Sight-threatening Diabetic Retinopathy at Presentation to Screening Services in Fiji

Abstract

Purpose: To report the spectrum of retinopathy at first presentation to photoscreening services, to determine the proportion of patients that present with sight-threatening diabetic retinopathy (STDR), and to raise awareness of the burden of diabetic eye disease in Fiji.

Methods: This retrospective observational cohort study used data from the initial visit of all new patients presenting to the diabetes retinal screening service at the Pacific Eye Institute in Fiji over the 3-month period between July and September 2012. Patients were assessed using a detailed questionnaire regarding diabetes type, duration of disease, medications, complications and co-morbidities, and blood sugar control. Patients subsequently underwent non-mydriatic fundus photography according to Pacific diabetes retinal screening guidelines. Images were graded at the time of acquisition, and data were entered onto a computerized database. For the purposes of this study, information regarding retinopathy grading, visual acuity and patient demographics was used.

Results: A total of 522 new patients were screened over the 3-month period. STDR was observed in 27% of patients, with 15% observed to have bilateral STDR. Diabetes control was generally poor. Blindness and visual impairment were observed in 2.7% and 6.7% of the cohort, respectively.

Conclusion: Severe and advanced diabetic retinopathy was present in this population presenting to screening. This was observed 4 years after the formal expansion of the screening services and reflects the high prevalence of diabetes in the population. The need for increased public awareness and greater resource allocation into diabetes and its complications is emphasized.

• Diabetic retinopathy
• diabetic retinopathy screening
• Pacific
• sight-threatening

Acknowledgments

We would like to acknowledge Mrs Ramila Patel, diabetic nurse at PEI, for her help with data collection and introduction to the service; Dr Gillian Clover, ophthalmologist, for her significant contribution to the development of the diabetes service at PEI; and Mr Avinesh Patel, Lecturer in Statistics at the University of Auckland for his input into the statistical analysis of these results.

Dr Erika Damato, Dr Neil Murray, Dr Biu Sikivou and Dr John Szetu hold contracts with the Fred Hollows Foundation, New Zealand. Dr Damato is employed as a research fellow.