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Das T, Islam K, Dorji P, Narayanan R, Rani PK, Takkar B, Thapa R, Moin M, Piyasena PN, Sivaprasad S. Health transition and eye care policy planning for people with diabetic retinopathy in south Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100435. [PMID: 38966677 PMCID: PMC11222815 DOI: 10.1016/j.lansea.2024.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/10/2024] [Accepted: 05/30/2024] [Indexed: 07/06/2024]
Abstract
The prevalence of type 2 diabetes (T2D), associated systemic disorders, diabetic retinopathy (DR) and current health policies in south Asian countries were analysed to assess country-specific preparedness to meet the 2030 Sustainable Development Goals. The south Asian countries were classified by human development index, socio-demographic index, multidimensional poverty indices, and eye health resources for epidemiological resource-level analysis. In south Asia, the prevalence of diagnosed and undiagnosed T2D in adults aged 40 years or above, was higher in Pakistan (26.3%) and Afghanistan (71.4%), respectively; India has the highest absolute number of people with DR, and Afghanistan has the highest prevalence of DR (50.6%). In this region, out-of-pocket spending is high (∼77%). This Health Policy is a situational analysis of data available on the prevalence of DR and common eye diseases in people with T2D in south Asia and available resources to suggest tailored health policies to local needs. The common issues in the region are insufficient human resources for eye health, unequal distribution of available workforce, and inadequate infrastructure. Addressing these challenges of individuals with T2D and DR, a 10-point strategy is suggested to improve infrastructure, augment human resources, reduce out-of-pocket spending, employ targeted screening, and encourage public-private partnerships.
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Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute- Srimati Kanuri Sathamma Centre for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Khaleda Islam
- Primary Health Care Director (Retired), Ministry of Health & Family Welfare, Bangladesh
| | - Phuntsho Dorji
- Gyalyum Kesang Choden Wangchuck National Eye Centre, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan
| | - Raja Narayanan
- Anant Bajaj Retina Institute- Srimati Kanuri Sathamma Centre for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Health Economics Research Centre, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Padmaja K. Rani
- Anant Bajaj Retina Institute- Srimati Kanuri Sathamma Centre for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Anant Bajaj Retina Institute- Srimati Kanuri Sathamma Centre for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Health Economics Research Centre, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Raba Thapa
- Department of Vitreous-Retina, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Muhammad Moin
- College of Ophthalmology & Visual Sciences, Department of Ophthalmology, King Edward Medical College University, Mayo Hospital, Lahore, Pakistan
| | - Prabhath N. Piyasena
- Centre for Public Health Institute of Clinical Sciences, Queen's University Belfast, Ireland
- Department of Vitreous-Retina, National Eye Hospital, Colombo, Sri Lanka
| | - Sobha Sivaprasad
- National Institute of Health and Care Research, Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, UK
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Bhandari G, Bhandari S, Byanju R, Pradhan S, Sah RK, Kandel RP, Thompson IJ, Rotchford AP, West SK, Muñoz B, Stevens VM, Oatts JT, Ou Y, Lietman TM, O’Brien KS, Keenan JD. Relationship Between Intraocular Pressure and Age: A Population-Based Study in Nepal. J Glaucoma 2023; 32:983-988. [PMID: 37670512 PMCID: PMC10840987 DOI: 10.1097/ijg.0000000000002291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/02/2023] [Indexed: 09/07/2023]
Abstract
PRCIS Intraocular pressure (IOP) decreased with age in a population-based study in Nepal, from a mean of 14.1 mm Hg among those 60-64 years old to 13.0 mm Hg among those 80 years old or older. PURPOSE Few studies have assessed the distribution of IOP from the Indian subcontinent, despite its large population and high burden of glaucoma. The objective of this study was to assess the distribution of IOP measurements from adults living in a lowland region of Nepal. METHODS In a population-based cross-sectional study, all individuals aged 60 years and older from an area of lowland Nepal were invited for an IOP assessment with a rebound tonometer. RESULTS Of 160 communities (28,672 people aged ≥60 y) enrolled, 79 (13,808 people aged ≥60 y) were randomly selected for IOP testing. Of those eligible, 10,017 (72.5%) individuals underwent tonometry. Mean IOP decreased monotonically over 5-year age groups, from 14.1 mm Hg (SD: 3.6) among those aged 60-64 years to 13.0 mm Hg (SD: 4.2) among those 80 years or older. The 97.5th percentile IOP measurement was 21.0 mm Hg for all age groups. In adjusted analyses, younger age, self-reported diabetes, and higher population density were each associated with higher IOP, and self-reported cataract surgery was associated with lower IOP. CONCLUSIONS Mean IOP was lower among older individuals in Nepal, consistent with many studies from East Asia and in contrast to many studies from western populations. These results suggest that ethnic background might be a consideration when diagnosing ocular hypertension.
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Affiliation(s)
| | | | | | | | | | | | - Isabel J Thompson
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Alan P Rotchford
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Gartnavel Hospital, Glasgow, UK
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Beatriz Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Valerie M Stevens
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Julius T Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kieran S O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Thapa R, Sharma S, Pradhan E, Duwal S, Poudel M, Shrestha KG, Paudyal GP. Prevalence and associated factors of diabetic retinopathy among people with diabetes screened using fundus photography at a community diabetic retinopathy screening program in Nepal. BMC Ophthalmol 2023; 23:429. [PMID: 37872518 PMCID: PMC10594880 DOI: 10.1186/s12886-023-03173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study aimed to assess the prevalence and associated factors of diabetic retinopathy (DR) and vision threatening DR (VTDR) among people with diabetes screened using fundus photography in Nepal. METHODS This is a retrospective study among people with diabetes presented for DR screening using fundus photography from 2013 to 2019. Detailed demographics, duration of diabetes, medical history, visual acuity, and grading of DR on fundus photography were analyzed. Fundus camera used in the study were;Topcon digital fundus camera 900 CXR and digital portable fundus cameras (Nidek-10 portable non-mydriatric fundus camera; Versacam & Trade & Alpha, France), and a Zeiss portable fundus camera (Zeiss Visucout 100). Macula centred and disc centred 45 degree two images were taken from each eye. Pupil were dilated in cases where there was media haze in un-dilated cases. DR was graded using early treatment diabetic retinopathy study criteria. The images were graded by fellowship trained retina specialist. DR prevalence included any DR changes in one or both eyes. RESULTS Total of 25,196 patients with diabetes were enrolled. Mean age was 54.2 years with Standard Deviation (S.D):12.9 years, ranging from 6 years to 97 years. Type 1 and type 2 diabetes comprised of 451 people (1.79%) and 24,747 (98.21%) respectively. Overall, 1.8% of the images were un-gradable. DR prevalence was 19.3% (95% Confidence Interval (CI): 18.8 - 19.7%). DR prevalence in type 1 and type 2 diabetes was 15.5% (95% CI: 12.5 - 18.6%) and 19.3% (CI: 18.8 - 19.8%) respectively. Clinically significant macular edema (CSME) was found in 5.9% (95% CI: 5.6-6.2%) and VTDR in 7.9% (95% CI: 7.7-8.3%). In multivariate analysis, our study revealed strong evidence to suggest that there is meaningful association between DR and VTDR with duration of diabetes, diabetic foot, diabetic neuropathy, agriculture occupation, those under oral hypoglycaemic agents or insulin or both as compared to those under diet only, and presenting visual acuity > 0.3LogMAR. CONCLUSION Prevalence and associated factors for DR and VTDR were similar to other DR screening programs in the region. Emphasis on wider coverage of DR screening could help for timely detection and treatment of STDR to avoid irreversible blindness.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, PO Box: 561, Nepal.
| | - Sanjita Sharma
- Tilganga Institute of Ophthalmology, Kathmandu, PO Box: 561, Nepal
| | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, PO Box: 561, Nepal
| | - Sushma Duwal
- Tilganga Institute of Ophthalmology, Kathmandu, PO Box: 561, Nepal
| | - Manish Poudel
- Tilganga Institute of Ophthalmology, Kathmandu, PO Box: 561, Nepal
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Shrestha R, Singh P, Dhakwa P, Tetali S, Batchu T, Thapa PS, Agiwal V, Pant H. "Augmenting the referral pathway for retinal services among diabetic patients at Reiyukai Eiko Masunaga Eye Hospital, Nepal: a non-randomized, pre-post intervention study". BMC Health Serv Res 2023; 23:126. [PMID: 36750897 PMCID: PMC9905012 DOI: 10.1186/s12913-023-09105-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an important public health issue in Nepal. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. DR screening uptake was low at Reiyukai Eiko Masunaga Eye Hospital(REMEH) since retina services were started. Scheer Memorial Hospital is a multispeciality hospital near to REMEH. It has no eye department but has been running a regular diabetic clinic. This was a site for referring diabetic patients for DR screening. Improving DR awareness among general physicians has the potential to address these challenges. METHODS The aim of our study was to investigate the effectiveness of providing health education to selected health personnel and establish a referral pathway on the attendance of diabetic patients for retinal screening at REMEH. This was a non-randomized, pre-post intervention study design. Total of three health education sessions were provided to the health care professionals of Scheer on diabetic retinopathy using Power Point presentations, posters, pamphlets and videos. The study period was 16 months (2020 June -2021 September) and divided into 8 months pre-intervention(baseline data collection) and 8 months post intervention period. The proportional increase in number of diabetes attendance pre and post intervention was calculated by Z test. The change in knowledge of health care personnels pre and post intervention was scored and evaluated through a questionnaire and calculated by paired- t test. Data was analyzed using Excel and Epi Info 7.The Protocol was published on August 21, 2021, in JMIR Publications. RESULTS The proportional increase in number of referrals of diabetes attendance post intervention increased from 50 to 95% and was statistically significant (p < 0.001, 95% CI: 0.214-0.688). The mean score of knowledge gained by physicians on DR awareness was more at post intervention (8.8 ± 1.32) than pre intervention (6.4 ± 1.51). It was statistically significant (p < 0.001). CONCLUSION This study shows that a well-planned health education intervention changes the knowledge in physicians about DR. There is an increase in the number of referrals and attendance of patients for DR screening with the change in knowledge and referral mechanism. TRIAL REGISTRATION Clinical Trials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 :02/04/2021.
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Affiliation(s)
- Ruchi Shrestha
- Reiyukai Eiko Masunaga Eye Hospital, Banepa, Kavre, Nepal.
| | - Prerana Singh
- Reiyukai Eiko Masunaga Eye Hospital, Banepa, Kavre Nepal
| | | | - Shailaja Tetali
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | - Tripura Batchu
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | | | - Varun Agiwal
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | - Hira Pant
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
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Cai K, Liu YP, Wang D. Prevalence of diabetic retinopathy in patients with newly diagnosed type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2023; 39:e3586. [PMID: 36286346 DOI: 10.1002/dmrr.3586] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/30/2022] [Indexed: 01/10/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) can remain undiagnosed for many years, during which micro- and macro-vascular complications may develop. This study aimed to assess the worldwide prevalence of diabetic retinopathy (DR) in patients with newly diagnosed T2DM. MATERIALS AND METHODS We systematically searched electronic databases for relevant studies published from inception to 01 January 2022. Selected studies reported the prevalence of DR among patients with newly diagnosed T2DM, specifying the case definition used. Random-effects meta-analysis was used to derive the pooled prevalence. Subgroup and meta-regression analyses were used to investigate variations in the prevalence estimates in terms of available variables. RESULTS Data from 77 studies including 99,847 patients with newly diagnosed T2DM were included from 26 countries. The pooled prevalence of DR among patients with newly diagnosed T2DM was 13.1% (95% CI, 11.1%-15.1%; I2 = 97.0%). DR was higher in clinic-based samples compared with community-based samples (15.0%, 95% CI = 12.4%-17.8% vs. 11.5%, 95% CI = 8.9%-14.5%; p = 0.05; I2 = 97.0%) and was higher in countries in the WHO African 19.2% (95% CI, 14.6%-24.3%; I2 = 76.0%), South-East Asia 15.4% (95% CI, 10.0%-21.6%; I2 = 79.1%), and European 15.0% (95% CI, 11.2%-19.2%; I2 = 82.0%) regions. A higher proportion of female patients was significantly associated with a lower prevalence of DR in patients with newly diagnosed T2DM. We observed that the prevalence of DR in patients with newly diagnosed T2DM has remained unchanged over time. CONCLUSIONS Globally, DR is a prevalent complication among patients with newly diagnosed T2DM indicating the importance of establishing effective strategies to promote regular screening for the early diagnosis of T2DM alongside routine ophthalmic assessment at the time of T2DM diagnosis to reduce the burden of vision-threatening retinopathy.
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Affiliation(s)
- Ke Cai
- School of Physical Education and Sport Sciences, Fujian Normal University, Provincial University Key Laboratory of Sport and Health Science, Fuzhou, China
| | - Yi-Ping Liu
- School of Physical Education and Sport Sciences, Fujian Normal University, Provincial University Key Laboratory of Sport and Health Science, Fuzhou, China
| | - Dan Wang
- School of Physical Education and Sport Sciences, Fujian Normal University, Provincial University Key Laboratory of Sport and Health Science, Fuzhou, China
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Pardhan S, Upadhyaya T, Smith L, Sharma T, Tuladhar S, Adhikari B, Kidd J, Sapkota R. Individual patient-centered target-driven intervention to improve clinical outcomes of diabetes, health literacy, and self-care practices in Nepal: A randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1076253. [PMID: 36742401 PMCID: PMC9893775 DOI: 10.3389/fendo.2023.1076253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To examine the effectiveness of a culturally and linguistically appropriate, patient-centered, target-driven lifestyle intervention with video education training in improving clinical outcomes, health literacy, and diabetic self-care practices in newly diagnosed patients in Nepal. METHODS A total of 110 participants with newly and consequently diagnosed Type 2 were randomly allocated into intervention (mean age = 45 ± 9.7 years) and control (mean age = 47 ± 12.5 years) groups. Intervention group participants were trained on a culturally and linguistically appropriate diabetic video education program and were given a customized dietary and physical activity plan with specific targets to practice at home. Participants' compliance was monitored weekly via telephone calls. Both groups received the usual treatment from their doctor and were followed up after three months. Outcome measures included changes in: i. diabetic health literacy, diet, and physical activity measured using self-reported questionnaires; and ii. blood glucose (glycated hemoglobin, HbA1c), cholesterol, blood pressure, body mass index, and visual acuity. Clinical outcome measures were blinded from randomization and intervention allocation. RESULTS After three months, HbA1c decreased to 6.1% from the baseline value of 7.2% in the intervention group compared to 6.6% in the control group from the baseline value of 7.1% (p <0.05). The intervention group had mean total cholesterol and low-density lipoprotein of 174 and 95.5 mg/dL, which were significantly lower than 186 and 107.5 mg/dL in the control group. Daily white rice consumption decreased by 36.5% in the intervention vs. 4% in the control group (p <0.05). After three months, the intervention group participants exercised more than the control group (p <0.05). All intervention group participants self-initiated retinal screening checks since the baseline visit among which 13% showed early diabetic retinopathy signs compared to 0% in the control group. Health literacy improvement in the intervention group was found to be sustained after three months too. CONCLUSIONS A culturally appropriate, target-driven lifestyle intervention with video education training is effective in improving clinical outcomes, health literacy, and self-care practice in newly diagnosed diabetic patients in Nepal, i.e., at a time period when effective diabetes control is vital to prevent further complications. The training intervention could be rolled out nationwide in order to reduce the risk of diabetic-related complications and improve people's quality of life and productivity.
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Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
- *Correspondence: Shahina Pardhan, ; Raju Sapkota,
| | - Tirthalal Upadhyaya
- Department of Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Tara Sharma
- Department of Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Sarita Tuladhar
- Department of Ophthalmology, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | | | - John Kidd
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Raju Sapkota
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
- *Correspondence: Shahina Pardhan, ; Raju Sapkota,
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Shah J, Cheong ZY, Tan B, Wong D, Liu X, Chua J. Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature. Nutrients 2022; 14:nu14235021. [PMID: 36501054 PMCID: PMC9735534 DOI: 10.3390/nu14235021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. The evidence connecting dietary intake and DR is emerging, but uncertain. We conducted a systematic review to comprehensively summarize the current understanding of the associations between dietary consumption, DR and diabetic macular edema (DME). We systematically searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials between January 1967 to May 2022 for all studies investigating the effect of diet on DR and DME. Of the 4962 articles initially identified, 54 relevant articles were retained. Our review found that higher intakes of fruits, vegetables, dietary fibers, fish, a Mediterranean diet, oleic acid, and tea were found to have a protective effect against DR. Conversely, high intakes of diet soda, caloric intake, rice, and choline were associated with a higher risk of DR. No association was seen between vitamin C, riboflavin, vitamin D, and milk and DR. Only one study in our review assessed dietary intake and DME and found a risk of high sodium intake for DME progression. Therefore, the general recommendation for nutritional counseling to manage diabetes may be beneficial to prevent DR risk, but prospective studies in diverse diabetic populations are needed to confirm our findings and expand clinical guidelines for DR management.
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Affiliation(s)
- Janika Shah
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
| | - Zi Yu Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-6322-4576; Fax: +65-6225-2568
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Shrestha P, Kaiti R, Shyangbo R. Blindness among Patients with Type II Diabetes Mellitus Presenting to the Outpatient Department of Ophthalmology of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:877-880. [PMID: 36705156 PMCID: PMC9924922 DOI: 10.31729/jnma.7702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Diabetic retinopathy is a major microvascular complication of diabetes, and may progress to sight-threatening stages causing blindness with a consequent decrease in their quality of life. This study aimed to find out the prevalence of blindness among patients with type II diabetes mellitus attending the Outpatient Department of Ophthalmology of a tertiary care hospital. Methods A descriptive cross-sectional study was conducted among patients with type II diabetes mellitus presenting to the Outpatient Department of Ophthalmology of a tertiary care centre from 2 August 2021 to 30 June 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 74/2021). Diabetic patients underwent detailed eye examination including vision, slit lamp biomicroscopy examination, and fundus evaluation with full pupil dilation. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among 449 type II diabetic patients, blindness was seen in 17 (3.79%) (2.02-5.56, 95% Confidence Interval) patients. Among them, 1 (5.88%) had severe non-proliferative diabetic retinopathy, 3 (17.65%) had proliferative diabetic retinopathy and 8 (47.06%) had severe diabetic macular oedema. Conclusions The prevalence of blindness among patients with type II diabetes mellitus was less than in other studies conducted in similar settings. Screening and timely management of diabetic retinopathy could reduce the prevalence of blindness due to diabetic retinopathy. Keywords blindness; diabetic retinopathy; prevalence.
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Affiliation(s)
- Pooja Shrestha
- Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal,Correspondence: Dr Pooja Shrestha, Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. , Phone: +977-9851082192
| | - Raju Kaiti
- Department of Optometry, Nepal Eye Hospital, Tripureshwor, Kathmandu, Nepal
| | - Ranjila Shyangbo
- Department of Optometry, National Academy of Medical Sciences, Mahaboudha, Kathmandu, Nepal
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Yasir M, Senthilkumar GP, Jayashree K, Ramesh Babu K, Vadivelan M, Palanivel C. Association of serum omentin-1, apelin and chemerin concentrations with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus patients. Arch Physiol Biochem 2022; 128:313-320. [PMID: 31686535 DOI: 10.1080/13813455.2019.1680698] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Omentin-1 is a novel adipokine with anti-inflammatory functions. Apelin is associated with hyperinsulinemia and pathological angiogenesis. Chemerin has both pro- and anti-inflammatory actions and implicated in insulin resistance and metabolic syndrome. The aim of this study was to assess serum omentin-1, apelin and chemerin concentrations and to investigate their association with the presence and severity of DR in T2DM patients. Serum omentin-1, apelin and chemerin were measured in 112 patients with DR and 56 patients without DR. Bivariate analysis showed omentin-1 correlated negatively with hsCRP and TyG index; while apelin correlated positively with chemerin. Linear regression data showed that apelin and chemerin were independent predictors of DR severity. ROC curve revealed that omentin-1 was the best discriminant for DR while apelin was the best discriminant for vision threatening retinopathy. Serum omentin-1 concentration correlates negatively, while serum apelin and chemerin concentrations correlate positively with DR presence and severity in T2DM patients.
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Affiliation(s)
- Md Yasir
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, India
| | | | - Kuppuswami Jayashree
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - K Ramesh Babu
- Department of Ophthalmology, JIPMER, Puducherry, India
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Shrestha R, Singh P, Dhakhwa P, Tetali S, Batchu T, Shrestha Thapa P. Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre-Post Intervention Study. JMIR Res Protoc 2021; 10:e33116. [PMID: 34927596 PMCID: PMC8726041 DOI: 10.2196/33116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Diabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges. Objective The aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal. Methods This is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7. Results The ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number # 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing. Conclusions Health education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal. Trial Registration ClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 International Registered Report Identifier (IRRID) DERR1-10.2196/33116
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Affiliation(s)
- Ruchi Shrestha
- Department of Vitreoretina, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
| | - Prerana Singh
- Department of Vitreoretina, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
| | | | - Shailaja Tetali
- Department of Research, Indian Institute of Public Health, Hyderabad, India
| | - Tripura Batchu
- Department of Research, Indian Institute of Public Health, Hyderabad, India
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11
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Hamati JN, Das AV, Prashanthi GS, Behera UC, Narayanan R, Rani PK. Factors protecting against diabetic retinopathy in a geriatric Indian cohort. Indian J Ophthalmol 2021; 69:3167-3172. [PMID: 34708765 PMCID: PMC8725154 DOI: 10.4103/ijo.ijo_1495_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Diabetic retinopathy (DR) is a potentially sight-threatening complication of diabetes mellitus. The majority of cases are in older adults. This study aims to evaluate modifiable and nonmodifiable protective factors against DR in a geriatric Indian population. Methods: This retrospective observational study uses data from a multitiered ophthalmology network to evaluate several demographic and clinical variables against diabetic retinopathy and visual acuity. Results: Our data show that high myopia, the female sex, and no cataract surgery are associated with lower prevalence of DR (OR = 0.21, 0.65, and 0.76, respectively; P < 0.001). We also found that among those with DR, people categorized as payers, retirees, and those living in urban or metropolitan areas have better visual acuity (OR = 0.65, 0.65, 0.83, and 0.73, respectively; P < 0.001). Among those with DR, females, presence of cataracts, and no cataract surgery had lower associations with sight-threatening DR (STDR) (OR = 0.68, 0.37, and 0.76, respectively; P < 0.001). Prevalence of DR decreased in older age groups while controlling for DM duration. Conclusion: It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.
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Affiliation(s)
- Jacquelyn N Hamati
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University; Department of Public Health, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Anthony Vipin Das
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gumpili Sai Prashanthi
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Umesh C Behera
- Department of Vitreoretinal Diseases, L. V. Prasad Eye Institute, Bhubaneshwar, Odisha, India
| | - Raja Narayanan
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja K Rani
- Smt. Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India, Indiaz
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Hashemi H, Rezvan F, Pakzad R, Ansaripour A, Heydarian S, Yekta A, Ostadimoghaddam H, Pakbin M, Khabazkhoob M. Global and Regional Prevalence of Diabetic Retinopathy; A Comprehensive Systematic Review and Meta-analysis. Semin Ophthalmol 2021; 37:291-306. [PMID: 34402390 DOI: 10.1080/08820538.2021.1962920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence. METHODS A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR. RESULTS Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I2 was 99% (p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity. CONCLUSION One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Farhad Rezvan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | | | | | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Rehabilitation Science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Pakbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Begum T, Rahman A, Nomani D, Mamun A, Adams A, Islam S, Khair Z, Khair Z, Anwar I. Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study. JMIR Public Health Surveill 2021; 7:e23538. [PMID: 33411671 PMCID: PMC7988391 DOI: 10.2196/23538] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/01/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. OBJECTIVE The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. METHODS This validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression. RESULTS In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P<.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (P=.04) with diabetic retinopathy. CONCLUSIONS Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.
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Affiliation(s)
- Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | | | | | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | | | | | - Zara Khair
- The Fred Hollow Foundation, Dhaka, Bangladesh
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Bhattarai MD, Thapa R, Bajracharya MR, Karki L, Karki BB, Rajouria AD. Fundus Photography as the Base of Three-Tier Diabetic Retinopathy Care System to Its Wider Roles: Learning from a Case Experience. JNMA J Nepal Med Assoc 2021; 59:100-107. [PMID: 34508452 PMCID: PMC7893383 DOI: 10.31729/jnma.5565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 11/28/2022] Open
Abstract
A case experience of initiating the ocular fundus photography (OFP) service in a diabetes outpatient clinic of a tertiary-care institution is presented. In the community and within the hospitals, the OFP helps to develop the three-tier diabetic retinopathy (DR) care system comprising: OFP-based DR screening and monitoring, an experienced ophthalmologist in laser therapy, and vitreo-retina specialist services. After three to six months of training, non-ophthalmic allied health professionals could also grade the DR. We also learned that such training program, however, requires broadening to encompass diabetes and major non-communicable diseases comprehensively to fulfill the need of the primary care nurses in health care settings and the full-time job and professional career for them. Medical students and residents now need to be 'directly' trained in the interpretation of OFP. The stakeholders involved in public health and medical education may recommend to the public hospitals and medical colleges for the provision of OFP service.
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Affiliation(s)
| | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | - Lochan Karki
- Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Budda B Karki
- Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Alark D Rajouria
- Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
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Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri BB, Paudel M, Paudyal G. Agreement and Diagnostic Test Accuracy on Grading Diabetic Retinopathy Using Fundus Photographs by Allied Medical Personnel at a Community Diabetic Retinopathy Screening Program in Nepal. Ophthalmic Epidemiol 2021; 28:509-515. [PMID: 33502930 DOI: 10.1080/09286586.2021.1877730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Diabetic retinopathy (DR) is a leading cause of blindness in low- and middle-income countries. This study aims to assess the agreement and diagnostic test accuracy of DR grading using fundus photographs by the allied medical personnel (AMP) as compared to ophthalmologist at DR screening program.Methods: Two 45 degree disc-centred and macula centred fundus photographs captured using digital fundus camera from 1344 eyes were graded by six AMP twice at three months and six months of training. DR grading was done using Early Treatment Diabetic Retinopathy Study criteria. Retina specialist grading was taken as the reference standard. Percentage agreement using kappa coefficient (k) and diagnostic test accuracy were assessed.Results: Intra-rater agreement of most AMP was almost perfect for detection of any DR and vision-threatening diabetic retinopathy (VTDR) at three and six months. Inter-rater agreement at 3 months at second grading was substantial for any DR (k = 0.62; 95% confidence interval (CI): 0.67-0.68) and VTDR (k = 0.63; 95% CI: 0.47-0.75). Inter-rater agreement in 6 months at second grading was also substantial for any DR (k = 0.66; 95% CI: 0.61-0.71) and VTDR (k = 0.64; 95% CI: 0.52-0.75). The sensitivity and specificity for any DR at second grading in 3 months was 94.99% and 63.97% and at 6 months was 95.55% and 66.91%, respectively.Conclusion: The inter-rater agreement of AMP as compared to ophthalmologists for any DR or VTDR was substantial at both 3 and 6 months. AMP can support as first-level DR graders for timely referral and treatment of VTDR.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Sanyam Bajimaya
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Eli Pradhan
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Sanjita Sharma
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Bal Bahadur Kshetri
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Manish Paudel
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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O'Brien KS, Stevens VM, Byanju R, Kandel RP, Bhandari G, Bhandari S, Melo JS, Porco TC, Lietman TM, Keenan JD. Cluster-randomised trial of community-based screening for eye disease in adults in Nepal: the Village-Integrated Eye Worker Trial II (VIEW II) trial protocol. BMJ Open 2020; 10:e040219. [PMID: 33060092 PMCID: PMC7566737 DOI: 10.1136/bmjopen-2020-040219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain important obstacles to addressing this burden. Leading causes of blindness like glaucoma, diabetic retinopathy and age-related macular degeneration have detectable early asymptomatic phases and can cause irreversible vision loss. Mass screening for such diseases could reduce visual impairment at the population level. METHODS AND ANALYSIS This protocol describes a parallel-group cluster-randomised trial designed to determine whether community-based screening for glaucoma, diabetic retinopathy and age-related macular degeneration reduces population-level visual impairment in Nepal. A door-to-door population census is conducted in all study communities. All adults aged ≥60 years have visual acuity tested at the census visit, and those meeting referral criteria are referred to a local eye care facility for further diagnosis and management. Communities are subsequently randomised to a community-based screening programme or to no additional intervention. The intervention consists of a single round of screening including intraocular pressure and optical coherence tomography assessment of all adults ≥60 years old with enhanced linkage to care for participants meeting referral criteria. Four years after implementation of the intervention, masked outcome assessors conduct a repeat census to collect data on the primary outcome, visual acuity. Individuals with incident visual impairment receive a comprehensive ophthalmological examination to determine the cause of visual impairment. Outcomes are compared by treatment arm according to the originally assigned intervention. ETHICS AND DISSEMINATION The trial has received ethical approval from the University of California San Francisco Institutional Review Board, Nepal Netra Jyoti Sangh and the Nepal Health Research Council. Results of this trial will be disseminated through publication in peer-reviewed journals and presentation at local and international meetings. TRIAL REGISTRATION NUMBER NCT03752840.
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Affiliation(s)
- Kieran S O'Brien
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Valerie M Stevens
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | | | | | | | | | - Jason S Melo
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
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Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri B, Paudyal G. Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal. Clin Ophthalmol 2020; 14:2731-2737. [PMID: 33061255 PMCID: PMC7518769 DOI: 10.2147/opth.s269002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist. Materials and Methods Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k). Results The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months. Conclusion Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.
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Affiliation(s)
- Raba Thapa
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Sanyam Bajimaya
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Eli Pradhan
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Sanjita Sharma
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | | | - Govinda Paudyal
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
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Thapa R, Khanal S, Tan HS, Thapa SS, van Rens GHMB. Prevalence, Pattern and Risk Factors of Retinal Diseases Among an Elderly Population in Nepal: The Bhaktapur Retina Study. Clin Ophthalmol 2020; 14:2109-2118. [PMID: 32801619 PMCID: PMC7399464 DOI: 10.2147/opth.s262131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Retinal diseases are an emerging cause of visual impairment in the developing world. The aim of this study was to explore the prevalence, pattern, and risk factors of retinal diseases in Nepal. Methods This is a population-based, cross-sectional study conducted from 2013 to 2015. The sample size was 2100 subjects age 60 years and above from 30 clusters of Bhaktapur district, Nepal. Detailed history, visual acuity, and anterior and posterior segment examinations were performed. Blood sugar and blood pressure were measured. Results Complete information was available for 1860 (88.57%) subjects. Mean age was 69.64±7.31 years, ranging from 60 to 95 years. The prevalence of any retinal disorder was 52.37% (95% confidence interval (CI): 50.07–54.66%). The prevalence of retinal disorders increased with ageing: 51.26% between 60 and 69 years and 53.05% among those age 80 years and above. Age-related macular degeneration (AMD) was the most common retinal disease (35.43%), followed by hypertensive retinopathy (4.35%), epiretinal membrane (ERM) (3.66%), branch retinal vein occlusion (BRVO) (2.90%), and diabetic retinopathy (DR) (2.15%). Other rare retinal disorders included myopic fundus (0.86%), chorioretinal scar (0.54%), retinal holes (0.32%), retinitis pigmentosa (0.32%), retinal detachment (0.16%), and coloboma (0.11%). In multivariate logistic regression analysis, those with prior cataract surgery (odds ratio (OR), 1.71; 95% CI: 1.32–2.22, p < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001–1.47, p = 0.049) had significantly increased retinal disorders. Conclusion Prevalence of retinal disorder was 52.37% at age 60 years and above. AMD, hypertensive retinopathy, ERM, BRVO, and DR were the most common retinal disorders. Retinal disorders increased with ageing. Retinal disorders were found associated with hypertension and prior cataract surgery. Timely screening, control of blood sugar and high blood pressure, and regular eye check-ups could help to save vision from retinal diseases.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Hendra Stevie Tan
- Department of Ophthalmology, Amsterdam University Medical Center, Vrije University Amsterdam, Amsterdam, the Netherlands
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Agroiya P, Alrawahi AH, Pambinezhuth F, Al Busaidi NB. Diabetic retinopathy among Omanis: Prevalence and clinical profile. Oman J Ophthalmol 2020; 13:76-83. [PMID: 32792802 PMCID: PMC7394070 DOI: 10.4103/ojo.ojo_225_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/13/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study is to describe the prevalence, severity and clinical profile of diabetic retinopathy (DR) among Omani diabetic patients attending a tertiary care hospital. MATERIALS AND METHODS This is a retrospective study involving the record review of diabetic patients attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and May 2016. Retinal evaluation of 442 native patients was conducted using direct ophthalmological examination and digital photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was conducted using SPSS, version 20. RESULTS The estimated total prevalence of DR was 31% (95% confidence interval: 26.6-35.3). Mild nonproliferative diabetic retinopathy (NPDR) constitutes 21.3%, while moderate-to-severe NPDR and proliferative diabetic retinopathy constitute 4.5% and 5.2%, respectively. The prevalence of vision-threatening diabetic retinopathy (VTDR) and diabetic maculopathy was 15.4% and 13.3%, respectively. Retinopathy was significantly associated with age, diabetes duration, Type 2 diabetes mellitus, coexisting comorbidities or complications, systolic blood pressure, glycated hemoglobin (HbA1c), fasting blood sugar, triglycerides, and albumin/creatinine ratio. In the regression analysis, age (P = 0.02), duration (P < 0.001), and HbA1c (P < 0.001) were independently associated with DR. CONCLUSIONS The prevalence of DR and VTDR among Omani diabetics is high. Age, duration of diabetes, and HbA1c are the risk factors for the development of DR among Omanis. This emphasizes the importance of planning resources for different modalities of treatment of DR to face the future challenge.
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Costa PCPD, Ribeiro E, Manzoli JPB, Ferreira RC, Botelho MTDSL, Duran ECM. USE OF THE TERMINOLOGICAL SUBSET "COMMUNITY NURSING" FOR HYPERTENSIVE AND/OR DIABETIC USERS. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to determine the accuracy measures of clinical indicators of nursing diagnoses contained in the Terminological Subset "Community Nursing" for hypertensive and/or diabetic users. Method: methodological diagnostic accuracy study. The study population consisted of 363 hypertensive and/or diabetic users under follow-up care in three Health Centers in the city of Campinas, from August 2017 to February 2018. Data were collected through anamnesis. Data analysis consisted of the characterization of the population through descriptive statistics, and the analysis of clinical indicators and their respective Nursing Diagnoses was performed through accuracy measures. Results: 25 Nursing diagnoses were listed, related to 37 clinical indicators, which could be used in the hypertensive and/or diabetic population. It is emphasized that three were not contained in the Terminological Subset "Community Nursing", and it is recommended that they be introduced in the International Council of Nurses. Conclusion: through the evaluation of accuracy measures, the Terminological Subset "Community Nursing" can and should be used in Brazil in the hypertensive and/or diabetic population.
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Sadat Mahmoudi Nezhad G, Razeghinejad R, Janghorbani M, Mohamadian A, Hassan Jalalpour M, Bazdar S, Salehi A, Molavi Vardanjani H. Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2019; 14:321-335. [PMID: 31660112 PMCID: PMC6815336 DOI: 10.18502/jovr.v14i3.4790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/06/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose
To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues. Methods
Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. Results A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI (P < 0.001), density of specialists (P = 0.004), subspecialists (P < 0.001), and sampling site (P = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C. Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
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Affiliation(s)
- Golnoush Sadat Mahmoudi Nezhad
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Mohsen Janghorbani
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mohamadian
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Jalalpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somaye Bazdar
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang Y, Shao Y, Shi WQ, Jiang L, Wang XY, Zhu PW, Yuan Q, Gao G, Lv JL, Wang GX. The predictive potential of altered spontaneous brain activity patterns in diabetic retinopathy and nephropathy. EPMA J 2019; 10:249-259. [PMID: 31462942 DOI: 10.1007/s13167-019-00171-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/12/2019] [Indexed: 12/14/2022]
Abstract
Objective The amplitude of low-frequency fluctuation (ALFF) fMRI technique was used to study the changes of spontaneous brain activity in patients with diabetic retinopathy and nephropathy (DRN), and to explore the application of ALFF technique in the potential prediction and the targeted prevention of diabetic microangiopathy. Methods Nineteen patients with diabetic retinopathy and nephropathy and 19 healthy controls (HCs) were matched for age and gender. Spontaneous cerebral activity variations were investigated using the ALFF technique. The average ALFF values of the DRN patients and the HCs were classified utilizing receiver operating characteristic (ROC) curves. Results In contrast to the results in the HCs, the patients with DRN had significantly higher ALFF values in the cerebellum (bilaterally in the posterior and anterior lobes) and the left inferior temporal gyrus, but the ALFF values of the bilateral medial frontal gyrus, right superior temporal gyrus, right middle frontal gyrus, left middle/inferior frontal gyrus, bilateral precuneus, and left inferior parietal lobule were lower. ROC curve analysis of each brain region showed the accuracy of AUC was excellent. However, the mean ALFF values in the different regions did not correlate with clinical performance. The subjects showed abnormal neuronal synchronization in many areas of the brain, which is consistent with cognitive and visual functional deficits. Conclusion Abnormal spontaneous activity was detected in many areas of the brain, which may provide useful information for understanding the pathology of DRN. Abnormal ALFF values of these brain regions may be of predictive value in the development of early DRN and be a targeted intervention indicator for individualized treatment of diabetic microvascular diseases.
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Affiliation(s)
- Yu Wang
- 1Department of Nephrology, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, Nanchang, 330006 Jiangxi People's Republic of China
| | - Yi Shao
- 2Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Wen-Qing Shi
- 2Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Lei Jiang
- 1Department of Nephrology, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, Nanchang, 330006 Jiangxi People's Republic of China
| | - Xiao-Yu Wang
- 1Department of Nephrology, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, Nanchang, 330006 Jiangxi People's Republic of China
| | - Pei-Wen Zhu
- 2Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Qing Yuan
- 2Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Ge Gao
- 3Department of General Surgery, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, Nanchang, 330006 Jiangxi People's Republic of China
| | - Jin-Lei Lv
- 1Department of Nephrology, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, Nanchang, 330006 Jiangxi People's Republic of China
| | - Gong-Xian Wang
- 4Department of Urinary Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
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