The first interview I conduct in Egypt is with Dr Ahmed Samy, an ophthalmologist specialised in laser surgery at the « Eye Care Center » in Maadi, Cairo.
As an eye doctor, Dr Ahmed Samy provides general facts and figures about the situation of diabetes in Egypt, as well as an insight on one of the most common complications caused by diabetes: the diabetic retinopathy.
Facts & Figures
The main characteristics of diabetes in Egypt are the following:
- Although studies differ, Egypt can be considered to have one of the highest prevalence of type 2 diabetes in the world, ranking 9th, with an estimated 15,60% of population between 20 and 79 years of age with type 2 diabetes (in « Epidemiology of and Risk Factors for Type 2 Diabetes in Egypt », Reffaat Hegazi, MD, PhD, Mohamed El-Gamal, MD, MSc, Nagy Abdel-Hady, MD, PhD, Osama Hamdy, MD, PhD, Annals of Global Health, Vol. 81, NO.6, 2015);
- Different factors explain this high figure: Obesity (50% of men and 65-80% of women between age 15 and 59); sedentary lifestyle (increased number of cars, hot weather, and cultural avoidance of exercising in public areas, tend to greatly induce a lack of exercise); exposure to agricultural pesticides;
- Women are more likely to develop type 2 diabetes due to cultural factors which prevent them from being active in the public space and, more specifically, to exercise on a regular basis;
- Many patients seek medical assistance too late, to treat complications of diabetes, often unaware of the fact they have diabetes;
- The increase of the price of insulin over the past years makes it difficult for certain patients to follow their treatment. This increase is caused by
- a. budgetary limitations of public healthcare services;
- b. the drop of the value of the Egyptian Pound against the USD, reducing the importation capacity of insulin and medical supplies;
- c. the rise in the price of insulin by the insulin producers;
- d. the rise of the unemployment rates in Egypt due to the drop of tourism after 11 September 2001 and the Egyptian Spring Revolution of 2011. As a consequence, more patients depend on subsidized insulin, available in limited quantities;
- The difficulty to reach patients living in remote areas;
- The high number of people suffering of diabetes complications which result in amputations and loss of sight.
Retinopathy and loss of sight
An untreated or not well treated diabetes will, over the years, result in the damage of blood vessels which will become porous or even burst because of chronic hyperglycaemia. Such damage can greatly impair the health of a patient, as blood vessels irrigate every part and every organ of the body. A common affection caused by diabetes is the diabetic retinopathy, which translates in a partial or total loss of sight. That loss of sight is caused by the leaking or the bursting of weakened blood vessels in the retina, situated in the fundus of the eye. As a result, the patient will have a blurry vision, sometimes associated with dark spots. Those spots are in fact small clogs of blood/fat that prevent the light to reach the macula of the eye. A total loss of sight is also possible.
It is estimated that diabetic retinopathy affects 80% of those who have diabetes for 20 years or more (https://en.wikipedia.org/wiki/Diabetic_retinopathy 26 Aug 2018)
Dr Ahmed Samy estimates that 80% of the patients come to the retina clinic because of diabetes.
A common way to diagnose a retinopathy is through a visual fundus examination. To facilitate such an examination, dilation drops are put in the patient’s eyes to dilate the pupils and, so, provide a view « inside » the eye of the patient, on the blood vessels covering the retina. In some cases, an intravenous fluorescent solution may be administered to clearly reveal the location and the importance of leaks and bursts of tiny vessels.
Fundus examinations are extremely important, not only because they can clearly indicate the seriousness of a retinopathy, but also, as explained earlier, because they constitute a warning of potential damage in other organs.
As an ophthalmologist specialised in laser surgery, Dr Ahmed Samy meets many patients encountering complications due to diabetes. Yet, the first steps in the treatment of a retinopathy is to control the diabetes in order to prevent further damages to the blood vessels, and, in some cases, reverse the trend.
It is only when the sugar levels are under control again that laser surgery can be done to remove blood/fat clogs in the eye. The success rate of such an operation is relatively high, but it won’t cure the patient or prevent future complications, hence the importance for the patient to maintain a balanced glycaemia. Moreover, laser surgery can’t be used to treat other organs or parts of the body.
Many thanks to Dr. Ahmed Samy for the time and energy invested in the interview!