Dr.Vijaya Jojo, V16880, Dr. Sushil Bajoria, Dr.
Surendra Prasad Jakhanwal
Aim – India currently has a diabetic load of 69.5 million 1and is soon headed to be the diabetic capital of the world. Various studies have shown the prevalence of diabetic retinopathy 9.23%-35.12% 2 with awareness noted to vary at around 40% .3
We aimed to look at the awareness of this disease among our population and try to analyse the possible factors and outcomes of the same. We also hoped to get some more insight as to how we can propagate simple plans to cut across this challenge of patient awareness
Materials and Methods – A prospective study was conducted in the Ophthalmology department from January 1st till March 31st2016, wherein diabetic patients who came in for routine eye check-up or with any complaints were evaluated in detail. A diabetic retinopathy screening form was created wherein, the age, sex, duration of Diabetes, visual acuity, fundus changes and awareness of diabetic retinopathy was noted using standard ETDRS classification system .Patients were also queried as to the reasons for not having a retinopathy screening done.
All findings documented as well as discussed with patients.
Results–195 patients were evaluated in this time period. The mean age group was 57.2years and there was a male to female ratio of 1.4 :1.
The overall awareness of diabetic retinopathy was noted at 29%.
52 % of the patients did not have diabetic retinopathy while 20.5% had severe non Proliferative or worse in one or other eye.
71% of patients insisted that they did not have any visual acuity problems and hence never got their eye check-up done.
47.8% patients mentioned that no medical professional had suggested a retinopathy evaluation. Other reasons mentioned were poor physical health to come for check-up and no relative to accompany them being 7.2% and 8.69% respectively.
Another frightening finding was that 19.6% patients who were not aware of diabetic retinopathy had severe NPDR or worse meaning that they had a good chance to lose vision in the near future with a further note that 51% of this group had presented with sudden vision loss in one or other eye.
Discussion-
Diabetic retinopathy is a dreaded complication of the disease due its silent nature.
Our study shows a very worrying trend of low diabetic retinopathy awareness. A further analysis reveals thesilent nature of the disease itself delaying patients from coming in for a screening.
As we note 68 % of our patients had a best corrected visual acuity of 6/9 and 71% had a visual acuity of 6/18 or better or better supporting our patients’ claim that they did not have any eye problems to warrant an eye examination.
As per the standard ETDRS study4 we know that the patients with severe NPDR have a 15 % chance of progression to high risk PDR with the risk increasing to 45 % if the patient had very severe NPDR.It is worrying to note that 19.6 % patients who were not aware of diabetic retinopathy already had severe NPDR or worse in one eye with potential to progress to PDR within a year. In fact more than 50% of the above group had sadly already come in for their eye visit with sight loss in one or other eye totally unaware of the underlying changes that led to the same.
The other important factor seemed to be the fact that the patientsin themselves were not made aware by medical professional about the need for screening. This is an issue which we as medical professional need to work on. We need to formulate a system much akin to the developed countries such as the UK towards working for a centralized national system of screening all patients for diabetic retinopathy thereby avoiding this situation .Also we need to keep reminding ourselves and our colleagues about highlighting the importance of diabetic retinopathy screening.
Conclusion – The poor awareness of this blinding but preventable and treatable disease is well seen in our study. On the basis of our study we have made some necessary changes to improve the awareness as well as the screening by mandatory retinal evaluation of inpatients irrespective of the condition they were admitted with.Provision of a coloured diabetic retinal screening card with a brief note on the date screened, the grade of diabetic retinopathy ,the follow up date and information leaflet regarding the diabetic eye disease in easy question answer format post screening.
This is a small study however the implications are huge and we plan to take this forward in a bigger way in the time to come. We feel it might also be a good idea to take this at a national level so that we have a uniform system in place to tackle this growing threat.
References:
- International Diabetes federation Publication (IDF)
- Salil S Gadkari, Quresh B Maskati, Barun Kumar Nayak :Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014:Indian Journal of Ophthalmol; 2016; 64 (1) 38-44.
- Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A et al, Awareness and knowledge of diabetes in Chennai – The Chennai Urban Rural Epidemiology Study [CURES-9]. J Assoc Physicians India 2005;53:283-7.
- Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991 May;98(5 Suppl):766-85.