Diabetic Retinopathy - Impacts
Five ways in which diabetic retinopathy (DR) affects the daily lives of patients in the US, China, Germany and Japan include the ability to read, ability to work, ability to travel, ability to access services, and economic burden.
Since many sources do not speak on how DR itself affects certain parts of a patient's life, we use the fact that DR causes visual impairment and combined that fact with how visual impairment affects different parts of a patient's life as a proxy to answer how DR affects the lives of those patients. Where there is a vast difference in the impact citizens of either Germany, Japan, China, or the US, we discuss the way in which they differ for that point, such as with economic burden.
ability to read
The weighted prevalence for the difficulty in reading in the US is 11.4%. With diabetic retinopathy, fluid accumulates in the part of the retina that helps with certain tasks such as reading, which is called macular edema. Macular edema often develops in people who have other signs of retinopathy. This part of the eye is also used for other tasks such as driving and recognizing faces. There is also contrast sensitivity, which affects the person’s ability to do simple reading tasks such as finding a telephone number in a directory or reading instructions. Hence, retinopathy can affect reading in many ways. For DR patients, it can interfere with how the markings on an insulin syringe or a display on a blood glucose monitor are read, which could cause conditions to worsen in the short and long term. Due to the decreased depth perception that comes with the lack of visual acuity, patients are less able to see edges and curves and to recognize faces in real life or in photographs, which ultimately affects their social life.
The Internet is the source of much reading and image content. Because of decreased contrast sensitivity and poor depth perception, text and images on a computer or handheld device are difficult to see. Also, patients with diabetic retinopathy often see dark blocking spots on a web page due to macular edema. The web is one of the places where things are changing for visually impaired individuals, as there is an increase in the use of screen readers. In the US, since 2001, the Bureau of Internet Accessibility has pushed web standards to make websites available to visually impaired people by way of screen readers, which converts text to speech. Things were very different in 2001 as there were not as many images on the Internet as there are now. With images now on nearly every page, screen readers can read these images using AI and simple algorithms to make the Internet more accessible to visually impaired individuals.
Ability to Work
For visually impaired people who seek work in the US, surveys have shown that employment of blind and visually impaired people is quite low, at 32%. Visually impaired people then face roadblocks with public financial support, lack of transportation, and problems with how their performance at work is rated. The weighted prevalence of US adults who experience the difficulty of working, especially with close-up work, is 9.7%. Some employees may struggle with doing their regular shifts at work because they have to time their medications and their meals. If they don't take their medication on time, they may worsen the retinopathy and make other diabetic symptoms, such as hypoglycemia worse.
If employers don't do a risk assessment and give the visually impaired employee the time needed for medication, eventual degradation of vision will occur. This is especially worriesome for those who operate heavy machinery, or for those who work in elevated areas. Poor depth perception, along with contrast sensitivity, both symptoms of diabetic retinopathy, have been associated with an increased risk of fall-related fractures. Visually impaired people are at a higher risk of injury. Many falls in the workplace come as a result of central and peripheral vision impairment.
Ability to Travel
The decreased visual acuity, loss of peripheral vision, and dark adaptation complications of DR can affect driving performance. The weighted prevalence of US adults who experience difficulty with driving is 1.8%, while the weighted prevalence of US adults who experience difficulty with their peripheral vision, as in only being able to see objects directly in front of them, is 4.43%.
Even though retinopathy can affect a person's ability to drive, it will most likely not restrict them from being able to obtain driving privileges, as studies have shown that driving with diabetic retinopathy does not translate to an increase in accidents. Depending on how severe the retinopathy is, medical evaluations by a doctor could be required before and after receipt of a drivers license. Most questionnaires and surveys required for a driver's license application ask applicants to disclose their medical conditions including diabetes.
People who are visually impaired are twice as likely as non-disabled people to not have access to transportation. Airports, however, are ahead in assisting the visually impaired as many of them have meet-and-assist programs. There are also apps such as the Aira app which connects visually impaired people with trained agents who can help with navigation.
Economic burden from the treatment of DR differs from country to country. In Germany, a 60 to 69-year-old man could spend anywhere from 671 EUR to 2,933 EUR per quarter for treatment at the time of the event. These are large costs, but it can be even more exorbitant when considering the amount of money that is spent on other conditions that come along with diabetes. Comorbid conditions like heart disease and stroke could cost as much as 8,700 EUR per quarter in the time of the event. Retinopathy treatments could cost as much as 24,662 EUR in the year of the event. Since GDP per capita is 39,501 EUR, it is a significant investment if retinopathy is allowed to progress.
According to a recent study, in Japan the earlier the detection of diabetic retinopathy and the earlier treatments are given out, the higher the quality-adjusted life year. Per their analysis, if people over age 40 are screened early, their cost-effectiveness ratio will be 944,981 yen, or $11,857. The usual loss of well-being cost is 46,164 yen per capita. This means the average Japanese citizen suffering from this illness could lose as much as 46,164 yen per year, or save as much as 944,981 per year, depending on how early they screen and treat retinopathy.
In Chinese diabetic patients, retinopathy is less prevalent than hypertension and cardiovascular diseases. This means hypertension would be the number one cause of high costs. Overall diabetes medical costs range from 2,383 to 2,780 USD.
In the US, $16,752 in medical costs are racked up per patient each year, with $9,601 attributed to diabetes alone.
Ability to Access Services for Visually Impaired
The US Government provides two main programs to blind and low-vision people: the Social Security Disability Insurance program, and the Supplemental Security Income program. These programs are automatically available to blind citizens (those whose vision can't be corrected better than 20/200 for a period of 12 months or more), but they're also available to those who are just visually impaired and have paid into the social security system long enough. This means that patients who became blind from DR and have been blind for at least 12 months automatically qualify, but those who are still able to work and see in some way will have a harder time getting these benefits.
China's social programs provides basic rehabilitation for its blind and visually disabled citizens, especially children. Even though they put more emphasis on the blind, they also look after those with degenerative diseases like DR. However, in Germany, DR patients receive many of the programs that fully blind people receive. Germany focuses on basic rehabilitation for its visually impaired citizens, especially seniors. Their services treat blind and visually sighted people the same through educational, legal, cultural, medical, and social ways.