The impact of delay in diabetic patient's referral for diabetic retinopathy screening on the level of retinopathy detected in adult Sudanese diabetic Sudanese patients

Abstract

Background: Diabetic retinopathy (DR) is the most common complications of diabetes mellitus (DM) which needs early detection. Delay in referral of patients with significant DR by physicians to the concerned ophthalmologist may compromise visual outcome since early treatment is associated with a 50% reduction in the risk of visual loss. Objective: The aim of this study is to assess the relationship between delays in diabetic patient's referral for DR screening after diagnosis of DM and the level of the DR detected at Sudan. Materials and Methods: A 2-year prospective cross-sectional study was conducted on 240 patients with type I and II, newly referred patients in the period from January 2013 to February 2015. The estimated time lapse between this first DR screening and the onset of DM was recorded as “delay period” in diabetic patient's referral for DR screening, which was compared with the level of DR and the level of visual loss at the time of the first visits. Results: In a 2-year study (2013–2015), 240 were newly referred diabetic patients, 225 type 2 DM (93.75%), and 15 (6.25%) type I DM. DM duration was 17.6 years (2–40 years); 202 with poor control. Eighty-nine were hypertensive with a mean duration of 3.7 years. About 83.3% were referred by general ophthalmologists, 10.4% by physicians, 4.2% by optometrists, and 2.1% by their own will. Nearly 85% referred for their visual disturbances and 15% for self-referral. Two hundred and eleven patients (87.09%) had one form of DR; while only 29 patients did not apparent DR. Low-risk DR recorded in 174 (72.5%), high risk in 66 (27.5), and diabetic macular edema (DME) in 94 (39.2%). The average delay was 14.8 years; 15.5 years for men and 14.04 years for women. The average percentage of visual loss in the low-risk group was 16.7% (visual score of 83.3%). While the visual loss in the high risk was 69.3% (visual score of 30.7%). DME reported 36.6% visual loss and 63.4% visual score. The mean visual loss in all diabetic study population was 40.9% with the total visual score of 59% which equivalent to 6/40 at the moderate low vision range of the World Health Organization. Conclusion: There was a strong correlation between the levels of DR detected and the percentage of visual loss. The “no apparent DR group” recorded the minimal detection of visual loss.