Screening for diabetic retinopathy in South Africa with 60° retinal colour photography

Joannou, J.; Kalk, W. J.; Ntsepo, S.; Berzin, M.; Joffe, B. I.; Raal, FJ; Sachs, Erich; Merwe, M. T. van der; Wing, Jeffrey; Mahomed, I

doi:10.1046/j.1365-2796.1996.413755000.x

Cited by 23 publications

(22 citation statements)

References 18 publications

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“…Other studies have shown that photos without mydriasis were often of poor quality and unable to be graded, especially in older patients and in the presence of media opacities 18 , 19 . The higher failure rate of fundus photography in our study (11%; 86/792) compared with the reported failure rate of dilated fundus photography (4%–8%) 14 ‐ 16 , 18 may have resulted from a higher prevalence of media opacities, such as corneal scarring and cataract, among Indigenous Australians 23 . Media opacity or small pupils would increase the likelihood of a false negative result, reducing the sensitivity of the screening photography.…”

Section: Discussioncontrasting

confidence: 70%

“…The presence and degree of DR was graded using the Early Treatment of Diabetic Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of DR 12 by clinical comparison with standardised photographs (Box 1). The DR was graded as either no DR (level 10-13), minimal non-proliferative DR (NPDR) (level [14][15][16][17][18][19], mild NPDR (level 20-39), moderate NPDR (level 40-49), severe NPDR (level 50-59) and proliferative DR (PDR) (level 60-85). Clinically significant macular oedema (CSMO) was defined as any retinal thickening within 500 μm of the fovea associated with retinal thickening that is at least one disc area in size within one disc diameter of the fovea.…”

Section: Methodsmentioning

confidence: 99%

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The reliability of single‐field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study

Landers

Henderson

et al. 2013

Medical Journal of Australia

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Section: Discussioncontrasting

confidence: 70%

Section: Methodsmentioning

confidence: 99%

The reliability of single‐field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study

Landers

Henderson

et al. 2013

Medical Journal of Australia

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“…Diabetic retinopathy in Africa • P. I. Burgess et al Not reported *Three reports [31,35,60] described grades of diabetic retinopathy in overlapping populations. Figure for any diabetic retinopathy taken from the largest report [31] (n = 1517); associations of diabetic retinopathy taken from smaller report (n = 507) [35].…”

Section: Diabeticmedicinementioning

confidence: 99%

Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

et al. 2013

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AimTo summarize findings from studies reporting the prevalence and incidence of diabetic retinopathy and diabetic maculopathy in African countries in light of the rising prevalence of diabetes mellitus.MethodsUsing a predefined search strategy, we systematically searched MEDLINE, EMBASE, Science Citation index and Conference Proceedings Citation index, African Index Medicus and the grey literature database ‘OpenSIGLE’ for studies published between January 1990 and February 2011. Included studies reported prevalence or incidence of diabetic retinopathy or diabetic maculopathy of subjects with diabetes resident in African countries.ResultsSixty-two studies from 21 countries were included: three population-based surveys; two cohort studies; five case–control studies; 32 diabetes clinic-based, nine eye clinic-based and 11 other hospital-based surveys. Included studies varied considerably in terms of patient selection, method of assessing the eye and retinopathy classification. In population-based studies, the reported prevalence range in patients with diabetes for diabetic retinopathy was 30.2 to 31.6%, proliferative diabetic retinopathy 0.9 to 1.3%, and any maculopathy 1.2 to 4.5%. In diabetes clinic-based surveys, the reported prevalence range for diabetic retinopathy was 7.0 to 62.4%, proliferative diabetic retinopathy 0 to 6.9%, and any maculopathy 1.2 to 31.1%. No obvious association between prevalence and income level of the country was detected.ConclusionsLarge, community-based cross-sectional and cohort studies are needed to investigate rates and determinants of prevalence of diabetic retinopathy, incidence and progression in Africa. Consensus is needed on the most appropriate methods of identification and classification of retinopathy for research and clinical practice. Estimates of prevalence of diabetic retinopathy, proliferative diabetic retinopathy and maculopathy are comparable with recent European and American studies.

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“…Screening using retinal photography has been piloted [26,27,29]. However, most reports have come from South Africa and these efforts have largely been initiated by local hospitals or by external funding and support.…”

Section: Discussionmentioning

confidence: 99%

“…Defining an eligible population is an essential component of a screening program but is another challenge in resource-poor settings. Apart from rudimentary costing [26], no evidence on cost effectiveness of screening programs on the continent is available. The fact that patients present late with diabetes must be considered.…”

Section: Discussionmentioning

confidence: 99%

Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic

Burgess

Msukwa

Beare

2013

BMC Med

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BackgroundSub-Saharan Africa faces an epidemic of diabetes. Diabetes causes significant morbidity including visual loss from diabetic retinopathy, which is largely preventable. In this resource-poor setting, health systems are poorly organized to deliver chronic care with multiple system involvement. The specific skills and resources needed to manage diabetic retinopathy are scarce. The costs of inaction for individuals, communities and countries are likely to be high.DiscussionScreening for and treatment of diabetic retinopathy have been shown to be effective, and cost-effective, in resource-rich settings. In sub-Saharan Africa, clinical services for diabetes need to be expanded with the provision of effective, integrated care, including case-finding and management of diabetic retinopathy. This should be underpinned by a high quality evidence base accounting for differences in diabetes types, resources, patients and society in Africa. Research must address the epidemiology of diabetic retinopathy in Africa, strategies for disease detection and management with laser treatment, and include health economic analyses. Models of care tailored to the local geographic and social context are most likely to be cost effective, and should draw on experience and expertise from other continents. Research into diabetic retinopathy in Africa can drive the political agenda for service development and enable informed prioritization of available health funding at a national level. Effective interventions need to be implemented in the near future to avert a large burden of visual loss from diabetic retinopathy in the continent.SummaryAn increase in visual loss from diabetic retinopathy is inevitable as the diabetes epidemic emerges in sub-Saharan Africa. This could be minimized by the provision of case-finding and laser treatment, but how to do this most effectively in the regional context is not known. Research into the epidemiology, case-finding and laser treatment of diabetic retinopathy in sub-Saharan Africa will highlight a poorly met need, as well as guide the development of services for that need as it expands.

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Screening for diabetic retinopathy in South Africa with 60° retinal colour photography

Abstract: 60 degrees retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.

Cited by 23 publications

References 18 publications

The reliability of single‐field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study

The reliability of single‐field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study

Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic

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