Diabetes is one of the major public health challenges of the 21st century. It is estimated that 463 million people worldwide are currently affected with diabetes. Research further indicates that Pacific island countries are among the top 10 countries in the world with the highest prevalence of diabetes.

Source: STEPwise approach to Surveillance (WHO STEPS Survey)

The Fred Hollows Foundation NZ Pacific Diabetic Retinopathy (DR) Programme

To prevent vision loss from DR, patients with diabetes need proper care with timely access to screening and treatment services. This requires effective diabetes and diabetic retinopathy services, both of which are underpinned by appropriate policy frameworks.

The goal of The Fred Hollows Foundation NZ Pacific DR Programme is to reduce the incidence of avoidable blindness due to diabetes amongst people living in the Pacific island countries. The Foundation works in partnership with national governments, local health authorities, local eyecare workforce, wider non-communicable disease (NCD) and diabetes sector, academic and training institutions to strengthen DR services and improve referral pathways for diabetes patients in their respective countries. In addition, ongoing support from multiple funding partners and institutional donors continues to help us achieve the goal and objectives of the Fred Hollows Foundation NZ Pacific DR Programme.

Alongside strengthening the capacity, skill and sustainability of the DR workforce and provision of equipment and infrastructure, this integrative approach to service delivery helps strengthen DR treatment pathways and ensures the long-term sustainability of the programme in the region.

The Mobile Eye Clinic

Patients at the Mobile Eye Clinic are screened comprehensively for all eye conditions including DR. Patients diagnosed with DR are then referred to the nearest main hospital eye clinics for treatment and management to ensure continuity of services in the future.

CASE STUDY – 28-year-old Fiji Indian Origin

Patient History:

  • Duration of diabetes – 8 years
  • Attending regular general diabetes care for 5 years at a private GP clinic
  • Taking oral meds for DM control
  • Last CBG-17mmols
  • Previous retinal exam-None (patient informed us that she was not informed to have a retinal examination)

Eye examination:

  • VA-6/9 each eye, unaided

L/E, 6/9                                                                              R/E, 6/9





Reduced to 6/36 in two weeks

Reduced to 6/60 one month later

Blind three months later

Case Summary:

  • Young 28-year-old female with a history of poorly controlled diabetes, most likely Type 1 diabetes. The patient was consulting a GP for diabetes management but was never referred for an eye examination.
  • Patient only presented at the eye clinic when she noticed slight vision loss which was 6/9 unaided in each eye. Patient was diagnosed with proliferative DR in both eyes despite reasonably good vision.
  • Patient received pan retinal laser photocoagulation in both eyes because of the severity of diabetic retinopathy. Unfortunately, the right eye progressed fast to retinal detachment in 3/12. The left eye (slide 6 shows worsening of vision from 6/9 to 6/60 in just a month with more bleeding). So, despite laser treatment to both eyes, DR progressed very fast.
  • Patient was then referred for Vitreo-retinal (VR) surgery in India, but no improvement in vision was noted post-surgery.
  • This case study highlights the challenges of DR in Fiji, especially around the lack of DR awareness and having appropriate referral pathways. Our DR programme continues to prioritise these areas.

The Foundation is intending to purchase VR equipment and employ a VR specialist at the Pacific Eye Institute in 2021. This will ensure that more comprehensive DR treatment services are locally available for DR patients in Fiji.