ARVO 2023: Friedenwald Award and Lecture – The Diabetic Retinopathy Pandemic and Evolving Global Strategies Prof Tien Wong, MD, PhD, FARVO

Dr Tien-En Tan, MBBS(Hons), FRCOphth
Singapore National Eye Centre, Singapore Eye Research Institute, Singapore

At the 2023 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Professor Tien Wong was conferred the 2023 Freidenwald Award and Lecture, for outstanding research in the field of diabetic retinopathy. Following an introduction by Professor Neil Bressler, Professor Tien Wong’s talk highlighted the challenges and scale of the global DR pandemic, and outlined broad strategies for tackling this problem.

Professor Wong likened the disease burden of DR to that of a “pandemic”, in particular pointing out that the disease is a global problem, and does not spare any particular racial group or population. He also showed data from epidemiologic studies and meta-analyses that project continued increases in the global burden of disease.

He suggested that to tackle the DR pandemic, as a community we need to focus on three broad strategies, aimed particularly at the secondary prevention of DR and its complications. First, we need better understanding of the public health challenges of DR. Current challenges include significant gaps in disease awareness, even in developed countries, and uniformly poor systemic risk factor control, despite the well-established benefits for DR outcomes. Second, we need to identify and validate novel biomarkers for DR onset and progression. Technology development in ocular imaging and artificial intelligence have allowed for the identification of potential biomarkers such as retinal neural dysfunction and degeneration, imaging biomarkers from OCT, OCTA, and ultra-widefield imaging, as well as AI-based retinal vessel assessments and hypothesis-free AI-based risk stratification.

Finally, we should focus on better screening strategies for DR. He highlighted examples of successful large-scale national DR screening programs around the world, and in particular shared the experience from Singapore. He described the establishment of a national tele-ophthalmology DR screening program in Singapore, and how the integration of AI-based DR screening tools can help to improve the efficiency and sustainability of the system. He concluded with the assertion that global, systems-wide strategies are needed to effectively tackle the DR pandemic.