Rapid assessment of avoidable blindness and diabetic retinopathy in people aged 50 years and older in the National Capital District of Papua New Guinea

Barriers to the uptake of eye care services: A cross-sectional survey from rural and urban communities

PURPOSE

To explore the barriers to the uptake of eye care services in urban and rural communities in Papua New Guinea.

METHODS

This was a population-based cross-sectional descriptive study and involved multi-stage sampling. Communities were randomly selected from each of the three clusters of Madang District for free eye care outreaches from June to September 2022. A structured questionnaire was used to collect data from the outreach patients. The study excluded attendees who refused to consent. Responses were rated from 1 (not a barrier) to 10 (a very strong barrier). The p-value significance was set at ≤ 0.05.

RESULTS

The majority of the 972 participants (60.2%) were from rural communities. The mean age of participants was 40.82 ± 13.14 years. Almost two-thirds of the participants (61.4%) never had an eye examination before this study was conducted. All the participants reported that time constraint, insufficient income, good vision in the fellow eye, not considering their eye conditions as serious issues and cultural beliefs were personal barriers to accessing eye care services. Provider-related challenges included long waiting periods at eye clinics and fear of procedure complications. There were differences in barriers with respect to the participants' demographic clusters.

CONCLUSION

There are major personal- and service-related barriers to eye care services in Madang. These barriers could be overcome through strategic human resource development, health education, school screening programs, and establishing eye care centres in the communities to improve the uptake of eye care services in Madang and more widely across the country.

Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low- and middle-income countries: a scoping review

BACKGROUND

Diabetes is a major public health concern, with approximately 80% of the burden falling on low- and middle-income countries (LMICs). Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes, and early detection through diabetic eye screening programmes is essential to prevent visual impairment and blindness. Careful planning at a national level is crucial for effective implementation of such programmes.

METHODS

A scoping review was conducted, and the protocol was published previously to explain the methods in detail. Data were collected from databases and searches, including grey literature. Furthermore, consultations were conducted with key informants from LMICs.

RESULTS

Lower-middle-income countries (29/50, 58%) and upper-middle-income countries (27/59, 45.8%) are making more progress than low-income countries (4/29, 13.8%) in terms of DR policy planning. However, no identified data for published policies have actually implemented national DR policies. Compared to low-income and lower-middle-income countries, upper-middle-income countries are making the most progress in implementing national diabetic eye screening programmes; however, their progress is still slow, with only 5/59 (8.5%) having such programmes.

CONCLUSION

There are significant gaps in the literature, with no data reported for 78/138 (56.5%) LMICs. Further research is clearly needed to support and document DR policy development in LMICs.

Knowledge and Awareness of Diabetes and Diabetic Retinopathy among Patients Seeking Eye Care Services in Madang Province, Papua New Guinea

Purpose. To assess the knowledge and awareness of diabetes and diabetic retinopathy among ophthalmic patients in Madang. Materials and Methods. This was a hospital-based study conducted at Madang Provincial Hospital Eye Clinic in Papua New Guinea. The study included all patients who visited the facility during the period of the study. A structured questionnaire was used to collect data on the patients’ demographics and their knowledge and awareness about diabetes and diabetic retinopathy. Results. A total of 203 (97.6%) patients consented and participated in the study out of 208 patients who were approached. The age of participants ranged from 19 to 78 years with a median (IQR) of 41 (53–29) years. 107 (52.7%) were female participants. A majority of the participants (62.6%) had at least secondary education. A few of the participants (3.9%) had known diabetes, and 134 (66%) had no relatives or friends with diabetes. A total of 145 (71.4%) participants knew that diabetes can affect the eye. Most of the participants (93.6%) checked their eyes only when their vision was affected, 161 (79.3%) agreed that regular eye checks are necessary, and more than half (54.2%) knew that diabetes can lead to blindness. Age, gender, level of education, and whether a participant or participant’s friends and relatives had been diagnosed with diabetes were significantly associated with the knowledge and awareness of participants about diabetes and diabetic retinopathy. Conclusion. A majority of the participants had good knowledge of diabetes and diabetic retinopathy. Health education and promotion will also help increase the awareness of diabetes and diabetic retinopathy in the country.

Prevalence of Risk Factors of Retinal Diseases among Patients in Madang Province, Papua New Guinea

PURPOSE

To explore the prevalence of risk factors of retinal diseases among patients seeking services from Madang Provincial Hospital Eye Clinic in Papua New Guinea.

MATERIALS AND METHODS

A hospital-based retrospective study was conducted at the only eye clinic serving the entire Madang province of Papua New Guinea. Purposive sampling was used to obtain data from patients' record cards at the eye clinic from January to June 2021. The data collected included gender, age, presenting visual acuity, blood pressure, blood sugar level, body mass index, smoking habits, and history of cataract surgery. The data was analyzed using the International Business Machines Corporation's Statistical Package for Social Sciences version 21. A p-value of <0.05 was considered statistically significant.

RESULTS

Two hundred and fifty-five (255) patients went through diabetes and hypertension screening during the period of the study (January to June 2021). The mean age of the patients was 53.14 ± 11.20 years and there were more males (56.86%) than females. Nearly half of the patients (43.6%) were either visually impaired or blind. More than half (52.6%) had diabetes mellitus. Majority of the patients (73.3%) were hypertensive and more than half (57.0%) of the patients had unhealthy body mass index (BMI <18.525 kg/m² or > 25 kg/m²). Overweight was significantly associated with hypertension (p < 0.001) and diabetes mellitus (p < 0.001). A few of them were smokers or had a history of cataract surgery (13.7% and 2.0%, respectively).

CONCLUSION

There is a high prevalence of diabetes, hypertension, and overweight among ophthalmic patients in Madang. It is important that measures are put in place to eliminate barriers to health care and to strengthen eye care services in Papua New Guinea.

MicroRNA-301a-3p promotes diabetic retinopathy via regulation of six-transmembrane epithelial antigen of prostate 4

OBJECTIVE AND DESIGN

Diabetic retinopathy (DR) is one of the most serious microvascular complications of diabetes mellitus (DM). MicroRNAs (miRNAs) have been discovered to play a crucial role in DR, but the mechanisms underlying the effects of miR-301a-3p on DR are poorly understood. This paper was designed to explore the possible role of miR-301a-3p in DR.

METHODS

The diabetic rat model was established by a single intraperitoneal injection of streptozotocin (STZ). The effects of miR-301a-3p on the biological functions of HRECs were determined through a series of experiments in vitro/vivo.

RESULTS

The results revealed that interference with miR-301a-3p could decrease the expressions of inflammatory factors and apoptosis in the retinal tissue of DR. Furthermore, it can alleviate the oxidative stress in DR serum, reduce VEGF expression, increase endothelial cell marker expression, and inhibit (High Glucose) HG-induced apoptosis of HRECs. Six-transmembrane epithelial antigen of prostate 4 (STEAP4) was the target of miR-301a-3p. All the effects of miR-301a-3p in DR model were reversed by STEAP4 inhibitor.

CONCLUSION

miR-301a-3p promotes diabetic retinopathy via regulation of STEAP4. The findings in this study may provide a vital reference for the drug research and development in DR treatment.

Rapid assessment of avoidable blindness-based healthcare costs of diabetic retinopathy in Hungary and its projection for the year 2045

BACKGROUND/AIMS

The purpose of this study was to estimate the total healthcare cost associated with diabetic retinopathy (DR) in the population aged 18 years and older in Hungary, and its projection for the year 2045.

METHODS

A cost model was developed based on the standardised rapid assessment of avoidable blindness with the diabetic retinopathy module (RAAB+DRM) methodology and recently reported prevalent-based cost of illness model. Projection for 2045 was made based on the estimation for increasing diabetes mellitus (DM) prevalence of the International Diabetes Federation. Costs were analysed from the perspective of the healthcare system and the patients. Our DR cost model was constructed according to the Scottish DR grading scale and based on the DR severity stadium.

RESULTS

The total DR-associated healthcare cost was US$145.8 million in 2016 and will increase to US$169.0 million by 2045. The two major cost drivers were intravitreal antivascular endothelial growth factor injections and vitrectomies in this study (US$126.4 million in 2016 and US$146.5 million in 2045); they amounted to 86.7% of the total treatment cost of DR. The DR-related cost per patient was US$180.5 in Hungary.

CONCLUSIONS

The cost per patient for treating DR was lower in Hungary than in other countries. Due to the increasing socioeconomic burden of proliferative DR and diabetes-related blindness, it would be important to invest in DR screening, prevention and early treatment. Our new RAAB-based cost of DR model may facilitate comparisons of DR treatment costs across countries.