The Silent Thief of Sight: Diabetic Retinopathy Threatens Ghana's Vision

As Ghana joins the global community in observing Diabetic Eye Disease Awareness Month this November, a sobering reality confronts the nation: diabetic retinopathy has emerged as one of the leading causes of preventable blindness among working-age adults, yet most Ghanaians living with diabetes remain unaware of the silent damage occurring in their eyes.

Recent research paints an alarming picture. Diabetic retinopathy prevalence was highest in Africa (35.90%) compared to all other global regions, with studies in Ghana revealing that cataract was the commonest anterior segment finding (56.4%), while non-proliferative diabetic retinopathy was the commonest posterior segment finding (31%) among diabetic patients examined.

Diabetic retinopathy is a complication of diabetes mellitus that damages the blood vessels in the retina—the light-sensitive tissue at the back of the eye that is essential for vision. The condition develops gradually and often shows no symptoms in its early stages, earning it the moniker "the silent thief of sight."

It is estimated that 35% of people with diabetes have some diabetic retinopathy and about 10% have vision-threatening diabetic retinopathy (VTDR), either proliferative DR or diabetic macula oedema. These statistics translate into millions of people across Africa, including hundreds of thousands in Ghana, who are at risk of losing their sight.

The diabetes epidemic sweeping across Africa creates a perfect storm for an explosion in diabetic eye disease. The number of people with diabetes mellitus in sub-Saharan Africa is projected to increase from 19.4 million in 2019 to 47.1 million by 2045.

All people with diabetes are at risk of developing diabetic retinopathy, and so the magnitude of DR will increase proportionally to the increase in diabetes. This projection means that Ghana must prepare for a dramatic increase in diabetic retinopathy cases over the next two decades—unless urgent action is taken now.

The global picture is equally concerning. Among individuals with diabetes, global prevalence was 22.27% for diabetic retinopathy, 6.17% for vision-threatening DR, and 4.07% for clinically significant macular edema. By 2045, the numbers are projected to increase to 160.50 million, 44.82 million, and 28.61 million, respectively.

Ghana's position within the African region, which has the world's highest diabetic retinopathy prevalence, means the country faces particularly acute challenges in preventing and managing this sight-threatening condition.

Most people don't experience symptoms until significant damage has already occurred. By the time vision problems become noticeable, the disease may have advanced to stages requiring intensive treatment or may have caused irreversible damage.

Most blindness caused by diabetic retinopathy can be prevented through early detection and treatment of vision-threatening DR as recommended by WHO. Yet in Ghana and across sub-Saharan Africa, screening services remain a challenge where access to eye care professionals is inadequate.

Once diabetic retinopathy reaches the proliferative stage, progression can be rapid and devastating. Without treatment, half of patients with proliferative diabetic retinopathy lose their sight within five years—yet many Ghanaians with diabetes have never had their eyes examined. Ghana's healthcare infrastructure faces significant challenges in addressing the diabetic retinopathy crisis, creating dangerous gaps between what patients need and what the system can provide.

Even when diabetic retinopathy is detected, access to treatment presents another formidable barrier. Studies from Ghana report outcomes and challenges of using anti-VEGF injections for the treatment of diabetic macular edema, revealing that while effective treatments exist, their availability and affordability remain limited.

The price of recommended diabetic retinopathy treatments (anti-VEGF injection and retinal laser photocoagulation) varies significantly across different settings, facility types, and regions in Ghana. The average price in the Greater Accra region was more than two times higher compared to that in the Ashanti region, creating geographic disparities in treatment access.

Comparison of treatment costs to average annual incomes reveals a harsh reality: many Ghanaian families simply cannot afford the treatments that could save their loved ones' sight, even when those treatments are available.

Ghana has a national health plan covering primary prevention of blindness; community awareness and patient education; clinical care, services, and supplies; and some complications but not including visual impairment. This gap in the national plan, combined with the concentration of specialized diabetic retinopathy services in major urban centers, leaves rural populations particularly vulnerable.

November's Diabetic Eye Disease Awareness Month 2025 arrives at a critical juncture for Ghana. The diabetes epidemic is accelerating, the diabetic retinopathy burden is growing, and the healthcare system faces significant gaps—yet the window for preventing a blindness crisis remains open.

The projection of diabetes cases nearly doubling in sub-Saharan Africa by 2045 means that without action now, Ghana will face an exponential increase in diabetic retinopathy and preventable blindness over the coming decades. The young people already going blind in their teens and twenties represent just the beginning of what could become a devastating wave of vision loss.

But this future is not inevitable. Most blindness caused by diabetic retinopathy can be prevented. The interventions that work includes screening, early detection, glycemic control, and timely treatment, are well established. What Ghana needs is the political will, resource allocation, and systematic implementation to make these interventions universally accessible.

This November, as Ghana observes Diabetic Eye Disease Awareness Month 2025, the message must be clear: awareness without action changes nothing. Every diabetic Ghanaian needs access to regular eye screening. Every person at risk needs to understand that blindness from diabetes is preventable. Every healthcare facility managing diabetes must integrate eye care into routine services.

The silent thief of sight is stealing vision from Ghanaians right now, at this moment, as blood vessels in countless eyes slowly deteriorate without symptoms or warning. But unlike a physical thief, this thief can be stopped—if Ghana chooses to act. See your eye doctor. Save your sight..

Osei Boaitey, PhD/ OD/ MPH/ MCHES
osei.boaitey@yahoo.com

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