Use of digital retinal camera to detect prevalence and severity of diabetic retinopathy in a screening program for type 2 diabetic refugees in Palestine

Abstract

Background: The purpose of this study was to determine the prevalence of diabetic retinopathy among Palestinian refugees serviced by the Diabetic Retinopathy Screening Program in the Occupied Palestinian Territories (DRS-OPT). Material and methods: This is a retrospective study of retinal images of 1891 diabetic patients in 15 urban UNRWA clinics participating in the DRS-OPT program in Palestine over 12 months. A nonmydriatic Canon CR-2 fundus retinal camera was used to capture two 450 non-stereo fundus images for each eye. Qualified graders (nurses) performed the grading based on the DRS-OPT grading system. Results: Out of the 1891 diabetic patients screened, 1694 had at least one gradable eye. 16% of patients had diabetic retinopathy (5.7% had mild nonproliferative diabetic retinopathy, 4.3% had moderate nonproliferative diabetic retinopathy, 1.1% had severe, moderate nonproliferative diabetic retinopathy, and 1.7% had proliferative diabetic retinopathy. Maculopathy without retinopathy amounted to 3%. Other findings included the identification of blinding diseases such as age-related macular degeneration and optic disc glaucomatous cupping. Conclusions: The retinopathy screening program using a nonmydriatic fundus camera identified diabetic retinopathy in 16% of diabetic Palestinian refugees. A total of 72% of these patients were diabetics with nonproliferative retinopathy. This program can be used to prevent progression by facilitating the education of patients and early intervention.