Awareness of diabetic retinopathy among diabetic patients in Nepal

Abstract

Dear Editor, D iabetes mellitus is a chronic disease with increasing prevalence worldwide. Among the total diabetic patients expected in 2030, half will be in Asian countries (Wild et al. 2004). This increase has been attributed to the rapid economic, demographic, and nutritional transition in the developing countries (Wild et al. 2004). Almost one-fourth of people 20 years and older and one-third 40 years and older in urban areas of Nepal exhibited diabetic tendencies in one populationbased study from Nepal (Singh & Bhattarai 2003), and now diabetes is considered as an epidemic health problem there. Urbanization, changing dietary patterns from a rough fiber diet to a more refined one with abundant fatty foods, and an increasingly sedentary life style are likely to contribute to additional cases in the future. Likewise, the tradition of excessive feeding of fatty and sweet foods following delivery appears to have increased obesity and diabetic predisposition in women in Nepalese society (Singh & Bhattarai 2003). Diabetic retinopathy (DR) is one of the common complications of diabetes mellitus. As in developed countries, DR could soon become one of the most common causes for blindness in developing nations like Nepal. Nepal’s situation is compounded by a low literacy rate and presumed lack of awareness of diabetic ocular complications. Since early detection and timely ocular treatment may prevent many of the blinding ocular complication of diabetes, enhanced awareness of these complications among diabetic patients and the general public could be an effective public health measure. Previous population-based and secondary health care level studies from Nepal have shown that only 50% of the diabetic patients were aware of potential diabetic ocular complications (Shrestha et al. 2007; Paudyal et al. 2008). When we surveyed new diabetic patients who presented to a tertiary eye care center in Nepal for ophthalmic evaluation, we found that 37% of patients were unaware of diabetic ocular complications even though a majority of the patients had been referred for further evaluation and management. Our unawareness rate was substantially higher than rates reported in studies from neighboring countries (Saikumar et al. 2007). In our series, almost half of the patients were illiterates who must rely on non-print sources for information on DR. Only half of those who were aware of diabetic ocular problems received their information from primary care physicians or from the referring ophthalmologist. This may reflect the small amount of time physicians and ophthalmologists can devote to discussion of diabetic complications with patients in a developing country with a low doctorto-patient ratio. The other major source of awareness was from family members, especially since one-third of cases had a positive family history in at least one-first-degree relative, presumably due to genetic predisposition and common environmental factors such as food habits and lifestyle. Media (magazines and radio) played a less important role in disseminating information in our patient group, in contrast to the study by Saikumar et al. (2007) in which media was the main source for awareness. This finding emphasizes the need for better media coverage to spread the awareness in our country. Although 51% of the total diabetic patients had a history of diabetes of more than 10 years duration, almost half of the subjects had never even had a fundus evaluation prior to their initial visit to the Tilganga Institute of Ophthalmology. Improved awareness campaigns and increased collaboration with primary-care physicians and comprehensive ophthalmologists to ensure timely and regular referrals of at-risk patients are imperative to reduce DR related blindness in countries such as Nepal.