Effectiveness of screening for diabetic retinopathy by nonspecialist doctors: the importance of physician-ophthalmologist collaboration in the prevention of blindness. Sri Lanka Young Diabetes Study (SLYDS)

Np Wijesinghe,Wmua Wijetunga,Ha Dissanayake,Dr Matthews,P Katulanda,S Pathirana,M Jayaweera

doi:10.4038/sjdem.v3i2.6363

Abstract

Introduction: Diabetes retinopathy (DR) is the fourth leading cause for blindness worldwide. Screening is vital for its early detection and prevention of blindness. However screening all diabetic patients by specialists is impossible, particularly in resource poor settings such as Sri Lanka. We aimed to compare the agreement between non-specialist doctors and specialist ophthalmologists in diagnosing DR and planning follow up. Methods: A descriptive study was conducted with a cohort of patients randomly recruited from the Sri Lanka Young Diabetes Study (SLYDS). They were examined by a group of non-specialist doctors by direct ophthalmoscopy after mydriasis, and specialists (by slit lamp biomicroscopy) who were blinded to non-specialist doctors’ finding. Agreement between DR grading according to International Clinical Diabetic Retinopathy Disease Severity Scale, and follow up decisions, by non-specialist and specialist doctors were assessed with kappa statistic, using SPSS-16. Results: Our study included 658 participants (males 36%, mean age 37.1 years, mean duration of diabetes 5.22 years (± 4.04), mean HbA1c 8.1% (±2.04)) and 123 (18.7%) had diabetes retinopathy and 54 (8.3%) required early referral. Exact agreement between ophthalmologists and non specialist doctors in determining absence or presence of diabetes retinopathy was 0.82 (Kappa 0.48, p Conclusion: Non-specialist doctors can identify DR with reasonable sensitivity. This should be encouraged in primary care, particularly in resource poor settings. Referring patients with any form of DR to a specialist should be recommended to prevent those with severe degrees of retinopathy from being missed for appropriate specialist care. DOI: http://dx.doi.org/10.4038/sjdem.v3i2.6363 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3 : 63-67

Highlights

Diabetes retinopathy (DR) is the fourth leading cause for blindness worldwide
Agreement between DR grading according to International Clinical Diabetic Retinopathy Disease Severity Scale, and follow up decisions, by non-specialist and specialist doctors were assessed with kappa statistic, using SPSS-16
Non-specialist doctors can identify DR with reasonable sensitivity. This should be encouraged in primary care, in resource poor settings

Summary

Introduction

Diabetes retinopathy (DR) is the fourth leading cause for blindness worldwide. According to the estimates of the International Diabetes Federation (IDF) 371 million people are affected by diabetes worldwide and 70 million of these live in the South East Asian region [1]. Diabetes mellitus is the fourth leading cause of blindness in the world [2]. There are approximately 93 million people with diabetic retinopathy (DR), 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with vision threatening DR worldwide [3]. The problem is expected to become worse due to the exponential increase of diabetes mellitus especially in the resource-limited nations such as Sri Lanka and India [4,5] in the South East Asian region, where 1 in 5 would have either diabetes or prediabetes.

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