Feasibility of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in industrialised countries: challenges and lessons learned in Hungary

ABSTRACT

Purpose: To present experiences gained during the planning, implementation, and practical performance of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in an established market economy.

Methods: A total of 3523 people aged 50 years or older were examined at their homes in 105 randomly selected clusters in Hungary. During the 4-month-long field work, five teams visited the clusters. Each team was composed of a senior ophthalmic resident or eye specialist, a nurse, an assistant, a driver, and a local guide. The local guides were found through local mayors of the towns or villages or other local leaders.

Results: Of all 105 clusters, 41% were completed in 1 day and 59% required a longer stay. The shortest daily examination time was 3.5 hours and the longest was 10 hours. Altogether, 7.6% of the enumeration areas needed revisit, mainly due to insufficient preparatory work and absence of the subjects. The best local guides were the local government workers, health visitors, and general practitioner (GP) nurses. Refusal of pupillary dilatation was relatively high and varied greatly among the study groups (7.7–43.8%).

Conclusion: The performance of a RAAB+DR study in a well-industrialised country is difficult, but may be successful. The most critical factor for success is an excellent local guide who is able to achieve participation of the people. The results of the RAAB are a solid basis for the development of a national programme for universal eye health and to prepare active media campaigns.

KEYWORDS:

• Causes of blindness
• causes of visual impairment
• population-based data collection
• rapid assessment of avoidable blindness (RAAB)
• screening

Acknowledgments

We thank the Hungarian Central Statistical Office, the National Institute of the Blind, the Hungarian Diabetes Society, the Hungarian Lions Clubs, and 77 Elektronika Kft. for their active support during the planning and implementation of this study.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Funding for this project was received from the Lions Clubs International Foundation (LCIF) SightFirst Research Grant Program (grant number: SF 1825/UND).