Department of Ophthalmology, Duke University, Durham, NC, USA.
Department of Ophthalmology, Bugando Medical Center, Mwanza, Tanzania.
Trop Med Int Health. 2020 Oct;25(10):1214-1225. doi: 10.1111/tmi.13463. Epub 2020 Aug 3.
Little is known about the retinal manifestations of arterial hypertension (HTN) and diabetes mellitus (DM) in Western Tanzania and how to maximise the utilisation of scarce eye health resources. To address this, we determined the prevalence of hypertensive and diabetic retinopathy (DR), associated risk factors and relevant patient knowledge.
Adults with HTN or DM attending outpatient clinics at Bugando Medical Center (BMC) from June to August 2017 were enrolled. Fundus photographs were obtained, and data were collected on blood pressure (BP), body mass index (BMI), blood sugar, visual acuity (VA) and responses to questions about the effects of HTN and DM on the eye.
A total of 180 persons were screened. When only individuals with DR were considered, bivariate regression found systolic BP was significantly associated with severity of DR (P = 0.034). Receiver operating characteristic (ROC) curve analysis using the maximum Youden index revealed the optimum cut-off using duration of DM to predict any DR was 8 years (AUC = 0.75, 95% CI 0.65-0.85). Fewer persons with HTN were aware of the effect of high BP on the eye (61.6%) than persons with DM who were aware of the effect of high blood sugar on the eye (74.4%) (P = 0.048).
Efforts should be made to vigorously treat HTN among adults with DM and refer adults with duration of DM of 8 years or more for a dilated retinal examination. Additional efforts should be made to promote awareness of the sight threatening potential of HTN in resource-limited settings.
在坦桑尼亚西部，关于动脉高血压（HTN）和糖尿病（DM）的视网膜表现知之甚少，以及如何最大限度地利用稀缺的眼部健康资源。为此，我们确定了高血压性和糖尿病性视网膜病变（DR）的患病率、相关危险因素和相关患者知识。
2017 年 6 月至 8 月期间，在布干达医疗中心（BMC）门诊就诊的 HTN 或 DM 成人患者入选本研究。获取眼底照片，并收集血压（BP）、体重指数（BMI）、血糖、视力（VA）和关于 HTN 和 DM 对眼睛影响的问题的答案。
共筛选了 180 人。仅考虑有 DR 的个体时，双变量回归发现收缩压与 DR 的严重程度显著相关（P=0.034）。使用最大 Youden 指数的接收器操作特性（ROC）曲线分析显示，使用 DM 持续时间来预测任何 DR 的最佳截断值为 8 年（AUC=0.75，95%CI 0.65-0.85）。高血压患者中意识到高血压对眼睛的影响的人（61.6%）比糖尿病患者中意识到高血糖对眼睛的影响的人（74.4%）少（P=0.048）。
应努力积极治疗患有 DM 的成年人中的 HTN，并将 DM 持续时间为 8 年或以上的成年人转诊进行散瞳视网膜检查。在资源有限的情况下，应进一步努力提高对 HTN 威胁视力的潜在风险的认识。
