scholarly journals Cukorbetegség és retinopathia diabetica regionális egyenlőtlenségei Magyarországon az 50 éves és idősebb korú lakosság körében

2017 ◽  
Vol 158 (10) ◽  
pp. 362-367 ◽  
Author(s):  
Gábor Tóth ◽  
Dorottya Szabó ◽  
Gábor László Sándor ◽  
Anita Pék ◽  
Irén Szalai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Rapid Assessment ◽  
Fundus Examination ◽  
Eye Care ◽  
Care Services ◽  
Eye Screening ◽  
Retinopathia Diabetica

Abstract: Introduction: Diabetes mellitus (DM) is one of the main causes of blindness among persons aged 50 years and older. Aim: The purpose of our survey was to estimate the prevalence of DM and diabetic retinopathy (DR), as well as to assess the coverage of diabetic eye care services in different regions of Hungary. Method: In 105 clusters, 3675 people aged 50 years and older were included in the survey. The standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used to examine the participants. Thereafter, differences between West-, Middle- and East-Hungary were analysed. Results: Prevalence of DM was higher in East-Hungary (20.9%), than in West- (19.5%) and in Middle-Hungary (19.5%). Prevalence od DR was higher in West-Hungary (24.1%), than in Middle- (17.8%) and in East-Hungary (19.6%). Proportion of participants who never had a fundus examination for DR was the lowest in Middle-Hungary (19.1%). Conclusions: Primary care should be strenghten mainly in country settlements or telemedical eye screening program should be started to decrease the prevalence of diabetic eye complications. Orv. Hetil., 2017, 158(10), 362–367.

Diabetes and blindness in people with diabetes in Hungary

2018 ◽  
Vol 29 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Gábor Tóth ◽  
Dorottya Szabó ◽  
Gábor L Sándor ◽  
Zoltán Z Nagy ◽  
Sehnaz Karadeniz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Visual Impairment ◽  
Rapid Assessment ◽  
High Rate ◽  
Undiagnosed Diabetes ◽  
Eye Screening ◽  
National Representative Survey ◽  
Prevalence Of Diabetes Mellitus ◽  
Undiagnosed Diabetes Mellitus

Introduction: The purpose of the study was to estimate the number of people with diabetes mellitus, the prevalence of diabetes mellitus and the prevalence of blindness and severe visual impairment among people with diabetes mellitus in Hungary based on our recent national representative survey. Methods: Altogether 105 clusters of 35 people aged 50 years or older were randomly selected. Standardized rapid assessment of avoidable blindness with the diabetic retinopathy module was used. Each individual received a visual acuity assessment, and every person with diabetes mellitus underwent dilated fundus examination. Results: The estimated number of people with diabetes mellitus was 807,885 in the adult (⩾18 years) population in Hungary with 9.9% prevalence. Diabetic retinopathy exhibited an increasing tendency with age. The prevalence rates of blindness and severe visual impairment in people with diabetes mellitus aged ⩾50 years were 1.0% and 0.9%, respectively. Diabetic retinopathy was responsible for 28% of blindness and 50% of severe visual impairment among participants aged ⩾50 years with diabetes mellitus. Conclusion: The estimated number of people with diabetes mellitus and prevalence of diabetes mellitus were lower than those recently reported. However, if we extend our estimation, prevalence of undiagnosed diabetes mellitus may be higher and thus prevalence of diabetes mellitus may reach a higher value (between 9.9% and 13.4%). Because of the high number of ophthalmologically uncontrolled diabetic eyes and high rate of blindness due to diabetic retinopathy, primary eye care should be improved, and a nationwide telemedical eye-screening programme should be undertaken.

scholarly journals Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India

2019 ◽  
Vol 4 (1) ◽  
pp. e000202
Author(s):  
Sucheta Kulkarni ◽  
Shridevi Kondalkar ◽  
Islay Mactaggart ◽  
B R Shamanna ◽  
Azher Lodhi ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Service Providers ◽  
Care Service ◽  
Rapid Assessment ◽  
Evidence Base ◽  
Posterior Segment ◽  
Western India ◽  
Eye Care ◽  
Care Services ◽  
Estimate Prevalence

PurposeTo estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services.Methods‘Rapid assessment of avoidable blindness and diabetic retinopathy’ methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software.ResultsThe response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. ‘Need not felt’ (36.6%) and ‘cost’ (31.7%) were the most common barriers for cataract surgery.ConclusionPrevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.

scholarly journals Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047757
Author(s):  
Heba AlSawahli ◽  
Caleb D Mpyet ◽  
Gamal Ezzelarab ◽  
Ibrahim Hassanin ◽  
Mohammad Shalaby ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Rapid Assessment ◽  
Good Control ◽  
Population Based ◽  
Secondary Outcome ◽  
Public Health Approach ◽  
Eye Care ◽  
Cross Sectional Survey ◽  
Prevalence Survey ◽  
Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

scholarly journals Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review

2021 ◽  
Vol 6 (3) ◽  
pp. e004484
Author(s):  
Helen Burn ◽  
Lisa Hamm ◽  
Joanna Black ◽  
Anthea Burnett ◽  
Matire Harwood ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Service Delivery ◽  
Indigenous Peoples ◽  
Indigenous Communities ◽  
High Income ◽  
Eye Care ◽  
Service Delivery Models ◽  
Care Services ◽  
Delivery Models ◽  
Improve Access

PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.

Clinical staff impressions on implementation of a teleophthalmology program to improve diabetic retinopathy surveillance informed by implementation science frameworks (Preprint)

2021 ◽  
Author(s):  
Rajeev S. Ramchandran ◽  
Reza Yousefi-Nooraie ◽  
Porooshat Dadgostar ◽  
Sule Yilmaz ◽  
Jesica Basant ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Coordination ◽  
Low Income ◽  
Safety Net ◽  
The United States ◽  
Eye Care ◽  
Continuous Training ◽  
Effective Care ◽  
Store And Forward

BACKGROUND Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. OBJECTIVE Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. METHODS This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks. RESULTS Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability. CONCLUSIONS Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.

scholarly journals Modeling a Telemedicine Screening Program for Diabetic Retinopathy in Iran and Implementing a Pilot Project in Tehran Suburb

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Sare Safi ◽  
Hamid Ahmadieh ◽  
Marzieh Katibeh ◽  
Mehdi Yaseri ◽  
Homayoun Nikkhah ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Gold Standard ◽  
Web Application ◽  
Mixed Model ◽  
Screening Program ◽  
National Level ◽  
Pilot Project ◽  
Fundus Photography ◽  
Care Services ◽  
Model Study

Purpose. To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods. In this mixed model study, a web application called the “Iranian Retinopathy Teleophthalmology Screening (IRTOS)” was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results. Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions. Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.

Diagnosis of retinal detachments by a tele-ophthalmology screening program

2018 ◽  
Vol 25 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Sarah A McCord ◽  
Mary G Lynch ◽  
April Y Maa
Keyword(s):  
Primary Care ◽  
Screening Program ◽  
Medical Center ◽  
Case Reports ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Eye Care ◽  
Primary Care Clinics ◽  
The Usa

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.

scholarly journals A 15 Month Experience with a Primary Care-based Telemedicine Screening Program for Diabetic Retinopathy.

2020 ◽  
Author(s):  
James Benjamin ◽  
Justin Sun ◽  
Devon Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
University Hospital ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions: Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

scholarly journals Estimating the magnitude of diabetes mellitus and diabetic retinopathy in an older age urban population in Pune, western India

2019 ◽  
Vol 4 (1) ◽  
pp. e000201 ◽  
Author(s):  
Sucheta Kulkarni ◽  
Shridevi Kondalkar ◽  
Islay Mactaggart ◽  
B R Shamanna ◽  
Azher Lodhi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Survey Methodology ◽  
Rapid Assessment ◽  
Cluster Sampling ◽  
High Risk Population ◽  
Western India ◽  
Visual Acuity Testing ◽  
Eye Examination ◽  
Status Data

ObjectiveTo estimate magnitude of diabetes mellitus (DM) and diabetic retinopathy (DR) in a high risk population in Pune, western India.MethodsDR module in rapid assessment of avoidable blindness (RAAB) survey methodology was used. Sample size of 3527 was calculated based on estimates from previous studies in India. A certified RAAB trainer conducted a training of survey teams. Random cluster sampling with probability proportionate to size was adapted to select 60 clusters consisting of 60 individuals each. Two teams visited door to door until they finished visiting 60 persons each day. Visual acuity testing, torch light examination, red glow test were carried out to determine persons with visual impairment and its cause. Every participant then underwent a random blood sugar level testing. All diabetics (known and newly detected) underwent dilated retina evaluation with indirect ophthalmoscopy to determine their DR status. Data were entered into RAAB6 software and descriptive statistics generated.ResultsResponse rate was 89.5 % (3221/3600), females (55.3%). The prevalence of DM in the sample was (706/3221) 21.9 %(95 CI 20.1 to 23.7). Prevalence of DR was 14.3 % (95% CI 11.7 to 16.9). Most diabetics (401/579, 69.3%) never had an eye examination for DR in the past. Cataract was the principal cause of blindness (50 % cases) among diabetics.ConclusionDM affects over fifth of persons above 50 years of age in western India. Nearly seventh of the diabetics have DR, but coverage of screening is poor in Pune.

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