Kerala Journal of Ophthalmology (Jan 2019)
Integrating diabetic retinopathy detection with noncommunicable disease clinics at government hospitals in Kerala through teleophthalmology
Abstract
Purpose: The purpose of this study is to analyze the effect of integration of the existing noncommunicable disease clinics (NCDC) in government hospitals for early detection and treatment of diabetic retinopathy (DR) using teleophthalmology. Methods: Population-based screening was done in selected clusters of Thrissur district of Kerala, covering the population attending the NCDCs. Trained optometrists screened all the patients with diabetes mellitus (DM), using handheld nonmydriatic fundus camera (Bosch Eye Care Solutions, Finland). Those who required treatment were referred to higher centers. The data were statistically analyzed. Results: Out of the 11,298 patients screened, DR was present among 914 (8.09%) patients. Nonproliferative DR was detected in 727 (80%) and proliferative DR (PDR) in 187 (20%). There was significant association between >10-year duration of DM and occurrence of PDR (P 5-year duration of DM and the occurrence of PDR (P < 0.001, Chi-square test, odds ratio = 2.56). There was significant association between irregular follow-up status for DM at the NCDCs and the occurrence of PDR (P < 0.0001, Chi-square test, odds ratio = 3.4). There was no significant association between age (P = 0.57) and gender (P = 0.08) with follow-up status at NCDCs. Conclusion: Prevalence of DR among DM patients attending NCD clinics of Kerala is 8.09%. There is a significant association between duration of DM, irregular follow-up at NCDCs for DM with the occurrence of PDR. Although DM is routinely treated at the NCDCs of Kerala, DR detection has not received the needed attention. This missing link has to be strengthened.
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