Prevalence of diabetic retinopathy in Peruvian patients with type 2 diabetes: results of a hospital-based retinal telescreening program / Prevalencia de retinopatía diabética en pacientes con diabetes tipo 2 en el Perú: resultados de un programa hospitalario de detección sistemßtica mediante telemedicina

OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes and to determine any association with clinical factors. METHODS: This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. RESULTS: Of 1 311 patients screened, appropriate retinal images were obtained in 1 222 subjects (93.2 percent). DR was detected in 282 patients (23.1 percent) [95 percent confidence interval (CI): 20.71-25.44]; 249 patients (20.4 percent) (95 percent CI: 18.1-22.6) had nonproliferative DR and 33 (2.7 percent) (95 percent CI: 1.8-3.6) had proliferative DR. In 32 patients (11.3 percent), DR was unilateral. The frequency of DR was the same in both sexes. Prevalence of blindness was twice as frequent in patients with DR as in those without it (9.4 percent and 4.6 percent, respectively) (P = 0.001). The frequency of DR at diagnosis was 3.5 percent and it increased with the duration of diabetes. DR was more frequent in patients with arterial hypertension, macrovascular or microvascular complications, and hemoglobin A1c (HbA1c) > 7.0 percent and in those treated with insulin or sulfonylureas. It was less prevalent in those with HbA1c < 7.0 percent, with greater body mass index, and who had been treated with metformin. CONCLUSIONS: The prevalence of DR in these patients with type 2 diabetes was 23.1 percent. Nonproliferative retinopathy accounted for 77.0 percent of cases. Although less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion.

OBJETIVO: Calcular la prevalencia de la retinopatía diabética en pacientes con diabetes tipo 2 y determinar su asociación con factores clínicos. MÉTODOS: Este proyecto de detección sistemßtica hospitalaria se dise±ó para detectar de manera prospectiva la presencia de retinopatía diabética en pacientes con diabetes tipo 2 mediante la valoración de imßgenes obtenidas con una cßmara digital para fotografía retiniana. RESULTADOS: Se evaluó a 1 311 pacientes y se obtuvieron imßgenes retinianas apropiadas en 1 222 de ellos (93,2 por ciento). Se detectó retinopatía diabética en 282 pacientes (23,1 por ciento) (intervalo de confianza [IC] de 95 por ciento: 20,71-25,44): 249 pacientes (20,4 por ciento) (IC de 95 por ciento: 18,1-22,6) tenían retinopatía diabética no proliferativa y 33 (2,7 por ciento) (IC 95 por ciento: 1,8-3,6) presentaban retinopatía diabética proliferativa. En 32 pacientes (11,3 por ciento), la retinopatía diabética era unilateral. La frecuencia de retinopatía diabética fue la misma en ambos sexos. La prevalencia de ceguera fue del doble en los pacientes con retinopatía diabética que en aquellos sin ella (9,4 por ciento y 4,6 por ciento, respectivamente) (P = 0,001). La frecuencia de retinopatía diabética en el momento del diagnóstico fue de 3,5 por ciento y aumentó con la duración de la diabetes. La retinopatía diabética fue mßs frecuente en los pacientes con hipertensión arterial, complicaciones macrovasculares o microvasculares y hemoglobina A1c (HbA1c) > 7,0 por ciento, y en aquellos tratados con insulina o sulfonilureas. Fue menos prevalente en los pacientes con HbA1c < 7,0 por ciento, en aquellos con mayor índice de masa corporal y en los tratados con metformina. CONCLUSIONES: La prevalencia de retinopatía diabética en estos pacientes con diabetes tipo 2 fue de 23,1 por ciento. La retinopatía no proliferativa representó 77,0 por ciento de los casos. Aunque la prevalencia de la ceguera fue menor que en un informe anterior...

Prevalence of diabetic retinopathy in Peruvian patients with type 2 diabetes: results of a hospital-based retinal telescreening program.

OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes and to determine any association with clinical factors. METHODS: This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. RESULTS: Of 1 311 patients screened, appropriate retinal images were obtained in 1 222 subjects (93.2%). DR was detected in 282 patients (23.1%) [95% confidence interval (CI): 20.71-25.44]; 249 patients (20.4%) (95% CI: 18.1-22.6) had nonproliferative DR and 33 (2.7%) (95% CI: 1.8-3.6) had proliferative DR. In 32 patients (11.3%), DR was unilateral. The frequency of DR was the same in both sexes. Prevalence of blindness was twice as frequent in patients with DR as in those without it (9.4% and 4.6%, respectively) (P = 0.001). The frequency of DR at diagnosis was 3.5% and it increased with the duration of diabetes. DR was more frequent in patients with arterial hypertension, macrovascular or microvascular complications, and hemoglobin A1c (HbA1c) > 7.0% and in those treated with insulin or sulfonylureas. It was less prevalent in those with HbA1c < 7.0%, with greater body mass index, and who had been treated with metformin. CONCLUSIONS: The prevalence of DR in these patients with type 2 diabetes was 23.1%. Nonproliferative retinopathy accounted for 77.0% of cases. Although less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion.

Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: the Vine Hill study.

OBJECTIVE: To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic. RESEARCH DESIGN AND METHODS: This retrospective cohort study included all diabetic patients aged > or = 18 years (n = 495) seen at Vine Hill Community Clinic between 1 September 2003 and 31 August 2004. Patients were offered ophthalmology referral or digital screening. Patients choosing referral received the next available (within 3 months) appointment at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit. RESULTS: Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity (chi2 = 7.9, P < 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%). CONCLUSIONS: Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need.

A portable visual acuity device used in diabetic retinal screening.

PURPOSE: To correlate visual acuity measured with the Optec 800 to the gold-standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart. DESIGN: Prospective, cross-sectional study. METHODS: Forty patients of the Vanderbilt Eye Institute agreed to undergo visual acuity testing. Five patients were excluded because of enucleation or functional blindness of one or both eyes. Two patients were excluded because of poor cooperation during testing. Patients were randomized to one of the two methods and participated in visual acuity testing in a forced-choice manner. The sequence was repeated with the alternate instrument. A total-correct score was calculated for each data set. RESULTS: There was no statistically significant difference in scores between the two methods (P(1) = .153, P(2) = .307.) Other factors such as gender, age, and instrument testing order did not affect performance. Age was inversely correlated with total correct score. CONCLUSIONS: In this small cohort, the Optec 800 (Chicago, Illinois, USA) and the ETDRS chart recorded similar visual acuity measurements.

Monoscopic versus stereoscopic photography in screening for clinically significant macular edema.

The purpose of the study was to determine whether monoscopic photography could serve as an accurate tool when used to screen for clinically significant macular edema. In a masked randomized fashion, two readers evaluated monoscopic and stereoscopic retinal photographs of 100 eyes. The photographs were evaluated first individually for probable clinically significant macular edema based on the Early Treatment Diabetic Retinopathy Study criteria and then as stereoscopic pairs. Graders were evaluated for sensitivity and specificity individually and in combination. Individually, reader one had a sensitivity of 0.93 and a specificity of 0.77, and reader two had a sensitivity of 0.88 and a specificity of 0.94. In combination, the readers had a sensitivity of 0.91 and a specificity of 0.86. They correlated on 0.76 of the stereoscopic readings and 0.92 of the monoscopic readings. These results indicate that the use of monoscopic retinal photography may be an accurate screening tool for clinically significant macular edema.