Abstract
Diabetic retinopathy (DR) is the leading cause of low vision among working-age adults. An estimated 6.9 million people in Bangladesh were living with diabetes in 2017, which is projected to increase to more than 10 million people in 2025. Currently, no standardized and/or large-scale DR screening program exists in Bangladesh. To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individuals with diabetes. In this cross-sectional study, 49 264 patients with diabetes underwent opportunistic eye screening at 2 eye hospitals and 1 diabetic hospital in Bangladesh between June 1, 2010, and September 30, 2017. The data set was analyzed from April 8 to December 30, 2018. Technicians were trained to obtain 2-field digital fundus photographs and to grade each according to a standardized DR severity scale. Each patient was counseled and triaged for treatment using defined DR referral criteria. Primary DR grading outcomes, visual acuity, and treatment outcomes. A total of 49 264 patients (54.3% male; mean [SD] age, 50.8 [12.3] years) underwent DR screening during a 7-year period. The DR prevalence rate across all 3 sites was 33% (95% CI, 33%-33%). Prevalence rates varied by center (Chittagong, 64.6% [95% CI, 64.0%-65.0%]; Dhaka, 39.8% [95% CI, 39.0%-41.0%]; and Feni, 13.0% [95% CI, 13.0%-14.0%]). Across all age groups, male patients were at higher risk of prevalent DR than female patients (odds ratio, 1.99; 95% CI, 1.90-2.07). The prevalence was 3.9% for preproliferative DR, 7.8% for proliferative DR, and 19.2% for maculopathy. Individuals with DR had significantly worse visual acuity than those with no DR (best-corrected visual acuity, 0.35 vs 0.21 logMAR; P < .001). The rate of moderate visual impairment was 12.2%, and the rate of blindness was 2.5%. Primary treatments included laser photocoagulation (n = 1637), intravitreal injection (n = 1440), and vitrectomy (n = 309). Screening Bangladeshi individuals known to have diabetes using fundus photography identified large numbers of patients with sight-threatening proliferative DR, maculopathy, and visual impairment or blindness. Expansion of eye screening services in Bangladesh is warranted as part of a national government eye care and diabetes health policy.
Highlights
Type 1 and type 2 diabetes is rapidly increasing as a major cause of morbidity and mortality globally.[1,2] According to the World Health Organization and the International Diabetes Federation, the number of people living with diabetes was 425 million in 2017 and is projected to increase to 629 million in 2045.3 The International Diabetes Federation estimated that 6.9 million people in Bangladesh were living with diabetes in 2017, increasing to more than 10 million in 2025.3VISION 2020: The Right to Sight initiative lists diabetic retinopathy (DR) as one of its priority eye diseases for Southeast Asia and other regions.[4]
Male patients were at higher risk of prevalent DR than female patients
All data were collected at the 2 participating eye hospitals—Chittagong Eye Infirmary and Training Complex (CEITC) and the National Institute of Ophthalmology (NIO) and Hospital—as well as at Feni Diabetes Hospital (FDH)
Summary
Type 1 and type 2 diabetes is rapidly increasing as a major cause of morbidity and mortality globally.[1,2] According to the World Health Organization and the International Diabetes Federation, the number of people living with diabetes was 425 million in 2017 and is projected to increase to 629 million in 2045.3 The International Diabetes Federation estimated that 6.9 million people in Bangladesh were living with diabetes in 2017, increasing to more than 10 million in 2025.3VISION 2020: The Right to Sight initiative lists diabetic retinopathy (DR) as one of its priority eye diseases for Southeast Asia and other regions.[4]. Type 1 and type 2 diabetes is rapidly increasing as a major cause of morbidity and mortality globally.[1,2] According to the World Health Organization and the International Diabetes Federation, the number of people living with diabetes was 425 million in 2017 and is projected to increase to 629 million in 2045.3 The International Diabetes Federation estimated that 6.9 million people in Bangladesh were living with diabetes in 2017, increasing to more than 10 million in 2025.3. Bangladesh has among the world’s largest number of people with diabetes, with 35% of the population older than 35 years receiving a diagnosis of diabetes or prediabetes.[7,8] The public and private health care systems in Bangladesh lack effective models for implementing DR screening programs at the national level. The current system fails to raise awareness and motivate patients to seek regular screening for DR, and almost no organizations are systematically engaged in screening for DR
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