DR often starts without noticeable symptoms but can progressively lead to vision problems. As it advances, patients may experience blurred vision, difficulty seeing at night, and dark or empty spots in their visual field. In severe cases, there may be sudden vision loss due to bleeding in the retina (vitreous haemorrhage) or retinal detachment. Swelling of the retina (macular oedema) may also cause distortion of central vision. Early detection through regular eye exams is crucial for preventing significant vision impairment.

Clinical findings of DR include microaneurysms, retinal haemorrhages, and cotton wool spots, which are signs of retinal damage. As the disease progresses, more severe changes such as neovascularization, macular oedema, and vitreous haemorrhage may occur. Advanced cases may also show retinal detachment and proliferative lesions, leading to vision loss.

These include hypertensive retinopathy, which presents with similar retinal changes like haemorrhages and cotton wool spots. Retinal vein occlusion can also mimic diabetic retinopathy, causing sudden vision loss and retinal haemorrhages. Age-related macular degeneration (AMD) may present with vision impairment and macular changes, while retinal vasculitis and ocular ischemic syndrome can cause retinal damage and vision disturbances similar to diabetic retinopathy. Lastly, sickle cell retinopathy should be considered in patients with a history of sickle cell disease, as it can cause retinal ischemia and neovascularization.

 Management of diabetic retinopathy focuses on controlling blood sugar, blood pressure, and cholesterol levels to slow disease progression. Regular eye exams are crucial for early detection and monitoring. For more advanced stages, treatments such as laser photocoagulation may be used to prevent further retinal damage, while intravitreal injections of anti-VEGF agents help reduce macular oedema and neovascularization. In severe cases, vitrectomy surgery may be required to address vitreous haemorrhage or retinal detachment. Lifestyle changes, including diet, exercise, and smoking cessation, are also important in managing overall diabetes and reducing the risk of complications.

Limited Healthcare infrastructure: Many countries in sub-Saharan Africa lack specialized facilities and trained Ophthalmologists to diagnose and manage diabetic retinopathy. Also access to basic eye care services in rural area is extremely limited

Late Diagnosis: Low awareness, poor access to screening service, diabetic retinopathy is often diagnosed at advanced stages when treatment options are limited and less effective

High cost of Treatment: Laser therapy, anti-VEGF injections, and vitrectomy are expensive and not widely available in many public health systems. This makes treatment inaccessible for many patients, leading to higher rates of preventable blindness.

Lack of Awareness and Screening programs: Public awareness of diabetic retinopathy and the need for regular eye check-ups is low, and there are limited screening programs. Patients with diabetes are not aware of the risks of diabetic retinopathy, and healthcare providers may not prioritize routine examination

Unavailability of Resources: Even in countries where Diabetic retinopathy treatment is available, resources such as equipment and medications may not be relatively available, thus limiting the number of patients who can be treated effectively

Increasing public awareness: Public health campaigns to increase awareness of the link between diabetes and eye health through community outreach, media, and health education. This can encourage more people to go for screening

Organizing screening programs: Establishing cost-effective screening especially in rural areas, can help identify cases of diabetic retinopathy early. Placement of fundus cameras in strategic places can aid the use of telemedicine to reach underserved population

Training and Capacity Building: Training of healthcare workers to screen for and manage diabetic retinopathy can improve early detection and proper referral for treatment

Improving Access to Treatment: Making treatment like laser photocoagulation and anti-VEGF injections more accessible and affordable through partnerships with governments, NGOs and pharmaceutical companies can reduce the number of people going blind from diabetic retinopathy

Integration into Diabetes care: Integrating regular eye exams into the standard care protocol for diabetes patients would help detect diabetic retinopathy early and improve outcomes

Addressing diabetic retinopathy in sub-Sahara Africa requires a multi-faceted approach that combines public health interventions, better health care infrastructure and access to quality eye care service