Prevalence and causes of blindness and diabetic retinopathy in Southern Saudi Arabia

A meta-analysis of prevalence of diabetic retinopathy in Asia

INTRODUCTION

Diabetic retinopathy (DR) is a common microvascular complication of diabetes. This review reports the prevalence of DR in Asia and guides healthcare provision in screening and treatment.

EVIDENCE ACQUISITION

Medline was searched for articles describing the prevalence of DR in Asia. Statistical analysis was performed using Freeman-Tukey double arcsine transformation and the DerSimonian and Laird model. The prevalence of DR was estimated according to the following subgroups: Economic status (high, middle, and low income), country, and ethnicity. The risk of bias of the articles was also assessed.

EVIDENCE SYNTHESIS

A total of 66 studies were included, and out of 2,599,857 patients with diabetes, 201,646 were diagnosed with DR. The overall prevalence of DR, non-proliferative DR (NPDR), proliferative DR (PDR) and maculopathy were recorded at 21.7% (CI: 19.1-24.6%), 19.9% (CI: 17.3-22.8%), 2.3% (CI: 1.6-3.4%) and 4.8% (CI: 3.5-6.7%) respectively. Low-income countries had the lowest prevalence of DR, NPDR, PDR and maculopathy compared to the middle- and high-income countries. Middle-income countries had the highest prevalence of DR (23.9%; CI: 19.4-29.2%), NPDR (21.1%; CI: 17.0-25.9%), moderate NPDR (7.9%; CI: 5.7-11.0%), PDR (3.0%; CI: 1.8-4.9%) and maculopathy (4.7%; CI: 3.0-7.4%), while high-income countries had the highest prevalence of mild (10.3%; CI: 4.2-23.2%) and severe NPDR (3.0%; CI: 1.0-8.4%).

CONCLUSIONS

One in five people with diabetes have diabetic retinopathy. It is imperative that public healthcare take heeds to heighten the screening program to provide all patients with diabetes equitable access to DR screening and ophthalmology services.

Prevalence and Predictors of Diabetic Retinopathy in Saudi Arabia: Insights from a Systematic Review and Meta-Analysis

BACKGROUND

Diabetic retinopathy (DR) is one of the leading causes of blindness among diabetic patients, particularly in areas with an increase in diabetes epidemics, such as Saudi Arabia. Notwithstanding the significant public health implications, data on the prevalence and risk factors of DR in Saudi Arabia are few and scattered, limited to certain geographic areas. Our study objective is to conduct a systematic review of the literature and a meta-analysis of the prevalence and predictors for DR in Saudi Arabia, within both type 1 and type 2 diabetes.

METHODS

A systematic review and meta-analysis were constructed according to PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar electronic databases for studies published from 2000-2023. Any study related to the prevalence of diabetic retinopathy in T1DM or T2DM among adult patients aged ≥18 years that was conducted in Saudi Arabia was included. Pooling prevalence estimates were calculated using a random-effects model, and heterogeneity across the studies was tested by the I2 statistic and Cochran's Q test.

RESULTS

A total of 11 studies published between 2006 and 2019 met the inclusion criteria, with sample sizes ranging from 99 to over 50,000 participants. The overall pooled prevalence of DR was estimated to be 31% (95% CI: 24-39%), with substantial heterogeneity observed across studies (I2 = 99%). Prevalence estimates ranged from 16.7% to 69.8% and were influenced by variables such as study design, duration of diabetes, and glycemic control. Among individuals with type 2 diabetes, the pooled prevalence was 24% (95% CI: 20-28%). Poor glycemic control and longer diabetes duration were consistently identified as significant predictors of DR, while other factors, such as obesity and hypertension, were also associated with an increased risk of DR.

CONCLUSIONS

The high prevalence of DR in Saudi Arabia highlights the critical need for focused public health initiatives, especially among those with type 2 diabetes. To minimize the effects of DR, early intervention, routine DR screening programs, and optimal diabetes control are essential. The increasing prevalence of DR in Saudi Arabia requires careful consideration of healthcare policy and resource allocation, which is made possible by our results.

Perceptions and Misconceptions About Eye Disease Treatment: A Cross-Sectional Study From Jazan, Saudi Arabia

BACKGROUND

Eye diseases such as cataracts and glaucoma significantly contribute to vision impairment and blindness worldwide. While cataracts are the leading cause of preventable blindness, glaucoma, often referred to as the "silent thief of sight", can lead to irreversible vision loss if untreated. Despite their prevalence, awareness and understanding of these conditions remain low, particularly in regions like Saudi Arabia, where demographic changes and rising diabetes rates exacerbate the burden of eye diseases. This study aims to assess the knowledge and perceptions of cataracts and glaucoma among residents of Jazan to identify gaps and inform public health interventions.

METHODS

A cross-sectional online survey was conducted among participants aged 18 years and older in Jazan. The structured questionnaire assessed demographic information, awareness of cataracts and glaucoma, understanding of symptoms, and perceptions of treatment options. Data collection took place over four weeks, with statistical analysis performed using descriptive statistics to summarize findings.

RESULTS

A total of 426 participants completed the survey. Of these, 43.9% (n = 186) were aware of cataracts, while only 28.1% (n = 119) recognized glaucoma. Awareness of cataract symptoms varied, with 43.4% (n = 184) identifying blurred vision; however, 71.5% (n = 303) reported being unaware of glaucoma. A significant majority (68.2%, n = 289) recognized surgical treatment for cataracts, but only 27.8% (n = 118) were aware of treatment options for glaucoma. High levels of uncertainty about both conditions suggest a critical lack of understanding in the community.

CONCLUSION

This study emphasizes the need for improved awareness and understanding of cataracts and glaucoma in Jazan, Saudi Arabia. By implementing targeted public health strategies, healthcare providers can enhance knowledge, encourage regular eye examinations, and ultimately reduce the burden of visual impairment in the community.

Knowledge, Attitude, and Practice on Diabetic Retinopathy among Final-Year Medical Students in Riyadh

Introduction

This study aimed to evaluate the awareness, knowledge, and attitude on diabetic retinopathy of final-year medical students and the association of knowledge, attitude, and practice with the gender of medical students.

Methods

A descriptive cross-sectional study was conducted at the College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. The initial part of the questionnaire included demographic details, while the remaining parts of the questionnaire included six questions on knowledge, four on attitude, and three on practice. IBM SPSS Statistics 24 was used to retrieve and analyze data from an Excel file. A P value <0.05 was considered as statistically significant.

Results

Of 84 medical students, 51 (60.71%) and 33 (39.19%) were male and female medical students, respectively. The total knowledge score for male and female medical students was 4.28 (SD = 0.92). The majority of students correctly answered practice questions, indicating good significant practice toward diabetic retinopathy among diabetic patients with A score of 1.93 (SD = 0.83).

Conclusion

The majority of final-year medical students were good in knowledge and practice toward prevention and treatment of diabetic retinopathy, which helps them become better future care providers for patients with diabetes and diabetic retinopathy.

The Evaluation of Diabetic Patients' Awareness of Diabetic Retinopathy and Its Complications in the Western Region of Saudi Arabia

Background Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia. Globally, 382 million people have diabetes mellitus, and 90% of these patients suffer from type 2 diabetes. Saudi Arabia has the second-highest prevalence of diabetes among all Middle Eastern countries. Diabetic retinopathy (DR) is a significant complication of diabetes; early detection and proper intervention are important for its management and prognosis. Aim This study aims to assess the awareness of diabetic patients of diabetic retinopathy symptoms and complications in the western region of Saudi Arabia. Methods This is a cross-sectional study in which a convenience sampling technique was implemented for collecting data from all patients who fulfilled the inclusion criteria within the timeframe between February 2022 and October 2022 among diabetic patients at the National Guard Health Affairs in the western region. We included both type 1 and type 2 diabetic participants who are older than 18 years of age and have at least one visit to any outpatient ophthalmology clinic. Results This study involved 259 participants. The mean age of the participants is 46.69 (standard deviation {SD}: 15.59). Type 2 was more prevalent among the applicants (58.3%). A total of 242 (93%) participants were aware that diabetes could affect their eyes. Surprisingly, 130 (50.2%) do not know about diabetic retinopathy therapy options. The most significant obstacle to being examined early for ophthalmological diseases among diabetic patients was the deficient knowledge of diabetic retinopathy. Also, a significant statistical relationship was found between the year of diagnosis and the level of awareness regarding eye complications. Conclusion Despite the high level of awareness of diabetic retinopathy among diabetic patients shown in our study, it did not correspond to a high level of self-awareness on the importance of preventive measures such as annual diabetic retinopathy screening.

Awareness of Diabetic Retinopathy Among Patients With Type 2 Diabetes Mellitus in Primary Healthcare Centers in Madinah, Saudi Arabia: A Cross-Sectional Study

Background The prevalence of diabetes mellitus (DM) in Saudi Arabia is among the highest in the Middle East and North Africa (MENA) regions. Various complications of DM can cause problems in the long term. One of the most prevalent microvascular problems and the primary cause of blindness is diabetic retinopathy (DR), and a significant proportion of the population with diabetes eventually develop diabetes retinopathy. Recognizing and understanding DR may be crucial for patients in identifying and averting this complication.  Objectives The objective of this atudy is to assess the awareness of DR among patients with type 2 DM at primary healthcare centers in Madinah, Saudi Arabia.  Methods This cross-sectional study involved a survey of patients with diabetes who attended Madinah primary care clinics between August and September 2023. The study was conducted in Madinah, Saudi Arabia, from May to November 2023.  Results A total of 240 patients participated with a median age of 49.7 years and a gender distribution of 121 (50.4%) men. Overall, less than half of patients had a fair level of knowledge (47.1%) and a good level of knowledge (42.1%) about DR, whereas 10.8% had poor knowledge. Physicians were the primary source of information for patients, followed by the internet, family, and friends. Higher levels of education, diabetes that had been present for a longer period, and regular eye exams were associated with better understanding. This study emphasizes the importance of improving patient knowledge and awareness of DR.  Conclusions We observed a high level of awareness of DR among participants. Furthermore, higher awareness was associated with longer disease duration and compliance with diabetes treatment.

Neutrophil-Lymphocyte Ratios in Dry Age-Related Macular Degeneration

Inflammation plays a role in the etiopathogenesis of age-related macular degeneration (AMD). A retrospective case-control study was conducted to assess the significance of the neutrophil-lymphocyte ratio (NLR) as a systemic inflammatory indicator in dry AMD. Clinical diagnosis and complete blood count (CBC) results were extracted from medical records for patients with dry AMD and age/sex-matched controls. This study included 90 patients diagnosed with dry AMD and 270 controls without AMD. There were no significant differences in the CBC results between the cases and controls. Patients with dry AMD had a slightly higher mean NLR than controls; however, this increase was not significant (P = .13). In the NLR model, age and sex were significant factors affecting the NLR values in the dry AMD group (P = .03 and 0.01, respectively). The NLR alone cannot predict dry AMD. Therefore, exploring other routine laboratory measurements may shed light on early disease prediction and prevention.

Prevalence of diabetic retinopathy in patients with diabetes in Alexandria and North-West Delta, Egypt

PURPOSE

The purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region.

METHODS

All diabetic patients attending the general ophthalmology clinics (Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders. Adjudication by a consultant was done when needed.

RESULTS

Out of 11,033 screened patients, 10,811 had a gradable fundus photograph in at least one eye and were included. The numbers of cases in groups 1, 2 and 3 were 3940, 2826, and 4045, respectively. Males represented 38.35% of the cases. Mean age was 55 ± 12.63. For the whole sample, groups 1, 2 and 3, the DR prevalence was 32.49, 46.4%, 29.13%, and 21.29%, respectively. The prevalence of proliferative DR (grade R4) was 6.16%, 11.83%, 5.02%, and 1.45%, respectively, and of referable maculopathy (Grade M2) was 19.95%, 31.42%, 15.92%, and 11.59%, respectively. In univariate analysis, older age, higher random blood glucose, and longer DM duration were associated with a higher risk of both DR and referable diabetic maculopathy. This association was maintained in multivariate analysis for the high random blood glucose level and the longer duration of DM (but not for the older age).

CONCLUSION

A significantly higher prevalence of DR, grades R4 and M2 was found in the hospital-recruited patients than in diabetics from the local communities.

Prevalence and Determinants of Diabetic Retinopathy Among Type 2 Diabetic Patients in Saudi Arabia: A Systematic Review

Diabetic retinopathy (DR) is a preventable complication of diabetes; however, it is a serious one if not early recognized and properly managed as it can lead to visual impairment. This review aimed to summarize the prevalence and determinants of DR among type 2 diabetic patients in Saudi Arabia. Eligible articles for this systematic review were quantitative observational studies that were English-published between 2015 and 2021, peer-reviewed, and conducted on patients with type 2 diabetes mellitus (DM). The studies were obtained by searching PubMed/Medline, ScienceDirect, Cochrane Library Database, and Google Scholar. The risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Out of 16 preliminary studies, 12 were eligible for inclusion in this systematic review. One study was a chart review, one was a prospective study, and the remaining were cross-sectional studies. Regarding the study tool, retinopathy was diagnosed by an ophthalmologist using fundus photography and/or slit-lamp examination in most of the studies (n=7). However, some studies reported obtaining data from patient interviews and medical files (n=4). Concerning the outcome, an overall high prevalence of DR (ranging between 6.25% and 88.1%) and some significant associated risk factors were determined, including longer duration of diabetes, older age, poor blood pressure control, poor glycemic control, and physical inactivity. Most studies showed moderate overall quality. In conclusion, DR is a common complication of type 2 diabetes in Saudi Arabia. Some avoidable risk factors are identified, through which the doctors can identify patients at high risk of DR through early screening and can, thus, initiate prompt treatment to reduce the risk of vision deterioration.

Assessment of macular pigment optical density in Arab population and its relationship to people's anthropometric data: a cross-sectional study

Background

Anthropometry facilitates the evaluation of risks associated with reduced macular pigment optical density (MPOD).

Objectives

To investigate the predictors and anthropometric indices associated with MPOD in healthy adult in Arab population.

Design

This is a cross-sectional study.

Methods

The MPOD was measured at 0.5° from fovea using a heterochromatic flicker photometer. Healthy participants aged between 20 and 40 years were recruited. The study evaluated the following data of the participants: height, weight, body mass index, body fat percentage, basal metabolic rate, visceral fat level, muscle mass, bone mineral content, and percentage of protein and body water. The correlation between MPOD with anthropometrics and demographic data was evaluated using Spearman's correlation test. The differences among genders were investigated using the Mann-Whitney U test. The smoking effect on MPOD was analyzed using the Friedman test.

Results

In all, 143 participants were recruited. The median ± interquartile range was calculated for age (23 ± 4 years), visual acuity (0.00 ± 0.00 logMAR), and MPOD (0.41 ± 0.18). The average MPOD was higher in males than in females but it was not statistically significant (p > 0.05); on the other hand, they were statistically significantly different in most of the anthropometric data. A significant relationship was found between MPOD and percentage of body fat, protein, and body water (r = 0.30, p < 0.05). The observed median MPOD value was higher in this study than that found in previous studies in white populations, but lower than that found in studies investigating Asian populations.

Conclusion

One of the most important risk factors of age-related macular degeneration is associated with a relative absence of macular pigment. This study brought into focus percentage of protein and body water for further studies as well as the well-established links with body fat and obesity. Unknown predictors of MPOD remain uncovered. The study also provided first report on normative values of MPOD for Arab population and confirmed the differences from other ethnicities.

An Assessment on the Awareness of Diabetic Retinopathy Among Participants Attending the Diabetes Awareness Camp in Saudi Arabia

Aim The objective of this study is to assess the level of awareness of the effect of diabetes and diabetic retinopathy (DR) on the eye among a sample of the Jeddah community. Methods A cross-sectional study was conducted among those attending a diabetes awareness camp in Jeddah, Saudi Arabia, in November 2021. Participants were asked to answer questions in a structured questionnaire that was already used in a previous study. Responses were analyzed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 352 participants were included in this study, 184 (52.3%) of them were females. Of the participants, only 74 (21%) had diabetes mellitus (DM). The vast majority (94%) of the participants believed that diabetes could affect the eyes, and 94.3% believed that maintaining the level of blood sugar could maintain the eye and the level of vision. Moreover, 77.3% were aware that diabetes could lead to visual impairment and blindness. Around one-third of the total participants and less than half of the diabetic group were found familiar with DR. Although 96% of diabetic participants reported the need for diabetics to get their eyes checked annually, only 70% did so. Lack of awareness of the effect of diabetes on the retina was the main barrier preventing diabetic groups from getting their eye checked. Conclusion Despite the good level of awareness among the community and diabetics about diabetes and its effect on the eyes, there is less awareness that DR is one of the most dangerous complications that lead to visual impairments. These findings assure the importance to raise awareness of DR among the community and diabetics and increase awareness of the importance of annual eye examinations.

Prevalence of diabetic retinopathy in the Eastern Mediterranean Region: a systematic review and meta-analysis

Objectives

Individual studies in the Eastern Mediterranean Region (EMR) have shown the high prevalence of diabetic retinopathy. We conducted a meta-analysis to yield an estimate of the prevalence of diabetic (type 1 and 2) retinopathy in the EMR. Additionally, we explored its potential modulators.

Methods

Two-step screening of relevant articles published from 1 January 2000 to 13 December 2019 was carried out. An estimation of summary proportions, subgroup analysis, meta-regression, and publication bias assessment were performed.

Results

One hundred nine articles were included in the meta-analysis, involving 280,566 patients. The prevalence of diabetic retinopathy was 31% (95% confidence interval [CI] = 28, 33). The highest and lowest diabetic retinopathy prevalence rates were observed in low human development index (HDI) countries (63.6; 95% CI = 52.4, 74.0) and very high HDI countries 22.6 (95% CI = 20.5, 24.7), respectively.

Conclusions

The prevalence of diabetic retinopathy is high in the EMR. Our results provide important information for diverse healthcare surveillance systems in the EMR to implement the modifiable risk factors, diabetes screening to decrease undiagnosed diabetes, early detection of retinopathy, and proper diabetes care to decrease untreated diabetes.

Evaluating validity and reliability of the Arabic-version low-vision quality-of-life questionnaire

Low-vision quality-of-life questionnaire (LVQOL) has not been developed in the Arabic language, and none has been translated into Arabic. This study would demonstrate the effectiveness of the translated questionnaire. The English LVQOL was translated into Arabic (ARB-LVQOL) through five stages. A total of 52 low vision and 30 normally sighted individuals participated in this study. The internal consistency reliability, item-total correlation reliability, construct validity, convergent validity, discriminative validity, and respondent burden of the ARB-LVQOL were calculated. The translation team recommended that the ARB-LVQOL replicated the meaning of the LVQOL. The cultural differences were also noted during the translation process. Cronbach’s coefficient was α = 0.90 in both low vision (LV) and simulated groups. The item-total correlation ranged from 0.50 to 0.70 in both groups. The intra-class correlation coefficient indicated good test–retest reliability (LV group, ranged 0.82–0.93; control group ranged 0.83–0.94). The factor analysis, using varimax rotation, of the ARB-VQOL identified seven factors. A moderate to a strong relationship between the score of each domain with the total index score was observed, indicating an adequate convergent validity. The ARB-LVQOL discriminated between normally sighted and simulated low-vision participants and also to some extent between the simulated and real low-vision individuals. The respondent burden was less than 15 min in most responses. The ARB-LVQOL was found to relate well with patients’ visual functions and some patients’ characteristics, providing further evidence of the validity of ARB-LVQOL. The ARB-LVQOL showed psychometric properties analogous to the English version. The ARB-LVQOL could be used in clinical settings and research in adults with low vision in Arabic populations.

Knowledge, Attitudes, and Practices towards Diabetic Retinopathy among Primary Care Physicians of Saudi Arabia: A Multicenter Cross-Sectional Study

Primary care physicians play a vital role in preventing the progression of diabetic retinopathy (DR) from the initial stages to the late stages. This questionnaire-based analytical cross-sectional study was carried out to assess the knowledge, attitude, practices, and their correlation among 274 randomly selected primary care physicians in Saudi Arabia. Among the studied population, high knowledge, attitudes, and practice scores were observed in 21.5%, 15%, and 29.2% of the physicians, respectively. The mean knowledge score was significantly higher among the age group of less than 30 years (p = 0.031) and the female gender (p = 0.012). The attitude scores were significantly higher among the Saudi physicians (p = 0.027) and those with PHC work experience of less than five years (p < 0.001). Regarding the practices, a significant association was found among the age group of less than 30 years (p = 0.019) and Saudi physicians (p = 0.003). There was a significant positive correlation between knowledge (correlation coefficient (r) = 0.739, p < 0.001) and attitude (r = 0.479, p = 0.007) with the practice scores. It is recommended that targeted continuous medical education, workshops, and seminars are conducted on the prevention and care of DR among primary care physicians. Furthermore, an exploratory multicenter study that involves primary care physicians belonging to all ministries and private sectors is warranted.

Awareness, knowledge, and practice regarding to diabetic retinopathy among KKU students besides medical students in Abha, Saudi Arabia

Background:

Diabetes mellitus (DM) is a global public health problem. Global prevalence of diabetes is 8.5% in adult population. The prevalence of diabetic retinopathy (DR) is increasing day by day, the number of persons with diabetes will double by 2030. It is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. This study's intent to estimate and improve level of awareness (A), knowledge (K), and practice (P) among all King Khalid University (KKU) students besides medical students in Abha, Saudi Arabia.

Methods and Materials:

This is a cross-sectional survey that targets all KKU students besides medical students in Abha, Saudi Arabia. The researchers will use closed-end questions for awareness (A), knowledge (K), and practice (P). The data and the questionnaires will be sent to the sample by social media. The data will be analyzed by statistical package for the social sciences program (SPSS).

Results:

A total of 635 KKU students completed the questionnaire. Female students were more than male students, 334 (52.6%) for females and 301 (47.4%) for males, respectively. Ages ranged from 18 to 24 years with a mean 23 ± 2 years. There was a good awareness for some of the factors related to the DR which is noted in the results. Awareness of smoking and pregnancy rate is extremely low compared to the rest of the factors related to the DR.

Conclusion:

There was high awareness regarding DR and its risk factors among KKU students but low awareness regarding smoking and pregnancy relationship with DR. Improvement is required for smoking and pregnancy with the progression DR.

Knowledge, Attitudes, and Practices of Optometrists Regarding Low Vision Services in Saudi Arabia

Purpose:

To address the human resources challenge for the provision of low vision services in Saudi Arabia, this study sought to investigate the knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision services. The knowledge and attitudes to low vision services can influence the provision of low vision services by optometrists.

Methods:

A prospective cross-sectional survey of optometrists practicing in Saudi Arabia was undertaken using an online questionnaire designed to elicit the opinions of respondents. The online questionnaire was sent out to optometrists on the official mailing list of registered optometrists and those on the mailing list of the Saudi Society of Optometry.

Results:

Only 26.5% of the respondents correctly indicated the correct designation of low vision in terms of visual acuity. Although 95.8% indicated that optical low vision devices could help people with low vision, 81.6% reported that low vision devices were expensive, and 42.9% felt low vision practice was not profitable. Only 10.4% of respondents provide low vision services in their practice. Insufficient training in low vision care was the main barrier militating against the provision of low vision services.

Conclusion:

The pertinent finding in this study is that about a quarter of the respondents could correctly designate low vision in terms of visual acuity using the World Health Organization (WHO) definition. The study concluded that there was poor knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision, which has implications for the provision of low vision services by optometrists.

Barriers to Low Vision Services Among Optometrists in Saudi Arabia

Introduction:

This study identifies the barriers and challenges to the provision of low vision services among practicing optometrists in Saudi Arabia.

Methods:

In this study, a self-administered online structured survey for practicing optometrists was used. Responses were collected to understand the number and percentage of low vision service providers, level of awareness, and barriers to the provision of low vision services.

Results:

This study included 154 (79 females and 75 males) practicing optometrists. They were from the five regions of Saudi Arabia (23 cities). The age of the practitioners ranged from 22 to 54 years. They had Bachelor’s, Master’s, and Doctor of Philosophy degrees. Forty-four participants (30%) provided low vision services. The major barriers reported were lack of training (87%), lack of awareness about low vision services (76%), lack of availability of low vision devices (70%), lack of motivation (65%), low vision services being time-consuming (55%), being busy in providing general optometry (65%), and lack of financial sources (31%).

Conclusion:

Building an efficient model for low vision rehabilitation in Saudi Arabia is needed. Moreover, encouraging more optometrists to be involved in low vision rehabilitation is necessary. There is also a need for more low vision education, national health coverage of patients with low vision, and better collaboration between low vision service providers.

Diet Sugar-Free Carbonated Soda Beverage, Non-Caloric Flavors Consumption, and Diabetic Retinopathy: Any Linkage

PURPOSE

Assessing diabetic retinopathy (DR) risk factors and daily nutrition habits are vital for prevention. This study aims to evaluate the relationship between diet soda cans, non-nutritive sweetener consumption, and diabetic retinopathy.

PATIENTS AND METHODS

A cross-sectional study was conducted among 200 patients attending a diabetes center in Tabuk City, Saudi Arabia, from September 2019 to July 2020. A structured questionnaire was used to collect patients' demographic factors, and DR risk factors including the use of diet soda, non-nutritive sweeteners, and exercise habits. Dilated fundus eye examination was done to detect any diabetic retinopathy. A blood sample was taken for measuring glycated hemoglobin to assess the degree of glycemic control.

RESULTS

The participant's age was 50.74 ±13.51 years, and the duration since the diagnosis of diabetes was 9.99 ±6.97 years, body mass index was 27.28 ±4.68, and HbA1c %, 8.50 ±1.61), the patients used to consume 1.31 ±1.57 diet soda cans/week, and 1.06±1.39 artificial sweeteners/sachet/day. DR was found in 33%. Diet sugar-free carbonated soda beverage was associated with poor glycemic control and retinopathy, while non-caloric flavor consumption was associated with obesity (P-value<0.05). No association was evident regarding other factors (P-value>0.05).

CONCLUSION

Diet sugar-free carbonated soda beverage was associated with higher HbA1c and retinopathy, while non-caloric flavor consumption was associated with obesity. No association was evident regarding other factors. Further larger multicenter studies are needed.

Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group

Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.

Correlates of diabetic retinopathy in type 2 diabetes mellitus patients in Makkah Al-Mukarramah, Saudi Arabia

BACKGROUND:

Diabetic retinopathy (DR) is a serious complication of diabetes that can cause visual impairment. The objective of this study was to estimate the prevalence and identify the determinants of DR in type 2 diabetes mellitus patients attending the diabetic center at Al-Noor Specialist Hospital in Makkah, Saudi Arabia.

MATERIALS AND METHODS:

A cross-sectional study was conducted in a sample of type 2 diabetic patients registered at the diabetic center at Al-Noor Specialist Hospital. Data was collected using a validated self-administered questionnaire. Grading of DR was done by slit-lamp examination and colored fundus photographs. Descriptive analysis included frequency and percentage for categorical variables, and mean, median, standard deviation (SD), and interquartile range, for continuous variables. Chi-square test used to test for association between two categorical variables; Student's t-test or Mann-Whitney U test as appropriate employed to compare continuous variable between two groups. Logistic regression analysis was utilized to identify correlates of DR after controlling for confounders.

RESULTS:

The study comprised 251 type 2 diabetic patients aged between 28 and 80 years, with an arithmetic mean of 56.8 and standard deviation of ±9.9 years. The prevalence of DR was 54.6%; mild nonproliferative (NP) type was present in 52.6% of the patients with DR, whereas severe NP type was present in 15.3% of them; the proliferative type was present in only 4.4% of those with DR. Multivariate logistic regression analysis revealed that patients who had had diabetes for a 11 to 16 years (adjusted odds ratio [AOR] = 3.52, P = 0.035), patients who did not take daily medications on time (AOR = 9.75, P = 0.008), patients who did not go for fundus examination annually (AOR = 3.62, P = 0.011), and patients with uncontrolled diabetes (AOR = 12.18, P < 0.001) were at higher significant risk for DR. Patients not treated with insulin were 70% less likely to develop DR (AOR = 0.30, P = 0.015). An increase of one unit in body mass index was significantly associated with increase in the probability of developing DR by 11% (AOR = 1.11, P = 0.024).

CONCLUSION:

DR is very prevalent in type 2 diabetic patients attending the diabetic center at Al-Noor Specialist Hospital, Makkah Al-Mukarramah; particularly the mild NP type.

The Association Between HbA1c and Other Biomarkers With the Prevalence and Severity of Diabetic Retinopathy

INTRODUCTION

 Diabetes mellitus (DM) is considered to be a significant public health problem globally. According to the American Society of Retina Specialists, diabetic retinopathy (DR) is a complication of diabetes that causes damage to the blood vessels of the retina. In a Japanese study showed that HbA1c and fasting blood glucose values can be considered as predictors for the future development of DR. Thus, this study aimed to determine the prevalence and severity of DR among diabetic patients in Medina, Saudi Arabia, and to assess its relationship with HbA1c and other biomarkers.

METHODS

This cross-sectional study was conducted at Prince Abdulaziz Bin Majed Diabetes Center and Charitable Healthcare Society in Medina, Saudi Arabia, in July 2018. The data were collected from direct interview questionnaires that were administered to 130 randomly selected diabetic subjects. The subjects' demographic information, eye disease history, medical backgrounds, and laboratory biomarkers were noted. Fundus examinations using a slit lamp were conducted by ophthalmic physicians to diagnose and grade DR. The data were analyzed using Statistical Package for Social Sciences (SPSS) (IBM Corp., Armonk, NY, USA).

RESULTS

All 130 diabetic patients were examined for DR. DR was prevalent among 35 (26.9%) of the participants. According to the DR severity grading, 95 (73.1%) had no apparent DR, 11 (8.5%) had mild non-proliferative diabetic retinopathy (NPDR), 11 (8.5%) had moderate NPDR, 11 (8.5%) had severe NPDR, and only two (1.5%) had proliferative diabetic retinopathy (PDR). There was a significant association between the development of DR and HbA1c levels (p = 0.040). The duration of DM was also determined to be a significant risk factor for DR (p = 0.001). No other factors were found to have a significant association with DR.

CONCLUSION

Around one-third of the participants in our study had DR. HbA1c levels and duration of DM were established as important risk factors for DR. Screening is necessary, even in patients with good HbA1c levels, to avoid the late presentation of severe DR and to prevent blindness.

Knowledge, attitude and practice regarding diabetic retinopathy screening and its management among diabetic patients at a private hospital of Riyadh, Saudi Arabia

PURPOSE:

We present the KAP levels and the determinants for diabetic retinopathy (DR) screening and management at a private hospital in Riyadh, Saudi Arabia.

METHODS:

A chart review was performed of DM patients to collect the demographics and diabetes related information in June to December 2017. A close ended questionnaire was used that queried knowledge (7), attitude (5) and practice for DR screening (7).

RESULTS:

Two hundred participants were interviewed half from endocrinology unit and half from the eye clinic. An excellent knowledge of the ophthalmic effects of diabetes was noted in 91 [45.5% (95% Confidence Interval CI 38.6–52.4) of participants. Thirty-eight [19% (95% CI 13.6–24.4)] participants had a positive attitude. None had an excellent grade of practice and poor practice was noted in 168 [74% (95% CI 78.9–89.1)] participants. Longer duration of DM (P = 0.07) and systemic complications (P = 0.06) were associated with good knowledge. Attitude was not significantly associated with any determinants. Good practice was associated with the presence of systemic complications of DM (P < 0.01) and those recruited to the eye clinic (P = 0.06). Only 35% of patients had undergone an annual DR screening. Only 4 patients had a history of laser treatment.

CONCLUSION:

The KAP of diabetic patients regarding DR screening and management is less than desired. Establishing protocols and public health promotion activities directed at early detection and management are urgently needed in private sectors of Saudi Arabia.

Prevalence, Risk Factors, and Patient Awareness of Diabetic Retinopathy in Saudi Arabia: A Review of the Literature

Diabetes mellitus is a common disease in Saudi Arabia and globally, with some studies reporting about 30% prevalence among the Saudi population. Diabetic retinopathy (DR) is the leading cause of blindness among working-age patients, and it has a prevalence of 34.6% among diabetics worldwide. The objectives of this review were to examine the prevalence of DR in Saudi Arabia, describe the major associated risk factors, and raise awareness about the disease among diabetics.

The prevalence of DR in Saudi Arabia has risen substantially in recent decades. Significant risk factors associated with DR include older age, longer duration of diabetes, poor glycemic control, and hypertension. Awareness and education about diabetes are associated with better outcomes and fewer complications.

Luteolin Attenuates IL-1β-Induced THP-1 Adhesion to ARPE-19 Cells via Suppression of NF-κB and MAPK Pathways

Cytokine-induced endothelial dysfunction leads to inflammation and vascular adhesion molecule production in retinal pigment epithelium (RPE) cells. Inflammation is a critical mediator in retinal degeneration (RD) diseases, including age-related macular degeneration (AMD), and RD progression may be prevented through anti-inflammatory activity in RPE cells. The flavonoid polyphenol luteolin (LU) has anti-inflammatory and antidiabetes activities, but its effects regarding retinal protection remain unknown. Here, we examined the ability of luteolin to alleviate markers of inflammation related to RD in cytokine-primed APPE-19 cells. We found that luteolin decreased the levels of interleukin- (IL-) 6, IL-8, soluble intercellular adhesion molecule-1 (sICAM-1), and monocyte chemoattractant protein-1 (MCP-1) and attenuated adherence of the human monocytic leukemia cell line THP-1 to IL-1β-stimulated ARPE-19 cells. Luteolin also increased anti-inflammatory protein heme oxygenase-1 (HO-1) levels. Interestingly, luteolin induced protein kinase B (AKT) phosphorylation, thus inhibiting nuclear factor- (NF-) κB transfer from cytoplasm into the nucleus and suppressing mitogen-activated protein kinase (MAPK) inflammatory pathways. Furthermore, cotreatment with MAPK inhibitors and luteolin decreased inflammatory cytokine and chemokine levels, and further suppressed THP-1 adhesion. Overall, these results provide evidence that luteolin protects ARPE-19 cells from IL-1β-stimulated increases of IL-6, IL-8, sICAM-1, and MCP-1 production by blocking the activation of MAPK and NF-κB signaling pathways, thus ameliorating the inflammatory response.

Awareness of diabetic retinopathy among Saudis with diabetes type 2 in Riyadh city

Objective:

To assess awareness of diabetic retinopathy (DR) for Saudis with diabetes mellitus (DM) type 2 in Riyadh City.

Methods:

A cross-sectional study that used self-administered questionnaires conducted in primary healthcare centers in Riyadh City between October and December 2019.

Results:

There were 267 Saudi participants with diabetes mellitus type 2 visiting primary healthcare clinics. (52.4%) were aged 40 years or above at time of diagnosis with diabetes. (73%) had diabetes for at least 5 years. Most of the participants have a good blood glucose control and they do home measurements. In regard to DR, (64.4%) of participants had no subjective or objective indicators of retinopathy, and (70%) had visited ophthalmology clinics. Majority of the participants were advised about DR or referred to an ophthalmologist by their primary physician, with the percentages being (64.8%) and (59.6%), respectively. Regarding other risk factors of DR, (19.5%) had a family history of DR, (23.2%) of participant are smokers and (41.6%) were hypertensives. Majority of the participants were aware about all the aspects of DR, its consequences, and appropriate management except the laser therapy. In terms of area of living and education respondents, who lived in the center of Riyadh City and the secondary level or less educated participants had the lowest level of education.

Conclusions:

Awareness of DR is acceptable but should not lead this information to reduced awareness and educational programs. Outreach researchers' efforts should cover other directions instead awareness of DR.

Evidence Based Prediction and Progression Monitoring on Retinal Images from Three Nations

Purpose

The aim of this work is to demonstrate how a retinal image analysis system, DAPHNE, supports the optimization of diabetic retinopathy (DR) screening programs for grading color fundus photography.

Method

Retinal image sets, graded by trained and certified human graders, were acquired from Saudi Arabia, China, and Kenya. Each image was subsequently analyzed by the DAPHNE automated software. The sensitivity, specificity, and positive and negative predictive values for the detection of referable DR or diabetic macular edema were evaluated, taking human grading or clinical assessment outcomes to be the gold standard. The automated software's ability to identify co-pathology and to correctly label DR lesions was also assessed.

Results

In all three datasets the agreement between the automated software and human grading was between 0.84 to 0.88. Sensitivity did not vary significantly between populations (94.28%–97.1%) with specificity ranging between 90.33% to 92.12%. There were excellent negative predictive values above 93% in all image sets. The software was able to monitor DR progression between baseline and follow-up images with the changes visualized. No cases of proliferative DR or DME were missed in the referable recommendations.

Conclusions

The DAPHNE automated software demonstrated its ability not only to grade images but also to reliably monitor and visualize progression. Therefore it has the potential to assist timely image analysis in patients with diabetes in varied populations and also help to discover subtle signs of sight-threatening disease onset.

Translational Relevance

This article takes research on machine vision and evaluates its readiness for clinical use.

Knowledge, attitudes, and practices regarding diabetic retinopathy among primary health care physicians in Al-Hasa, Saudi Arabia

Background

Diabetic retinopathy (DR) has been shown to be the third most observed cause of visual loss in Saudi Arabia. In the Al-Hasa region in particular, the prevalence of DR has been shown to be 30%. Primary health centre (PHC) physicians play a central role in the early detection and prevention of DR. The aim of this study was to evaluate the knowledge, attitudes, and practices regarding DR of PHC physicians in Al-Hasa, Saudi Arabia.

Methods

A cross-sectional descriptive study was conducted at PHCs in Al-Hasa, Saudi Arabia. A self-administered questionnaire was provided to every participant along with a consent form. Out of 71 centres in the region, 63 were included in this study. The questionnaire consisted of three sections and a total of 18 questions. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 21 software program (IBM Corp., Armonk, NY, USA).

Results

One hundred forty-one of 209 physicians completed the questionnaire for a response rate of 67%. The mean of overall knowledge score for all participants was 2.6 ± 1.16 points out of four points. Only 34 (24.1%) of the participants correctly referred their diabetic patients according to the guidelines of the American Academy of Ophthalmology. Additionally, only 52 (36.9%) physicians educated their patients regarding the early detection of diabetic complications.

Conclusion

The present study concluded that there exist gaps in applying the correct guidelines. Physicians’ attitudes toward patient education were overall satisfactory. Further medical symposiums and workshops are warranted to teach physicians about diabetic complications and screening schedules, including DR.

Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application

OBJECTIVE

The objectives of this study is to assess the quality of diabetic care at AlManhal PHCC based on CBAHI standards.

METHODS

This audit was conducted during 2018 at Al_Manhal PHCC through assessment all aspects of DM care ( structures, processes and outcomes) using CBAHI standards . Data entry and analysis were managed used SPSS.

RESULTS

Most of DM structures were available at the PHCC , however, health educational program , lab relevant facilities were partially met the standards. Records of 429 patients were assessed for process of care which were satisfactory except for laboratory investigations and eye examination which were partially met . Good DM metabolic control was (28%) , HTN control (71%) and lipid control( 54%), good compliance with appointment was 85% . The most common documented complications were retinopathy( 14%), nephropathy (4.5%) and CHD( 4%).

CONCLUSION AND RECOMMENDATIONS

This audit revealed that using of CBAHI standards for DM care at PHCC is simple and practical and could help to identify the weak areas that needs improvement. The present care of DM in our PHCC has acceptable infrastructures except for health education program , laboratory and referral system which should be scaled up to improve the processes and outcomes. DM control is still a big challenge and needs more collaborative effort between health care providers and patients.

Prevalence of Diabetes Mellitus and Diabetic Retinopathy in Persons 50 Years and Above in Katsina State Nigeria: A Population-based Cross-sectional Survey

PURPOSE

To estimate the prevalence and magnitude of diabetes mellitus and diabetic retinopathy among people with diabetes mellitus in Katsina State.

METHODS

A population-based cross-sectional study of persons aged 50 years and over in Katsina State Nigeria based on the rapid assessment of avoidable blindness survey plus diabetic retinopathy methodology. The study was conducted in November and December 2018.

RESULTS

A total of 2,653 of the 2,807 (94.5%) enrolled persons were examined. The unadjusted prevalence of diabetes was 3.3% (95% CI: 2.7-4.1) with females having higher risk of having diabetes than males (OR 1.04; (95% CI 1.00-1.07; P = .03). The age-sex adjusted magnitude of diabetes mellitus is 15,492 persons in the study population, but 60% of the people are unaware of their disease status. The proportion of people with diabetes mellitus and any retinopathy is 26.2% (95%CI: 14.4-31.6); 15.8% in males and 35.7% in females. The proportion of people with diabetes mellitus with any maculopathy is 12.5% (95% CI: 6.9 - 21.5). The proportion of people with diabetes mellitus having any retinopathy and/or maculopathy is 26.2% while that of a sight-threatening lesion is 7.5%.

CONCLUSION

The burden of diabetes and diabetic retinopathy in the population is lower than national average and elsewhere. However, there is still need to establish a simple cost-effective diabetic retinopathy service for the population as the burden of the problem will only increase with time.

Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment

OBJECTIVES

To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB).

DESIGN

Population-based diagnostic accuracy study.

METHODS

A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye.

MAIN OUTCOME MEASURES

The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI.

RESULTS

A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively.

CONCLUSION

The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.

Diabetic retinopathy (DR) among 40 years and older Saudi population with diabetes in Riyadh governorate, Saudi Arabia - A population based survey

Purpose

To present the prevalence and determinants of diabetic retinopathy (DR) among more than 40 years old Saudi population.

Methods

A population based survey was conducted in Riyadh district between 2014 and 2017. All Saudi aged >40 years suffering from diabetes and confirmed in the diabetes register of the Primary Health Center (PHC) were the study population. Representative sample was examined. The Best corrected Visual acuity (BCVA), anterior and posterior segment assessment was performed. Digital fundus camera captured the retinal images. DR was graded into No DR, Non-proliferative DR (Mild, Moderate, Severe) and proliferative DR (PDR). Diabetic macular edema (DME) was separately noted. Sight Threatening Diabetic Retinopathy (STDR) included PDR and/or DME.

Results

We examined 890 persons. The age sex adjusted prevalence of DR was 44.7% (95% CI 44.1 – 45.3). The DR among male was significantly higher than in females. [RR = 1.4 (95% CI 1.02 – 1.8)]. The DR in 60 plus population was higher compared to 40 to 60 years old diabetics [RR = 1.64 (95% CI 1.6 – 1.7), P < 0.001]. The crude prevalence of STDR was 12.4% (95% CI 9.1 – 15.7). Among diabetic with DR, bilateral and unilateral Severe Visual Impairment (SVI) rate were 1% and 1.8%. The coverage of retinal laser treatment for STDR was 6.1%.

Conclusions

The DR among diabetics is high among adult Saudi population. Both DR and STDR were more in males. Visual disabilities among DR cases were few. For early detection and timely management the services need urgent attention.

Adults visual impairment and blindness - An overview of prevalence and causes in Saudi Arabia

BACKGROUND

A major socio-economic development in Saudi Arabia affected the pattern and causes of visual impairment for the past 40 years. Moreover, an up-to-date summary of available data is vital for planning, monitoring, and evaluating national blindness prevention program.

AIM

This study conducted to provide a summary overview of prevalence, causes, and changes in the pattern of blindness and visual impairment for the past 40 years among Saudi adults, with brief discussion of the related socio-economic and ecological factors.

METHODS

The review was confined to the published epidemiological studies performed in Saudi Arabia covering the age group 18 year and older from 1985 onwards.

RESULTS

Six epidemiological studies were included from 1985 onwards. In1986, the prevalence of blindness and visual impairment in Saudi Arabia were 1.5% and 7.8%, respectively which is 20 times the magnitude of blindness in the United States. Multiple regional population based studies conducted later in areas with disparate ecological and socio-economical determinants at different time intervals showed variable prevalence of blindness 3.3% Eastern Province 1986, 0.7% Bisha 1993. Recently, in older than 50 year population the reported prevalence was 2.6% Taif 2012 and 5.7% Jazan 2015 and 6.4% in Ahsa. Since 1986, the single leading cause of adult blindness in Saudi Arabia is cataract. Although, Trachoma reported to be the second primary cause of blindness on 1986, its burden is reduced in Jizan (2015) and minimal in Taif (2012) which is replaced by chronic diseases related etiologies i.e Diabetic Retinopathy.

CONCLUSION

Ecological and socio-economical determinants play critical role in the magnitude and causes of blindness and visual impairment in Saudi Arabia. Significant data gaps obscure monitoring and evaluation of the eye health. Eye health indicators should be integrated into the national health information system for dynamic monitoring and evaluation.

Rapid Assessment of Avoidable Blindness in Kurdistan, Iran

Purpose:

To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology.

Methods:

In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI.

Results:

A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%).

Conclusion:

The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.

Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia

Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.

Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in primary health care in security forces hospital Riyadh, Saudi Arabia

Background

Diabetes mellitus (DM) is a metabolic disease that is characterized by distortion in the metabolism of carbohydrates, lipids, and proteins and involves hyperglycemia. DM has different types. Several complications are associated with diabetes including diabetic retinopathy (DR). DR can further results in bad outcomes that can be avoided by early diagnosis and management.

Aim

The aim of this paper is to assess the awareness and knowledge level about DR among type 2 DM patients in primary health care in security forces hospital.

Methods

This is a cross-sectional study that was conducted on Saudi patients with type 2 DM who visited primary health care in security forces hospital.

Results

This study included 174 participants, with equal male to female ratio was 1:1, there were 64.9% participants who reported controlled blood glucose level, and 47.1% reported that eye was affected by diabetes. There were 82.8% participants who had awareness about DR; the level of awareness differs significantly with sex (P value = 0.04) and the level of DM control (P value = 0.02).

Conclusion

There was high level of knowledge regarding DR; however, there were few percent of participants who had no awareness and still at risk.

Awareness, knowledge, and practices related to diabetic retinopathy among diabetic patients in primary healthcare centers at Riyadh, Saudi Arabia

Context

Diabetic retinopathy (DR) is a microvascular complication for diabetes mellitus (DM), with around 35% of diabetic patients developing some form of DR.

Aims

This study assessed the awareness toward DR, practice of regular eye examination, and DM control among diabetic patients.

Settings and Design

This was a cross-sectional study among diabetics at two primary healthcare centers in Riyadh, Saudi Arabia, who were selected by convenience sampling.

Methods and Materials

The questionnaire contained sections for demography, knowledge, attitude, and practice toward DR, and compliance to DM treatment. The association of awareness about retinopathy with demographics was compared.

Statistical Analysis Used

The association of awareness about retinopathy and education level with demographics and compliance with treatment were compared using Chi-square test.

Results

In total, 280 diabetic patients were included, 187 (67%) were males, mean age was 58.9 ± 10.1 years, and median duration of diabetes was 10 years. There was good awareness about DR, diabetes was well controlled in 170 (61%) patients, but less than half (45%) had their eyes checked within 1 year. Patients with education level of high school and above had higher awareness than those with no formal education (P < 0.001). Also, those with income level >10,000 SR had higher awareness than those with income ≤5,000 SR (P < 0.05).

Conclusion

There was high awareness among the diabetic patients regarding DR but annual check-up was done in less than half of the patients. Improvement is required for scheduling annual eye examinations for the early detection of DR.

Assessment of Ophthalmology Residency Programs in Saudi Arabia: A Trainee-Based Survey

PURPOSE

To assess the satisfaction and competency of Saudi ophthalmology residents and compare their performance against International Council of Ophthalmology (ICO) standards.

METHODS

A cross-sectional web-based survey of senior ophthalmology residents (postgraduate years [PGY] 3-4) and recent graduates (from 2010 to 2015) assessed various aspects of training. The questionnaire was sent to the participants and was divided into 3 main domains: demographics, training program evaluation, and preparedness for board exams and clinical practice.

RESULTS

Out of the 145 invitees, 120 (82.8%) responded. Fifty percent of respondents reported an overall satisfaction with the program. Adequate clinical exposure was reported in most subspecialties except refraction and low vision rehabilitation with inadequate exposure reported by 55.8% and 95.8%, respectively. Surgical exposure was reported as adequate for phacoemulsification (58.3%) and strabismus surgery (68.3%) only. Eighty-nine percent of respondents reported performing less than 80 cases of phacoemulsification. Of the respondents who had graduated, most (89.7%) passed the final board exam at the first attempt. There were 73.5% of respondents who reported that residency training prepared them well for the board exam. Ongoing clinical and call duties were reported as having a negative impact on exam performance.

CONCLUSIONS

Saudi ophthalmology residents demonstrate a high level of clinical competency. However, additional efforts should aim at improving surgical training to increase the level of satisfaction among residents and improve the quality of training to meet international standards.

Knowledge, Awareness, and Eye Care-Seeking Behavior in Diabetic Retinopathy: A Cross-Sectional Study in Jeddah, Kingdom of Saudi Arabia

Introduction

Diabetes mellitus (DM) is common metabolic disorder that is characterized by increased circulating blood glucose levels. Long-term, continuous hyperglycemia leads to vasculature-related disorders, including those affecting the eyes, such as retinopathy. The objective of this study was to assess the awareness of diabetic complications, specifically diabetic retinopathy, among diabetic patients attending the Jeddah Eye Hospital.

Methods

This was a cross-sectional study targeting the outpatient clinics of Jeddah Eye Hospital for a period of 2 months. A total of 380 participants were randomly selected based on sample size calculations. A closed-ended questionnaire, generated after an extensive literature review, was distributed among the selected individuals. The questions focused on the participants’ clinical status of DM, socio-demographic characteristics, awareness of eye complications secondary to DM, eye screening, and eye care-seeking behavior.

Results

The mean age of the patients was 58.3 (standard deviation 10.9) years, and 52.4% of patients were female. The majority (89.7%) of participants had type II DM (T2DM). The level of awareness was satisfactory (92.4%); however, only 10.5% of participants knew the recommended frequency for eye check-ups. The level of awareness of related complications was directly influenced by education level, source of patient information, place of residence, and frequency of follow-up visits.

Conclusion

The results of this study indicate that although the awareness of diabetes-related eye complications was satisfactory in the patient population, eye care-seeking behavior and frequency of eye check-ups were not optimal. Efforts are needed to promote eye care-seeking behavior in this patient group.

Electronic supplementary material

The online version of this article (10.1007/s40123-018-0147-5) contains supplementary material, which is available to authorized users.

Global prevalence and causes of visual impairment with special reference to the general population of Saudi Arabia

Objective:

This review was undertaken to highlight the worldwide prevalence and causes of visual impairment (VI), on the basis of a wide range of recent and clearly defined data and in comparison with published articles from the Kingdom of Saudi Arabia.

Methods:

These data are mainly based on PubMed indexed journal articles. Some representative surveys from each of the six WHO regions across the globe were included in this review with special reference to Saudi Arabian studies.

Results:

Published literature show that the prevalence and causes of VI varies markedly in different parts of the world and from region to region within the same country. Cataract, uncorrected refractive errors and glaucoma were shown to be the leading causes of VI worldwide and in Saudi Arabia. Diabetic retinopathy was found to have more contribution in Saudi Arabia due the higher prevalence of diabetes mellitus in this country.

Conclusion:

Epidemiological surveys about the prevalence and causes of VI are crucial for the formulation of preventive and curative measures. Data about VI are still scarce with a need to make wider population based surveys, worldwide and in Saudi Arabia for in-depth evaluation of the problem and better strategies to reduce the burden of VI.

Diabetics Retinopathy Knowledge and Awareness Assessment among the Type 2 Diabetics

INTRODUCTION

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. In Saudi Arabia and other Arab countries, several studies estimated the prevalence of DR ranging from 30 - 40%.

AIM

To assess the DR knowledge and its association with diabetes control among Type 2 diabetic patients.

METHODS

A cross-sectional study of patients with Type II diabetes (T2D) who had a routine visit to the endocrine clinic to assess the DR knowledge and its relation to the glycemic control. We used a questionnaire that was used in previously published studies, and the reliability was assessed using the alpha Cronbach coefficient. Patients who answered correctly > 60% were considered to have good knowledge about DR.

RESULTS

Total of 253 patients participated, 43.4% has diabetes > 10 years and 30.7% have it for 5 - 10 years, 36.4% did college degree or higher, 40.8% considered having low income. 37.7% of participants were not screened for the DR in the past year. 28.4% of participants think that seeing optometrist is enough for DR diagnosis. Diabetics with good knowledge who have T2D > 10 years were 46.3% compared to 38.6% (p = 0.04). Diabetics with good knowledge have mean A1c of 8.55 vs. 8.59 (p = 0.32), mean BMI 30.4 vs. 30.2 (p = 0.46), mean diastolic pressure was 77.12% vs. 79.48% (p = 0.03).

CONCLUSION

Almost two-thirds of screened T2D were considered to have good knowledge about DR. The good knowledge group tends to have a longer duration of T2D, more likely to have a college degree, and tend to have non -significantly better A1c control.

Risk Factors for Microvascular Complications of Diabetes in a High-Risk Middle East Population

AIMS

Much of the diabetes burden is caused by its complications. This cross-sectional study aimed to determine the prevalence and risk factors for diabetic microvascular complications (retinopathy, nephropathy, and neuropathy) in a high-risk population.

METHODS

We collected information via a structured questionnaire and directly from the patient's record on 1034 adult type 2 diabetic patients who were attending outpatient clinics in Qatar.

RESULTS

The mean age of the patients was 55 ± 10 years, and the mean duration of diabetes was 12.4 ± 8.9 years. Forty-five percent had one or more microvascular complications. Shared risk factors for multiplicity and for individual complications included family history, severity and duration of diabetes, and hypertension, but some risk factors were specific for individual microvascular complications. Early age at onset of diabetes was strongly associated with multiplicity of complications (P = 0.0003).

CONCLUSIONS

About half the diabetics in this high-risk population had one or more microvascular complications. Several well-established risk factors were associated with multiplicity and individual microvascular complications, but each separate microvascular complication was linked to a somewhat different constellation of risk factors.

Recent developments in age-related macular degeneration: a review

Background

Visual impairment in elderly people is a considerable health problem that significantly affects quality of life of millions worldwide. The magnitude of this issue is becoming more evident with an aging population and an increasing number of older individuals.

Objective

The objective of this article was to review the clinical and pathological aspects of age-related macular degeneration (AMD), diagnostic tools, and therapeutic modalities presently available or underway for both atrophic and wet forms of the disease.

Methods

An online review of the PubMed database was performed, searching for the key words. The search was limited to articles published since 1980 to date.

Results

Several risk factors have been linked to AMD, such as age (>60 years), lifestyle (smoking and diet), and family history. Although the pathogenesis of AMD remains unclear, genetic factors have been implicated in the condition. Treatment for atrophic AMD is mainly close observation, coupled with nutritional supplements such as zinc and antioxidants, whereas treatment of wet AMD is based on targeting choroidal neovascular membranes.

Conclusion

Identification of modifiable risk factors would improve the possibilities of preventing the progression of AMD. The role of anti-vascular endothelial growth factor (anti-VEGF) agents has transformed the therapeutic approach of the potentially blinding disease “wet AMD” into a more favorable outcome.

Public Awareness regarding Common Eye Diseases among Saudi Adults in Riyadh City: A Quantitative Study

Aim

The current study aimed to evaluate the knowledge of eye disease and awareness of eye care among the Saudi adults and to explore existing eye-related misconceptions in the community.

Methods

A cross-sectional study was conducted in Riyadh city during May and June 2016. A self-administered anonymous online questionnaire was used to explore the most common misconceptions related to eye diseases and eye care.

Results

Out of 1000 individuals, only 711 (71.1%) participant responses were received. The participants' acceptable knowledge (score ≥50%) was high about the eye problem in diabetes (88.6%), ocular trauma (81.2%), and other general eye diseases (91.3%), whereas low about refractive errors (63%), pediatric eye problems (51.5%), and glaucoma (14.8%). The variation in knowledge about specific ocular morbidities was significant (p < 0.001). The majority of participants reported sources of information about the common eye diseases and eye care encountered from the community, internet-based resources, and social media.

Conclusions

The majority of the participants had awareness about the common eye diseases, whereas low percentage of participant's awareness about specific condition of eye diseases. Public eye health awareness should be more focused on social media and the internet to be able to cover the younger individuals of the community.

Diffusion-weighted imaging of injuries to the visual centers of the brain in patients with type 2 diabetes and retinopathy

The present study aimed to investigate the ability of diffusion-weighted imaging (DWI) to identify injury to the visual centers of the brain in patients with type 2 diabetes with retinopathy. The study included 84 cases (63 patients with type 2 diabetic retinopathy and 21 healthy individuals) that were assessed using DWI. Diabetic patients were equally divided into three groups: Proliferative diabetic retinopathy (PDR), non-proliferative diabetic retinopathy (NPDR) and diabetic without retinopathy. The results demonstrated that individuals in the PDR group had significantly higher disease duration and glycated hemoglobin levels than the diabetic without retinopathy group (P<0.05). Apparent diffusion coefficient (ADC) values were significantly higher in functional brain areas of the PDR group compared with the NPDR group (P<0.001), whose values were significantly higher compared with the diabetic without retinopathy and control groups (P<0.001). In addition, glycated hemoglobin levels and disease duration were positively correlated with mean ADC values in the same functional areas of the brain. In conclusion, DWI-measured ADC values may be an effective indicator of brain dysfunction in individuals with type 2 diabetic retinopathy. DWI is able to assess brain injury in individuals with early diabetic retinopathy, which may make the diagnostic technique a useful predictor of early ocular disease.

Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy in Gilan Province, Iran

PURPOSE

To conduct an assessment of avoidable blindness and diabetic retinopathy (DR) in Gilan, 2014.

METHODS

A cross-sectional population-based survey was performed on a representative sample of urban and rural individuals aged ≥50 years of the province. Blindness was defined as presenting visual acuity (PVA) <3/60 in the better eye. Moderate visual impairment (MVI) and severe visual impairment (SVI) were defined as 6/60 ≤ PVA <6/18 and 3/60 ≤ PVA <6/60 in the better eye, respectively. Diabetes mellitus (DM) was determined based on random blood sugar (RBS) levels ≥200 mg/dL or a previous diagnosis. We used the Scottish grading system to grade DR.

RESULTS

We invited 2975 individuals from 85 clusters. Age- and sex-adjusted prevalence and 95% confidence interval (CI) of blindness, SVI, MVI, and DM in 2587 participants (response rate: 86.9%) were 1.5% (95% CI: 1.1-2.0), 1.5% (95% CI: 0.9-2.0), 11.3% (95% CI: 9.9-12.7) and 21.4% (95% CI: 19.2-23.7), respectively. The leading causes of blindness were cataract (47.1%), age-related macular degeneration (14.7%) and DR (8.8%). Cataract surgery (CS) coverage was 69.3%. The main challenges for CS were cost and unawareness. The outcome of CS was good in 66.9% of operated eyes. Any DR and/or maculopathy were observed in 25.3% (95% CI: 21.0-29.5) of subjects including 12.6% (95% CI: 9.7-15.6) sight-threatening DR. In previously known DM cases, 215 (41.7%) had never undergone an eye examination for DR.

CONCLUSION

The proportion of avoidable blindness and DR is considerable in Gilan Province.

Diabetic care initiatives to prevent blindness from diabetic retinopathy in India

It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20-50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.

Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014

Aim:

The aim of this study is to ascertain the prevalence of diabetic retinopathy (DR) in diabetic patients across the nation and attempt to establish history-based risk factors.

Materials and Methods:

A cross-sectional study of diabetic patients was conducted as an initiative of the All India Ophthalmological Society from 14^th November to 21^st November 2014. Known diabetics were evaluated voluntarily by members of the society at 194 centers using a structured protocol provided by the society for examination. The results were evaluated to ascertain the prevalence of DR in the population studied and to establish relation with gender, age, and history-based risk factors such as duration of diabetes, insulin use, and other end-organ disease using the Chi-square test.

Results:

A total of 6218 known diabetics were screened. Totally, 5130 data entry forms were considered suitable for further evaluation. About 61.2% were males, 88.6% were between 40 and 80 years of age, almost two-thirds of the patients were from the west and south zones, and over half had diabetes more than 5 years. The data set was predominantly urban 84.7% and 46.1% had no family history. DR prevalence in the entire data set was 21.7%. Prevalence was more in males (P = 0.007), diabetics more than 5 years (P = 0.001), those above 40 years (P = 0.01), insulin users (P = 0.001), and history of vascular accidents (P = 0.0014). Significantly 22.18% of patients detected with DR had a vision of 6/18 or better in the worse eye.

Conclusion:

The study reiterated the findings of earlier regional studies on a pan Indian scale and put data in perspective.

Diabetes and diabetic retinopathy in people aged 50 years and older in Hungary

BACKGROUND/AIMS

The purpose of this study was to estimate the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary, and to assess the coverage of diabetic eye care services.

METHODS

In total, 105 clusters of 35 people aged 50 years or older were randomly selected. The standardised rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used. Participants were classified as having DM if they were known to have DM or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed.

RESULTS

In total, 3523 (95.9%) out of 3675 eligible subjects were examined. And 705 (20.0%) out of 3523 had known (661) or newly diagnosed DM (44). Twenty per cent of participants with known DM had a blood glucose level ≥200 mg/dL, and 27.4% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 20.7% and prevalence of sight-threatening DR (STDR) was 4.3% in one or both eyes among participants with DM.

CONCLUSIONS

Prevalence of DM was in line with findings of other RAAB+DRM surveys and slightly lower than the unpublished earlier age-matched Hungarian estimate. Prevalence of DR was slightly lower than expected. The prevalence of STDR was low in people aged 50 years and older in Hungary compared with the results of other RAAB with DRM surveys. DR screening coverage was low. To prevent severe complications of DM and possible concomitant visual loss, the coverage of ophthalmic examinations in patients with DM should be increased.