Diabetic Retinopathy module for RAAB 5

David YorstonSarah Polack

Hannah KuperHans Limburg

Why assess DR in RAAB?

Diabetes – a growing problem

Source: International Diabetes Foundation, 2011

Diabetic retinopathy

Cataract 39%

Refractive error 18%

Glaucoma 10%

ARMD 7%

CO 4%

DR 4%

Trachoma 3%Childhood 3%

Other 11%

Few countries with population based DR prevalence data

What this will tell us

DR module provides estimates of:•Prevalence of diabetes•Prevalence of DR and sight threatening DR in

people with diabetes and in general population•Coverage of DR examinations among people with

known diabetes •Levels of glycaemic control among people with

diabetes ….among people aged 50+ years….to be used to inform service planning

Results from Chiapas, Mexico

Results

Prevalence of diabetes 20%

Prevalence of DR among diabetics 40%

Prevalence of sight threatening DR among diabetics 23%

Proportion of diabetic participants with previous eye exam 47%

Proportion of diabetic participants with poor glycaemic control (RBG≥200mg/dl) 73%

Methods

1. Obtain informed written consent

• Explain (participant information sheet):– Purpose of study– Procedures involved– Risks (affect of dilation on vision)– Participation is voluntary– Confidentiality

• Consenting participants must sign/thumb-print consent form

• To be done when first arrive at the household

2. Assess diabetes (section H)

• Ask about previous diagnosis

• Test random blood glucose

Diabetes: Previous diagnosis and/or

RBG ≥200mg/dl

Known diabetes: Previous diagnosis

(regardless of current RBG)

Newly diagnosed diabetes:

No previous diagnosis, but

RBG ≥200mg/dl

3. Ask questions to people with known diabetes (section I)

• Age of diagnosis• Diabetes treatment• Diabetic eye exam

4. Dilated eye examination of all people with diabetes (section J)

Dilated examination with direct & indirect ophthalmoscope

Diabetes classification‘Have you ever been told by

a doctor /nurse that you

have diabetes, sugar in your

urine or high blood sugar’

RBG level Classification Action

No 1-199mg/dl Does not have diabetes Finish!

No 200+ mg/dl Has newly diagnosed diabetes Complete section H only

Yes 1-199mg/dl Has known diabetes Complete sections I & J

Yes 200+ mg/dl Has known diabetes Complete sections I & J

Yes Refuses RBG test Has known diabetes Complete sections I & J

No Refuses RBG test Unknown status Finish!

Obtain informed consent

Diabetes assessment

Known ‘diabetes’ No ‘diabetes’

Finish!

Newly diagnosed ‘diabetes’

Ask questions about diabetes

Dilate pupils

Fundus examination

Standard RAAB protocol

However!

• Standard RAAB: – 4-5 days training; cost 20-40,000 US$

• RAAB + DR– 5-7 days training; cost 40-100,000 US$– Prevalence of diabetes >20% in people 50+– 1 team: 35 persons/day; 2 teams 60/day– Requires DR specialists and equipment– Special trainer for DR

Downloads of RAAB 5will soon be available at:

www.ICEH.org

Thank you!