from the Indonesian Ministry of Health and financial assistance from Hellen-Keller International/World Diabetes Foundation, Jakarta initiated DR screening concurrently with integrated elderly service posts in every community group.
In Bandung, DR screening was executed in collaboration with the diabetes association group (PERSADIA) led by internal medicine specialists.
“In Yogyakarta, DR screening is conducted in collaboration with family doctors overseeing diabetes patient groups in the community,” he said.
“Among the three DR screening models attempted, it was discerned that the most effective and sustainable screening model involves general practitioners or family doctors at primary healthcare facilities. Unfortunately, broader implementation has not been possible due to several constraints.”
In conclusion, Professor Sasongko stressed that optimizing DR screening through teleophthalmology at primary healthcare facilities is estimated to yield over 50 thousand hospital visits, resulting in total savings exceeding IDR 600 billion annually, compared to opportunistic screening at referral health facilities conducted by ophthalmologists.
Moreover, the implementation of teleophthalmology for DR screening is poised to rescue 20 million people with DM from severe visual impairment and prevent the addition of 100 thousand blindness cases due to DR annually by 2030.
This initiative, he believes, will safeguard individual and familial productivity and, on a grander scale, contribute to the nation’s productivity.
Nevertheless, several main challenges in initiating teleophthalmology for DR screening persist, including the requisite investments in retina cameras, human resource training, and the development of digital communication systems between primary healthcare services and referral facilities.
Teleophthalmology and DR Screening
Teleophthalmology refers to the exchange of medical information in the field of ophthalmology between two different locations using information and/or communication technology to enhance the patient’s health status.
The primary objective of teleophthalmology is to offer optimal, more affordable healthcare services that can reach various locations with challenging health access.
Teleophthalmology for DR screening has successfully been implemented in the UK, Singapore, Canada, Thailand, India, and Africa.
“The implementation of teleophthalmology for DR screening and its utilization holds immense potential for application in Indonesia,” he added.
“Aligned with the country’s geographical conditions as an archipelagic nation with uneven distribution of human resources, teleophthalmology can seamlessly integrate into Indonesia’s developing hierarchical health service system.”
Author: Agung Nugroho
Photographer: Firsto