Abstract
Objective:To find out prevalence of Diabetic Retinopathy in general population of three districts in Pakistan.Methods:A community based cross-sectional survey was conducted in three large districts of Pakistan namely Rawalpindi in Punjab, Peshawar in Khyber Pakhtoonkhwa and Hyderabad in Sindh between January 2013 and August 2015. Lady Health Workers identified individuals at high risk for diabetes based on pre-defined criteria. High risk population was tested for dysglycemia. Fundoscopic evaluation for evidence of DR was performed in all individuals with a random blood glucose >190mg/dl. Individuals with the evidence of DR were referred to affiliated tertiary care ophthalmology departments.Results:A total of 42,629 individuals reported at the project sites and 63% (n=26,859) were female. Fifty one percent (n=21,989) individuals met high risk criteria. Out of these 21,989 individuals, dysglycemia was found in 3,869 (17.6%). Fundoscopy showed evidence of DR in 1,042 (27%) individuals. Amongst high risk population, dysglycemia was significantly more common in females as compared to males. The frequency of DR in dysglycemic patients was comparable across both gender groups.Conclusion:The prevalence of DR in Pakistani population is alarmingly high. This preventable cause of blindness is largely undiagnosed in our population and a simple integrated model based on primary health care facilities can help identify and treat a large population of DR patients.
Highlights
Non communicable diseases (NCDs) kill 38 million people each year and Diabetes Mellitus (DM) is the fourth leading cause of NCD deaths
In a clinical based study conducted on 223 adult Pakistani diabetic patients with >3 years history of diabetes, more than 70% had never been assessed for diabetic retinopathy (DR).[9]
Out of all individuals reporting at the project sites (BHUs), majority (56.2%) reported on their own (n=23,957) while 34.4% (n=14,664) were referred by Lady Health Workers (LHWs), 5.5% (n=2,334) were referred by general practitioners (GPs) or family physicians and 7.4% (n=3,159) were referred by Lady Health Supervisors (LHS) from Basic Health Units (BHUs)
Summary
Non communicable diseases (NCDs) kill 38 million people each year and Diabetes Mellitus (DM) is the fourth leading cause of NCD deaths. According to WHO, the estimated global prevalence of DM among adults above 18 years of age is about 9%.1. According to the National Diabetes Survey, more than 10% of adult population of Pakistan has Detection of diabetic retinopathy diabetes.[3,4,5] Diabetic retinopathy is the leading cause of new cases of blindness in adults aged 20-74 years.[6] The prevalence of DR is reported to be up to 40% in a pooled analysis of population based eye surveys in the US.[7] Diabetes and diabetic retinopathy are under-diagnosed in Pakistan. The prevalence of DR in Pakistani diabetic population is reported to be 15.7% in a small population-based study (n=108).[10]
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