Gullapalli Pratibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.
BMC Ophthalmol. 2014 Jun 24;14:81. doi: 10.1186/1471-2415-14-81.
Diabetes and its related microvascular complications like Diabetic retinopathy are showing an alarming rise in developing countries like Zanzibar. Objective of the present study is to evaluate the impact of integrating eye screening for all subjects attending the diabetes clinic at Mnazi Mmoja Hospital in Zanzibar and to estimate the prevalence of visual impairment and diabetic retinopathy among the subjects.
This is a cross sectional study involving 356 randomly selected patients who had attended the diabetes clinic between July and August 2012. All subjects underwent comprehensive eye examination including fundus evaluation after dilatation by a cataract surgeon and an ophthalmologist, independently. Data was collected using the designated questionnaire and analysed using the SPSS software. Blindness and visual impairment was defined as presenting VA <3/60 and <6/18 to 6/60 in the better eye respectively and DR was graded using the International classification of Diabetic Retinopathy severity grading scale.
A total of 356/967 subjects were recruited in a duration of 2 months; 176 (49.4%) were male and the mean age was 52.21 (SD 15.3). Targeted eye screening of diabetics showed that 231/356 (65%) of the subjects had eye problems, including potentially blinding conditions that required immediate intervention in contrast to the existing self reported referral where only 10% of an average of 200 diabetics underwent eye checkup in a year. The prevalence of visual impairment was 20.2%; 95% CI: 16.4-24.7 and blindness in 9.3%; 95% CI: 6.7 -12.7. The prevalence of DR was 28.3% and sight-threatening DR was reported in 9%. Among the DR cases, 30% had sight threatening DR including 28% macular edema, 2% severe NPDR and PDR. Multivariate analysis showed a higher risk for any DR in older subjects >50 years (OR: 2.19; 95% CI: 1.14 - 4.25) and in females (OR: 1.92; 95% CI: 1.07 - 3.44).
Opportunistic DR screening model achieved higher yield of identification of visual impairment and DR compared to the yield of 10% of existing self reported Diabetic eye screening model at Zanzibar. Integration of eye screening at diabetes clinics helps in early identification and provision of appropriate treatment for reducing blindness due to diabetes.
糖尿病及其相关微血管并发症，如糖尿病视网膜病变，在像桑给巴尔这样的发展中国家呈上升趋势。本研究的目的是评估对在桑给巴尔 Mnazi Mmoja 医院就诊的糖尿病患者进行全面眼部筛查的效果，并估计这些患者的视力障碍和糖尿病视网膜病变的患病率。
这是一项横断面研究，共纳入了 2012 年 7 月至 8 月期间在糖尿病诊所就诊的 356 名随机患者。所有患者均由白内障外科医生和眼科医生独立进行散瞳后眼底评估的全面眼部检查。使用指定的问卷收集数据，并使用 SPSS 软件进行分析。盲和视力障碍定义为最佳眼的视力分别<3/60 和<6/18 至 6/60，糖尿病视网膜病变的严重程度分级使用国际糖尿病视网膜病变严重程度分级标准。
在 2 个月的时间内共招募了 356/967 名患者；其中男性 176 名（49.4%），平均年龄为 52.21（SD 15.3）岁。对糖尿病患者进行的有针对性的眼部筛查显示，231/356（65%）名患者存在眼部问题，包括需要立即干预的潜在致盲情况，而现有的自我报告转诊中，每年只有 10%的平均 200 名糖尿病患者接受眼部检查。视力障碍的患病率为 20.2%；95%CI：16.4-24.7，失明的患病率为 9.3%；95%CI：6.7-12.7。糖尿病视网膜病变的患病率为 28.3%，并报告了 9%的威胁视力的糖尿病视网膜病变。在糖尿病视网膜病变病例中，30%的患者有威胁视力的糖尿病视网膜病变，包括 28%的黄斑水肿、2%的严重非增生性糖尿病视网膜病变和增生性糖尿病视网膜病变。多变量分析显示，年龄大于 50 岁的患者（OR：2.19；95%CI：1.14-4.25）和女性（OR：1.92；95%CI：1.07-3.44）发生任何糖尿病视网膜病变的风险更高。
与桑给巴尔现有的 10%自我报告的糖尿病眼病筛查模式相比，机会性糖尿病视网膜病变筛查模型在识别视力障碍和糖尿病视网膜病变方面的效果更高。在糖尿病诊所进行眼部筛查有助于早期发现，并提供适当的治疗，以减少因糖尿病导致的失明。
