SPECIAL REPORT / Diseases that can cause blindness, such as diabetes-related complications, can be prevented with better healthcare. The EU should therefore ensure that statistics on blindness in Europe are more uniform so that best practices can be exchanged between member states, says Michael Larsen.
Michael Larsen is professor of Clinical Ophthalmology at Glostrup Hospital and the National Eye Clinic. He spoke to EurActiv's Henriette Jacobsen.
Talking about health and whether our health systems do a good job, I'd like to know which EU countries are front runners and which countries are lacking behind when it comes to treating eye diseases?
Scandinavia, the Benelux countries and the UK are the front runners. East and Southern Europe are lacking behind. However, it’s difficult to measure because the approaches when it comes to making statistics are not uniform.
How can the health system prevent eye diseases or a person from becoming blind?
This depends on the causes for the blindness. Primarily diseases such as cataracts and glaucoma can hit the eye and cause blindness. Other things could be the lack of access to glasses and contact lenses, but that is not the biggest problem in Europe. Complications related to diabetes can also lead to blindness. This is more interesting because it’s the most common source for blindness among the working force. It’s something which for the most part can be prevented and treated.
I’m guessing this is also something that will increase in the future as more people become obese and get diabetes?
Yes, but fortunately the progress in terms of prevention and treatment of blindness moves quicker than the increase in the number of people with diabetes. So even though we are seeing more people with diabetes, there treatment is becoming better which means they are also receiving better treatment for their eye complications related to the diabetes.
Though we have fewer blind people, we still have a high number of blinds and it’s an area of great inequality. Complications related to diabetes are more difficult to treat than just giving someone a vaccine. First, you have to make the diagnosis that someone has diabetes. Then you will introduce a lot of medicine which you would have to time and make available in the right doses. This is not necessarily cheap and many people have too bad contact with their general practitioner.
It becomes what we call a 'poly-pharmacy' as you need a number of different drugs and specialists. It has been proven that this works, but it’s not easy to implement this. So only in health systems with excess, this works.
How often do people go to their doctor if they feel they have problems with their eyes compared to problems with other body parts?
They are probably better at going to the ophthalmologist than to other specialists. You feel your eyes, but maybe not so much your kidneys.
So problems with blindness are not related to people waiting too long before they see a specialist?
No. Complications related to diabetes, you usually don’t feel before it’s too late. So this also requires a pedagogical effort by nurses and doctors to make sure that the patients go to preventative examinations in time. You see very clearly that in those places where they make it easy for people to go to examinations. Things work really well where everything is a stream-lined package solution when it comes to the different specialists.
Which groups in a society should worry about their eyes and becoming blind?
For older people there are a lot of diseases which threaten their sight. Some of these people can’t overcome the illness if their treatment is postponed. If we for example talk about glaucoma, it will have consequences for the patient if their treatment comes too late. For cataracts, it doesn’t matter that much when you are getting an operation. To operate on people who suffer from cataracts is something doctors usually like. But preventing glaucoma and complications related to diabetes… is not related to the same success experience. For cataracts, the patient will already feel the benefit the day after. For glaucoma and diabetes-related complications, you need annual check-ups afterwards and the patient isn’t feeling any positive effects immediately. So the doctors don’t have the same motivation factor for the patient. They prefer these operations with ‘wow’ effect.
How many people will be hit by eye diseases?
Usually, 50% of people in rich countries will have to have an operation before they pass away. In many countries, it can be difficult to sell the preventative part. In some places, the area isn’t prioritised either for example within their health insurances. For example, if you go to the US… They have big problems with the preventative efforts. This has to do with the fact that people change their health insurance companies all the time, on average around every third or fourth year. This also depends on where they are employed. If you don’t know if your employee will stay with you the next 10 years, you don’t help them prevent diseases which could occur within 10 to 15 years.
This is better in Europe because we have a better economy within the healthcare systems. But in Eastern Europe they are still relatively poor and are behind in many of these areas.
Easy access to an optometrist is very important. These are widely used in the UK, but not used at all in France. On the other hand, they have many ophthalmologists progressions in France compared to in the UK.
Looking in the crystal ball, there will be better treatments of the age-related diseases with earlier diagnostics. They will be treated earlier and more effectively. But the biggest revolution for the individual patient will come within the inherited illnesses among children and young people; there'll be gene therapy and electronic devices replacing cells.
So can we in the future expect that some eye diseases will disappear and that blindness will disappear if you aren't born blind, for example?
We could do it already now with the diabetes-related complications. If only we could make sure that diabetes patients would be offered treatment. Then we could avoid that people become blind from having diabetes. Maybe it would still weaken their sight, but in Iceland for example they have many doctors and almost no one becomes blind from diabetes-related complications.
Which initiatives would you like to see from the EU's side regarding prevention and treatment related to eye diseases and blindness?
The first thing the EU should do would be to make sure we have uniform approaches on the statistics in the different countries. We don't know how much blind and visually impaired people are being in treated in Europe. For example, in Denmark we only know how many people are blind and how many people become blind per year.
If we for example knew that in Belgium there are only a few blind, then Belgium must do something right that the rest of us do wrong. But these indications we don't know now.