Prevalence and Associated Risk Indicators of Retinopathy in a Rural Bangladeshi Population with and without Diabetes

Akhter, Afroza; Fatema, Kaniz; Ahmed, Sayed Foysal; Afroz, Afsana; Ali, Liaquat; Hussain, Akhtar

doi:10.3109/09286586.2013.809770

Cited by 34 publications

(36 citation statements)

References 19 publications

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“…The results from the local graders are comparable with another study conducted in a small sample in Bangladesh (21.6%) [21], the Hoorn study (23.5%) in Netherlands [22], but higher than the Finnish study in Finland (14.0%) and the Chennai Urban Rural Epidemiology Study (CURES) in India (17.6%)[23]. The prevalence of DR graded by the CERA grader would be higher than 22.1% if the grader had been able to grade 100% of the photos.…”

Section: Discussionsupporting

confidence: 84%

“…The prevalence of 22.1% was found from 75% of the gradable photos, indicating about 30% would have DR if all photos had been gradable. The higher prevalence of DR in our study compared to the previous study in Bangladesh can be attributed with the fact that our study was conducted in people of age 40 years or older, compared to 25 years and older in another study [21], as DR is consistently associated with older age [21, 22, 24]. …”

Section: Discussioncontrasting

confidence: 58%

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Accuracy and reliability of retinal photo grading for diabetic retinopathy: Remote graders from a developing country and standard retinal photo grader in Australia

Islam

2017

PLoS ONE

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BackgroundTo evaluate the accuracy and reliability of fundus retinal photos graded by local graders in Bangladesh with those graded by an expert at the Centre for Eye Research Australia (CERA) in the context of mass scale diabetic retinopathy (DR) screening in Bangladesh.MethodsA population-based cross-sectional study of 3,104 adults identified 213 (7.2%) eligible patients with diabetes of age ≥ 40 years in 2012–2013. Retinal photographs were collected using a non-mydriatic digital fundus retinal camera and a two-field imaging protocol. The photos were graded by two remote graders (G1 and G2) who were trained by a retinal specialist (RS) in Bangladesh, by the RS himself, and by a Centre for Eye Research Australia (CERA) grader. The local graders up skilled their grading ability by comparing 30% of the photos graded by the CERA grader with their own grades. Learning from that exercise was applied to the remaining 70% of photos, which were re-graded. Reliability and accuracy of grading amongst the graders were reported using cross tabulation, inter- and intra-grader reliability, and with sensitivity and specificity.ResultsOf 122 eyes from 61 patients, the mild (R1) DR was estimated to be 14 to 25%, pre-proliferative (R2) DR 4–8%, and proliferative (R3) DR 0.8 to 1.6%, whereas 25%, 8%, 18%, and 15% were found to be ungradable by CERA, RS, G1, and G2, respectively. Of 8 (6.6%) eyes identified as R2 by the CERA grader, 5 (63%), 3 (38%) and 3 (38%) were correctly classified as R2, whereas the rest were classified either as R1 or R3 but none were classified as no DR (R0) or ungradable by the RS, G1 and G2, respectively. After getting experience reviewing the 30% test set graded by the CERA grader, the local graders graded moderate and severe DR with 100% accuracy. After excluding ungradable photos, the sensitivity (specificity) relative to the CERA grader was 82% (88%) before and 80% (93%) after training for G1 and 56% (87%) before and 77% (90%) after training for G2. In case of maculopathy, the CERA grader reported 11.2% eyes with maculopathy, which included 100% of the 4.9% by RS, 6.6% by G1, and 7.4% by G2.ConclusionsLocal graders in Bangladesh are able to grade retinal photos with high accuracy if the DR is at least of a moderate level. With appropriate training and experience, local graders have the ability to contribute significantly to the grading of millions of retinal photos, which required grading in resource- poor countries.

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Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 58%

Accuracy and reliability of retinal photo grading for diabetic retinopathy: Remote graders from a developing country and standard retinal photo grader in Australia

Islam

2017

PLoS ONE

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“…Similarly, a recent multicenter study of 684 people with diabetes in Colombo, Sri Lanka, reported a prevalence of DR and maculopathy of 18.1% and 9.7%, respectively . Finally, 21.6% of people with diabetes in a rural community in Bangladesh had DR …”

Section: Diabetic Retinopathymentioning

confidence: 99%

“…36 Similarly, a recent multicenter study of 684 people with diabetes in Colombo, Sri Lanka, reported a prevalence of DR and maculopathy of 18.1% and 9.7%, respectively. 57 Finally, 21.6% of people with diabetes in a rural community in Bangladesh had DR. 75 Numerous studies have shown that migrant South Asians have a higher prevalence of DR than Caucasians. In the Diabetic Retinopathy in Various Ethnic groups in UK (DRIVE UK) study, in which 46 962 patients with T2DM from west Yorkshire and southeast London were studied, South Asians had a higher prevalence of DR compared with Caucasians (42.3% vs 38%; OR 1.1).…”

Section: Diabetic Retinopathymentioning

confidence: 99%

Epidemiology of microvascular complications of diabetes in South Asians and comparison with other ethnicities

Gupta

Misra

2016

Journal of Diabetes

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Type 2 diabetes mellitus is widely prevalent in South Asians, and has a significant effect on health, as well as the economies of South Asian countries, particularly when the disease is associated with complications. There are certain characteristics associated with the South Asian phenotype that make South Asians especially prone to diabetes, as well as its complications. Microvascular complications cause considerable morbidity and mortality. There are significant differences in the epidemiology of microvascular complications between South Asians and people of other races. There is evidence of higher prevalence of nephropathy and retinopathy in South Asians compared with Caucasians; however, recent studies indicate that this trend seems to be leveling off. Importantly, diabetic neuropathy occurs less frequently in South Asians compared with Caucasians. These observations have important implications in managing South Asian patients with diabetes and microvascular complications.

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“…So far available a population based study of Bangladesh showed that overall prevalence of DR was 5.4% among the rural people of age 30 years or older [22]. Our study demonstrated that compared with the rural people of other areas of Bangladesh, the coastal people had increased prevalence of DR. An estimated global prevalence of 'any DR' was found 6.96% (95CI, 6.87-7.04) [23].…”

Section: Discussionmentioning

confidence: 58%

Diabetic retinopathy and visual impairment in disaster prone coastal population of Bangladesh

et al. 2017

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Prevalence and Associated Risk Indicators of Retinopathy in a Rural Bangladeshi Population with and without Diabetes

Cited by 34 publications

References 19 publications

Accuracy and reliability of retinal photo grading for diabetic retinopathy: Remote graders from a developing country and standard retinal photo grader in Australia

Accuracy and reliability of retinal photo grading for diabetic retinopathy: Remote graders from a developing country and standard retinal photo grader in Australia

Epidemiology of microvascular complications of diabetes in South Asians and comparison with other ethnicities

Diabetic retinopathy and visual impairment in disaster prone coastal population of Bangladesh

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