DR Research

Background: Diabetic retinopathy (DR) is a common complication of diabetes that often results in blindness. There is limited data on the pattern and determinants of diabetic retinopathy among diabetic patients in Zimbabwe. Such data would inform planning of programs for early detection and treatment of diabetic retinopathy.

Objective: To describe the pattern and determinants of diabetic retinopathy among diabetic patients presenting for diabetic retinopathy screening at a private eye clinic in Mutare.

Method: Record cards of patients with diagnosis of diabetes who presented for diabetic retinopathy screening at a private eye clinic in Mutare were analysed. The screening process included measurement of visual acuity, slit lamp examination of anterior segment, refraction, intra-ocular pressure measurement and dilated fundus examination. Observed retinopathy was graded according to ICO guidelines for classification and grading of DR.  A questionnaire was completed detailing patient demographic information, duration of diabetes, current treatment and presence of systemic and ocular comorbidities. Blood analysis for fasting blood sugar, glycosylated haemoglobin level and fasting cholesterol were performed as well as urine analysis for protein.  Data was entered, processed and analysed in Stata.

Results: One hundred and three diabetics were screened for retinopathy in the period June 2017 –August 2018. Almost all screened diabetics (95%) had type 2 diabetes. Mean fasting blood glucose in mmols/L was 9.5±5.1, (range 4-30) and mean HbA1C was 9.0±4.3, (range 3.8-23.6). The prevalence and pattern of retinopathy was as follows; Any DR 42.2% (95% CI 32-51), Proliferative DR 19%(95%CI 12-28%and diabetic macula oedema (DME) 24.2%. Regression analysis, showed a strong association between presence of retinopathy and the following: Duration of diabetes>10 years (OR= 7.0 (95%CI 2.1-12.2); presence of visual symptoms at presentation (OR= 3.4, p=0.02, 95%CI 1.2-9.5) and presence of systemic hypertension(OR= 10.5, p=0.03, 95%CI 1.2-91.3). Blurred vision was the commonest presenting symptom present in 56% of patients. Despite private sector setting, the majority of patients could not afford essential laboratory investigations required for DR monitoring.

Conclusions and Recommendations: Diabetic retinopathy is prevalent among diabetics in Mutare. A high proportion of patients have sight threatening retinopathy. Patients are more likely to present for screening late after onset of visual symptoms. Access to laboratory monitoring investigations for diabetes control remains limited even within private sector context. Starting a public screening program and treatment centre in the city is recommended to facilitate early detection and treatment of DR. Knowledge of existence of this dreaded complication of diabetes and its potential effect on vision should be spread to diabetics and their family doctors.