Quinn Nicola, Yang Feibi, Ryan Christopher, Bursell Sven-Erik, Keech Anthony, Atkinson-Briggs Sharon, Jenkins Alicia, Brazionis Laima
NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2021 Nov;51(11):1897-1905. doi: 10.1111/imj.14971. Epub 2021 Oct 24.
Diabetic retinopathy (DR) prevalence is higher in Indigenous Australians than in other Australians and is a major cause of vision loss. Consequently, timely screening and treatment is paramount, and annual eye screening is recommended for Indigenous Australians.
To assess the prevalence of DR, reduced vision and DR treatment coverage among Indigenous Australian adults with diabetes attending Top End indigenous primary care health services.
A cross-sectional DR screening study conducted from November 2013 to December 2015 in two very remote Northern Territory Aboriginal primary healthcare services.
In 287 subjects, the prevalence of non-proliferative DR, proliferative DR and clinically significant diabetic macular oedema was 37.3%, 5.4% and 9.0% respectively. Treatment coverage for PDR was 60% (of 10 patients) and for CSMO was 17% (of 23 patients). Vision data were available from 122 participants at one site. The proportion with normal vision, reduced vision, impaired vision and blindness was 31.1%, 52.5%, 15.6% and 0.8% respectively. Overall, ungradable monocular image sets (46%) were associated with poorer quality images and missing protocol images (both P < 0.001). Ungradable images for DR were associated with presence of small pupils/media opacities (P < 0.001). Ungradable images for diabetic macular oedema were associated with poorer image quality (P < 0.001), cataracts (P < 0.001) and small pupils (P = 0.04).
A high prevalence of DR, CSMO and impaired vision was noted in Indigenous Australians with diabetes. Screening in primary care is feasible, but more effective screening methods are needed.
澳大利亚原住民糖尿病视网膜病变（DR）的患病率高于其他澳大利亚人，是视力丧失的主要原因。因此，及时筛查和治疗至关重要，建议澳大利亚原住民每年进行眼部筛查。
评估在顶端地区原住民初级保健卫生服务机构就诊的患有糖尿病的澳大利亚原住民成年人中DR、视力下降和DR治疗覆盖率的情况。
2013年11月至2015年12月在北领地两个非常偏远的原住民初级卫生保健服务机构进行了一项横断面DR筛查研究。
在287名受试者中，非增殖性DR、增殖性DR和临床显著性糖尿病黄斑水肿的患病率分别为37.3%、5.4%和9.0%。增殖性DR的治疗覆盖率为60%（10名患者中的），临床显著性黄斑水肿的治疗覆盖率为17%（23名患者中的）。在一个地点有122名参与者的视力数据。视力正常、视力下降、视力受损和失明的比例分别为31.1%、52.5%、15.6%和0.8%。总体而言，无法分级的单眼图像集（46%）与图像质量较差和方案图像缺失有关（两者P < 0.001）。DR的无法分级图像与小瞳孔/介质混浊有关（P < 0.001）。糖尿病黄斑水肿的无法分级图像与图像质量较差（P < 0.001）、白内障（P < 0.001）和小瞳孔（P = 0.04）有关。
在患有糖尿病的澳大利亚原住民中，DR、临床显著性黄斑水肿和视力受损的患病率较高。在初级保健中进行筛查是可行的，但需要更有效的筛查方法。
