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Diabetic Retinopathy module for RAAB 5
David YorstonSarah Polack
Hannah KuperHans Limburg
Why assess DR in RAAB?
Diabetes – a growing problem
Source: International Diabetes Foundation, 2011
Diabetic retinopathy
Cataract 39%
Refractive error 18%
Glaucoma 10%
ARMD 7%
CO 4%
DR 4%
Trachoma 3%Childhood 3%
Other 11%
Few countries with population based DR prevalence data
What this will tell us
DR module provides estimates of:•Prevalence of diabetes•Prevalence of DR and sight threatening DR in
people with diabetes and in general population•Coverage of DR examinations among people with
known diabetes •Levels of glycaemic control among people with
diabetes ….among people aged 50+ years….to be used to inform service planning
Results from Chiapas, Mexico
Results
Prevalence of diabetes 20%
Prevalence of DR among diabetics 40%
Prevalence of sight threatening DR among diabetics 23%
Proportion of diabetic participants with previous eye exam 47%
Proportion of diabetic participants with poor glycaemic control (RBG≥200mg/dl) 73%
Methods
1. Obtain informed written consent
• Explain (participant information sheet):– Purpose of study– Procedures involved– Risks (affect of dilation on vision)– Participation is voluntary– Confidentiality
• Consenting participants must sign/thumb-print consent form
• To be done when first arrive at the household
2. Assess diabetes (section H)
• Ask about previous diagnosis
• Test random blood glucose
Diabetes: Previous diagnosis and/or
RBG ≥200mg/dl
Known diabetes: Previous diagnosis
(regardless of current RBG)
Newly diagnosed diabetes:
No previous diagnosis, but
RBG ≥200mg/dl
3. Ask questions to people with known diabetes (section I)
• Age of diagnosis• Diabetes treatment• Diabetic eye exam
4. Dilated eye examination of all people with diabetes (section J)
Dilated examination with direct & indirect ophthalmoscope
Diabetes classification‘Have you ever been told by
a doctor /nurse that you
have diabetes, sugar in your
urine or high blood sugar’
RBG level Classification Action
No 1-199mg/dl Does not have diabetes Finish!
No 200+ mg/dl Has newly diagnosed diabetes Complete section H only
Yes 1-199mg/dl Has known diabetes Complete sections I & J
Yes 200+ mg/dl Has known diabetes Complete sections I & J
Yes Refuses RBG test Has known diabetes Complete sections I & J
No Refuses RBG test Unknown status Finish!
Obtain informed consent
Diabetes assessment
Known ‘diabetes’ No ‘diabetes’
Finish!
Newly diagnosed ‘diabetes’
Ask questions about diabetes
Dilate pupils
Fundus examination
Standard RAAB protocol
However!
• Standard RAAB: – 4-5 days training; cost 20-40,000 US$
• RAAB + DR– 5-7 days training; cost 40-100,000 US$– Prevalence of diabetes >20% in people 50+– 1 team: 35 persons/day; 2 teams 60/day– Requires DR specialists and equipment– Special trainer for DR
