Implementation of a diabetic retinopathy referral network, Peru

Omar Salamanca,Nancy Suárez,Sara Benavent,Amelia Geary,Merly Gonzalez

doi:10.2471/blt.18.212613

Omar Salamanca, Nancy Suárez + Show 3 more

Open Access

https://doi.org/10.2471/blt.18.212613

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Abstract

ObjectiveTo describe the implementation of a diabetic retinopathy referral network incorporating all levels of health care in La Libertad region, Peru.MethodThe nongovernmental organization Orbis International and the Regional Institute of Ophthalmology established a network of primary, secondary and tertiary health-care facilities for diabetic retinopathy screening and treatment. The programme included the provision of three non-mydriatic retinal cameras for patient examination, the development of a flowchart to guide patient referrals, training of health personnel, investment in laser technology for treatment and the delivery of public awareness activities for blindness prevention and the need for timely screening.FindingsFrom 2014–2017, 11 849 patients with diabetes were screened within the diabetic retinopathy referral network. In primary-care centres, 6012 patients with diabetes mellitus were identified and 5632 patients were referred for diabetic retinopathy screening. A further 4036 patients directly attended two secondary-level hospitals and 2181 attended the tertiary-level hospital for screening. This represented a 138.1% increase in diabetic retinopathy screenings from a baseline of 4977 patients screened at the regional institute of ophthalmology over 2010–2013. A total of 2922 patients (24.7%) were found to have diabetic retinopathy and 923 (31.6%) were treated: 508 with laser photocoagulation, 345 with intravitreal bevacizumab and 70 with vitreoretinal surgery.ConclusionEffective and timely treatment for diabetic retinopathy is possible when patient education, screening and care are fully integrated into the general health-care system across primary-, secondary- and tertiary-level facilities. This requires the integration of professionals at all levels and all relevant specialties.

Highlights

The prevalence of diabetes mellitus is growing, in low- and middle-income countries, and complications due to the disease are becoming major health issues requiring effective health interventions for prevention and treatment
An important vascular complication of diabetes is diabetic retinopathy, which affects the vision of 2.6 million people in the world,[1] and is responsible for 2.6% of global blindness (0.84 million of 32.4 million people).[2]
The rise of diabetic retinopathy requires programmes for early detection, accurate diagnosis and timely treatment to reduce the impact of associated vision loss

Summary

Introduction

The prevalence of diabetes mellitus is growing, in low- and middle-income countries, and complications due to the disease are becoming major health issues requiring effective health interventions for prevention and treatment. An important vascular complication of diabetes is diabetic retinopathy, which affects the vision of 2.6 million people in the world,[1] and is responsible for 2.6% of global blindness (0.84 million of 32.4 million people).[2] The rise of diabetic retinopathy requires programmes for early detection, accurate diagnosis and timely treatment to reduce the impact of associated vision loss. Diabetic retinopathy is the third highest cause of functional vision loss in people older than 50 years, corresponding to 173 out of 910 (19%) of patients.[7]

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