Browsing by Subject "Diabetic retinopathy"

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    Assessing the Knowledge and Practices regarding eye care and complications of Diabetes among Diabetic Patients 18 years and older, attending a tertiary Diabetic Clinic in Kampala, Uganda
    (2019) Hope, Mackline; Cook, Colin; Minnies, Deon
    Purpose The aim of this study was to audit the knowledge and practices regarding eye care and eye complications of diabetes mellitus (DM) among diabetic patients 18 years and above in Kampala, Uganda. Methods. A cross-sectional study was done to collect data on the demographics, level of awareness and practices of the 409 diabetic patients regarding eye care and eye complications of DM. Data collected was captured in EPIDATA version 3.1, exported to STATA version 15.0 for further management and analysis. Participants characteristics were summarized using summary statistics and graphs. Using a standard questionnaire, scores for knowledge and practice for diabetes; knowledge and practice on diabetic retinopathy were generated and in all the four scores aforesaid, participants were classified as having good or poor knowledge and practice1. Proportions of participants demonstrating good awareness and good practice were reported. Fishers and Pearson chi- square tests were used to test for associations between patient’s characteristics and knowledge and practice on DM. Bivariable and logistic regression analysis was performed and variables with a p-value of < 0.2 of the unadjusted odds ratio were further analyzed at multivariate logistic regression analysis to find out factors that significantly predict patient’s knowledge and practice on diabetes mellitus. Results. A total of 409 participants were interviewed in the study, majority were females 293 (71.6%) and mean age (SD) was 50 (12) years. A high proportion of participants 314 (76.9%) was aware that DM could affect the eyes but only 24 (5.9%) stated diabetic retinopathy as an eye complication in diabetic patients. Good knowledge about diabetes mellitus was demonstrated by 178 (43.5%) of the study participants. However, only 33.3% had good knowledge on eye care and diabetic retinopathy. It was determined that female diabetic patients and those who stayed with DM for 10 years and beyond were less likely to have good practice on DM compared to male patients and those who had been with DM for less than five years (OR, 95% CI: 0.58, 0.36-0.95, P=0.029: OR, 95% CI: 0.53, 0.32-0.87, P=0.011). It was also found that diabetic patients with good knowledge of DM were at least three times more likely to have good practice compared to those with the poor knowledge (OR, 95% CI: 3.2, 2.1 -4.8, P <0.001). Conclusion Lack of knowledge regarding the importance and need for periodic eye check-up for diabetic retinopathy was a significant finding in his study. Good knowledge on diabetes, gender and duration of DM had significant association with the patients practice patterns.
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    Feasibility of an automated AI-based screening tool for diabetic retinopathy at an endocrine outpatient clinic in SA
    (2024) Roux, Margaretha Magdalena; Steffen, Jonel
    INTRODUCTION: Diabetic retinopathy (DR) is a worsening global pandemic and a leading cause of blindness. Screening is paramount. In the South African public health sector, screening initiatives have faced significant challenges and leveraging new screening technologies may prove useful. This study aimed at evaluating the feasibility of an autonomous AI-based diagnostic tool in an endocrine outpatient clinic at Groote Schuur Hospital. METHODS: Patients identified as referable DR (moderate NPDR or worse) by autonomous AI screening, as well as patients with ungradable images, were referred to an ophthalmologist. We assessed the time it took to do screening, number of patients requiring dilation, number of ungradable images and their potential causes, referral burden, and number of patients requiring treatment. RESULTS: A total of 62 patients underwent screening, with a median AI screening time of 11.7 minutes. Of these, 55 (88.7%) required referral to ophthalmology. This included 36 patients (58.1%) with referable DR according to AI grading (of which 19 patients (30.6%) had vision-threatening DR) and 19 (30.6%) with ungradable images despite dilatation. Nine patients (14.5%) were lost to follow-up between AI screening and ophthalmology assessment, and 8 patients (12.9%) required treatment for vision-threatening DR according to ophthalmology human grading. Cataracts were the most important cause for ungradable images. . CONCLUSION: This study showed that screening for diabetic retinopathy using autonomous AI is feasible in terms of time. However, the significant burden of referrals and high number of ungradable images may be problematic within a resource-constrained public healthcare system.
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    Mechanism of worsening diabetic retinopathy with rapid lowering of blood glucose: the synergistic hypothesis
    (2017) Jingi, Ahmadou M; Tankeu, Aurel T; Ateba, Narcisse Assene; Noubiap, Jean Jacques
    Insulin treatment has been associated with a paradoxical worsening of diabetes retinopathy since many years in European cohorts. Recently, this issue has been stressed by some studies conducted in other parts of the world. However, the mechanism underlying such evolution is not well understood. An osmotic theory has been evocated but failed to explain the clinical features of the disease. Considering recent findings from basic and clinical research, we discuss the possibility of a synergistic hypothesis based on the simultaneous action of insulin and vascular endothelial growth factor on eye blood vessels. We postulate that exogenous insulin could act synergistically with the vascular endothelial growth factor expressed by ischemic retina so as to trigger vascular proliferation and the worsening of diabetes retinopathy.
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    Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
    (2016) Mtuya, Christina; Cleland, Charles R; Philippin, Heiko; Paulo, Kidayi; Njau, Bernard; Makupa, William U; Hall, Claudette; Hall, Anthony; Courtright, Paul; Mushi, Declare
    Abstract Background Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania. Methods All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up. Results Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis. Conclusions Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy.