Role of early screening for diabetic retinopathy in patients with diabetes mellitus: An overview

Abstract

Diabetes has emerged as a major public health problem in India. It is estimated that there were 40 million persons with diabetes in India in 2007 and this number is predicted to rise to almost 70 million by 2025. The impact of rapid urbanization, industrialization and lifestyle changes has led to an increasing trend in prevalence of diabetes and its associated complications such as neuropathy, nephropathy, vascular diseases (cardiac, cerebral and peripheral) and retinopathy. Diabetic retinopathy is a important cause of avoidable blindness in India. Treatment interventions at early stages of diabetic retinopathy can reduce burden of blindness due to diabetic retinopathy. With the available cost-effective methods of early screening, appropriate strategies/models need to be developed. Such models need to have a well-developed mode for screening, diagnosis and referral at each hierarchal level beginning from primary health centers to specialized institutes for eye care. The National Program for Control of Blindness of India recommends opportunistic screening for identification of diabetic retinopathy. Every opportunity of contact with high-risk cases for diabetes and/or diabetic retinopathy should be utilized for screening, diagnosis and referral. All the stakeholders including the private sector will need to play a role. Along with this, awareness generation and behavior change amongst the diabetics and care support systems should also be part of the overall model. A major role can be played by community participation and improving the health seeking behavior among diabetics in order to reach a larger population and increasing the compliance for continued care.

Screening for diabetic retinopathy: the optometrist’s perspective

“…This method of DR screening reduces the cost of transporting all the patients to the hospital. 111 Criteria for review and referral for DR by optometrists to an ophthalmologist In each examination, the optometrist should determine the level of DR by evaluating the presence and degree of hemorrhages, microaneurysms, IRMAs, venous beading, neovascularization, and ME. After retinopathy is detected, examinations should be repeated more frequently based on the level of retinopathy.…”

Role of KCa3.1 Channels in Proliferation and Migration of Vascular Smooth Muscle Cells by Diabetic Rat Serum

“…Diabetes mellitus is a complex disease com-prising a series of metabolic disturbances with hyperglycaemia, hyperinsulinemia and an increase in circulating AGEs, which are associated with vascular complications of diabetes such as nephropathy, retinopathy and the development of atherosclerosis (2,16,30). VSMCs may play an influential role in the progression of diabetic macroangiopathy.…”

National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal

“…DR is a vascular complication, the prevalence of which is strongly related to both the duration of T2DM as well as the level of glycaemic control. Consequently, optimal glycaemic control is necessary for reducing the risk or slowing the progression of DR. 38 An opportunistic screening model can be adopted for detection of other complications of T2DM when at risk patients present for screening or management of DR. 40 An initial dilated and comprehensive eye examination should be conducted by an ophthalmologist at the time of the diagnosis of T2DM. 38 Screening for diabetic retinopathy should involve a complete ophthalmic examination with refractory visual activity and fundus photography.…”