Availability of eye care infrastructure and human resources for managing diabetic retinopathy in the western province of Sri Lanka

BACKGROUND Visual impairment and blindness from diabetic retinopathy (DR), which can be reduced by early screening and treatment, is an emerging public health concern in low-income and middle-income countries (LMICs) owing to the increasing prevalence of diabetes mellitus (DM). However, no systematic screening exists in most LMIC settings. The Western province of Sri Lanka has the highest prevalence of DM (18.6%) in the country. A situational analysis identified a marked gap in DR screening (DRS) and treatment services uptake in this region; only opportunistic screening is practiced currently. OBJECTIVE The aim of this protocol is to describe the methods of development and validation of a DRS intervention using a hand-held nonmydriatic digital camera by physician graders in a non-ophthalmological setting at a tertiary-level medical clinic to propose a valid and feasible modality to improve uptake. METHODS DRS modality was developed after assessing barriers and identifying the most appropriate personnel, methods, and location for screening services, following formative research work. The validation will be conducted in a public sector tertiary care center in the Western province of Sri Lanka. The selected physicians will be trained on capturing and grading images according to a valid locally adopted protocol. Two physicians rated high on training will screen a sample of 506 people with DM at a medical clinic. They will use nonmydriatic and mydriatic 2-field imaging strategy. The validity of the proposed screening procedure will be assessed and compared with the mydriatic indirect biomicroscopic examination by a senior retinologist. RESULTS The validity of screening by physician graders will be analyzed and the sensitivity, specificity, and predictive values (with 95% CIs) calculated by the dilation status and for each grader. The diagnostic accuracy at each level of severity of DR will be assessed to define the most appropriate referable criteria. Data is currently being collected. CONCLUSIONS The outcome of this study will be useful for the detection of a defined level of DR at non-ophthalmological setting to filter the people with DM before referral to an eye clinic. This will be helpful to improve the uptake and identify risk groups in advance to prevent sight-threatening DR. Furthermore, evidence from this study will be useful for the implementation of a DRS program in this region and in similar communities. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/10900

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A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka

Tropical Medicine and Health ◽

10.1186/s41182-019-0160-y ◽

2019 ◽

Vol 47 (1) ◽

Cited By ~ 1

Author(s):

Mapa Mudiyanselage Prabhath Nishant Piyasena ◽

Gudlavalleti Venkata S. Murthy ◽

Jennifer L. Y. Yip ◽

Clare Gilbert ◽

Tunde Peto ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Sri Lanka ◽

Qualitative Study ◽

Diabetic Retinopathy Screening ◽

Barriers And Enablers ◽

Western Province ◽

Retinopathy Screening

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Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽

10.1136/bmjopen-2020-047757 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047757

Author(s):

Heba AlSawahli ◽

Caleb D Mpyet ◽

Gamal Ezzelarab ◽

Ibrahim Hassanin ◽

Mohammad Shalaby ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Rapid Assessment ◽

Good Control ◽

Population Based ◽

Secondary Outcome ◽

Public Health Approach ◽

Eye Care ◽

Cross Sectional Survey ◽

Prevalence Survey ◽

Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

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Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review

BMJ Global Health ◽

10.1136/bmjgh-2020-004484 ◽

2021 ◽

Vol 6 (3) ◽

pp. e004484

Author(s):

Helen Burn ◽

Lisa Hamm ◽

Joanna Black ◽

Anthea Burnett ◽

Matire Harwood ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Service Delivery ◽

Indigenous Peoples ◽

Indigenous Communities ◽

High Income ◽

Eye Care ◽

Service Delivery Models ◽

Care Services ◽

Delivery Models ◽

Improve Access

PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.

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Situational analysis of diabetic retinopathy treatment Services in Ghana

BMC Health Services Research ◽

10.1186/s12913-021-06608-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Agatha Mensah-Debrah ◽

Kwesi Nyan Amissah Arthur ◽

David Ben Kumah ◽

Kwadwo Owusu Akuffo ◽

Isaiah Osei Duah ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Vitreoretinal Surgery ◽

Health Facilities ◽

Service Utilisation ◽

Eye Care ◽

Treatment Service ◽

Treatment Services ◽

Disadvantaged Population ◽

Anti Vegf ◽

Geographical Regions

Abstract Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.

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Clinical staff impressions on implementation of a teleophthalmology program to improve diabetic retinopathy surveillance informed by implementation science frameworks (Preprint)

10.2196/preprints.32162 ◽

2021 ◽

Author(s):

Rajeev S. Ramchandran ◽

Reza Yousefi-Nooraie ◽

Porooshat Dadgostar ◽

Sule Yilmaz ◽

Jesica Basant ◽

...

Keyword(s):

Primary Care ◽

Diabetic Retinopathy ◽

Care Coordination ◽

Low Income ◽

Safety Net ◽

The United States ◽

Eye Care ◽

Continuous Training ◽

Effective Care ◽

Store And Forward

BACKGROUND Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. OBJECTIVE Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. METHODS This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks. RESULTS Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability. CONCLUSIONS Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.

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