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Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh.
JAMA Netw Open. 2019 11 01; 2(11):e1916285.JN

Abstract

Importance

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.

Objective

To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individuals with diabetes.

Design, Setting, and Participants

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.

Main Outcomes and Measures

Primary DR grading outcomes, visual acuity, and treatment outcomes.

Results

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).

Conclusions and Relevance

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.

Authors+Show Affiliations

Vitreoretinal Service, Moorfields Eye Hospital, National Health Service Trust, London, United Kingdom. Institute of Ophthalmology, University College London, London, United Kingdom.Helen Keller International, New York, New York.Helen Keller International, Dhaka, Bangladesh.Helen Keller International, Dhaka, Bangladesh.Helen Keller International, New York, New York.Helen Keller International, Dhaka, Bangladesh.Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia.Helen Keller International, Dhaka, Bangladesh.Retina Service, National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh.Retina Service, Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh.Massachusetts Eye and Ear, Harvard Medical School, Boston.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31774523

Citation

Muqit, Mahiul M K., et al. "Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh." JAMA Network Open, vol. 2, no. 11, 2019, pp. e1916285.
Muqit MMK, Kourgialis N, Jackson-deGraffenried M, et al. Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh. JAMA Netw Open. 2019;2(11):e1916285.
Muqit, M. M. K., Kourgialis, N., Jackson-deGraffenried, M., Talukder, Z., Khetran, E. R., Rahman, A., Chan, W. O., Chowdury, F. A., Nag, D., Ahmad, J., & Friedman, D. S. (2019). Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh. JAMA Network Open, 2(11), e1916285. https://doi.org/10.1001/jamanetworkopen.2019.16285
Muqit MMK, et al. Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh. JAMA Netw Open. 2019 11 1;2(11):e1916285. PubMed PMID: 31774523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh. AU - Muqit,Mahiul M K, AU - Kourgialis,Nick, AU - Jackson-deGraffenried,Meredith, AU - Talukder,Zaman, AU - Khetran,Erica R, AU - Rahman,Arifur, AU - Chan,Weng Onn, AU - Chowdury,Fakrhul A, AU - Nag,Dipak, AU - Ahmad,Jasmin, AU - Friedman,David S, Y1 - 2019/11/01/ PY - 2019/11/28/entrez PY - 2019/11/28/pubmed PY - 2020/6/17/medline SP - e1916285 EP - e1916285 JF - JAMA network open JO - JAMA Netw Open VL - 2 IS - 11 N2 - Importance: 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. Objective: To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individuals with diabetes. Design, Setting, and Participants: 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. Main Outcomes and Measures: Primary DR grading outcomes, visual acuity, and treatment outcomes. Results: 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). Conclusions and Relevance: 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. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/31774523/Trends_in_Diabetic_Retinopathy_Visual_Acuity_and_Treatment_Outcomes_for_Patients_Living_With_Diabetes_in_a_Fundus_Photograph_Based_Diabetic_Retinopathy_Screening_Program_in_Bangladesh_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.16285 DB - PRIME DP - Unbound Medicine ER -