ABSTRACT
BACKGROUND: Robust integration of diabetic retinopathy (DR) screening within health systems is essential to prevent DR-related blindness. This, however, remains a challenge in the developing world. The aim of this study was to evaluate two models of DR screening programs within rural general health-care services. MATERIALS AND METHODS: This was a retrospective observational study from two rural health centers. Demographic and clinical data of patients completing DR screening were analyzed. Patients were screened in regular ophthalmology clinics (ROC) or integrated diabetic clinics (IDC). Referral and treatment completion data were retrieved from the clinical charts at the base hospital. RESULTS: A total of 2535 DR screenings were conducted for 2296 patients. The total population prevalence for any DR was 14.2% (95% confidence interval [CI]: 12.8%-15.6%) and vision-threatening DR (VTDR) was 4.7% (95% CI: 3.8%-5.6%). In the ROC and IDC groups, respectively, the prevalence of any DR was 20.4% and 8.2%, VTDR, 7.8% and 1.7%, and blindness, 1.4% and 0.4% (all P < 0.001). Referral completion rates were higher in the ROC group (44.8% vs. 25.2%, P < 0.001), while treatment completion in both was similar (69.6% vs. 70.6%). Referral and treatment completion rates for referable DR were 61.2% and 48.2%, and for VTDR, 62% and 38.8%, respectively. Only 11.45% of patients completed the repeat screening follow-up. CONCLUSIONS: Patients attending IDCs had a significantly lower prevalence of any DR, VTDR, and blindness demonstrating the advantages of integrated diabetic care in a rural setting. However, referral uptake and DR treatment completion need strengthening.
ABSTRACT
PURPOSE: Healthcare workers (HCW) are exposed to numerous occupation-related eye hazards. We studied the epidemiological distribution, risk factors, and severity of acute work-related hazardous exposure/infection (WRHEI) to the eyes of HCW in a tertiary healthcare institution in Southern India. METHODS: In this prospective observational study, we included HCW who reported acute WRHEI between February 15, 2017 and August 14, 2017 from a total 11,628 HCWs (staff and students). Each HCW underwent a comprehensive eye examination. Information regarding WRHEI was collected by a structured questionnaire. Statistical analysis was performed using SPSS Version 20.0. RESULTS: Cumulative incidence of acute WRHEI in 6 months was 0.8%, 95% CI (0.64-0.96). Among the 94 reporting WRHEI, 82 (87.2%) were staff and 12 (12.8%) students. Mean age was 31.53 ± 8.39 years and 65 (69%) were females. Exposures were reported more commonly among nurses (25.5%), followed by technicians (18%), and housekeeping staff (15.9%). Infectious eye hazards accounted for 50%. Noninfectious eye hazards included exposure to chemicals (28%) and blood and body fluid (8%). Among them, awareness regarding personal protective equipment (PPE) and its usage was present in 44.6 and 27.6%, respectively. Multivariable logistic regression analysis showed that HCWs working in clinical areas (adjusted odd's ratio (AOR): 3.23, 95% CI: 1.12-9.34) and not wearing glasses (AOR: 3.72, 95% CI: 1.33-10.34) had a significantly higher risk of acute WRHEI. CONCLUSION: Cumulative Incidence of WRHEI eye was 8 per 1000 in 6 months. Infectious conjunctivitis is half the burden followed by chemical exposures. Awareness regarding eye safety and usage of PPE was low.
