Prevalence of blindness and diabetic retinopathy in northern Jordan. Eur J Ophthalmol. 2015;25:320-327. [PMID: 25684158 DOI: 10.5301/ejo.5000557]

Level of Adherence to Glaucoma Medication and Its Associated Factors Among Adult Jordanian Patients

BACKGROUND

Glaucoma is considered the second most common cause of blindness in patients above the age of 50. Lack of adherence to glaucoma medications frequently results in undesirable complications, specifically blindness and disability.

PURPOSE

The study's objectives are to evaluate the level of adherence to glaucoma topical medications and factors associated with adherence to glaucoma medications.

PATIENTS AND METHODS

In total, 348 patients, of whom 48.6% were above the age of 65, were recruited. A cross-sectional study from August 2018 to March 2020 was conducted on glaucoma patients who were referred to the Department of Ophthalmology in Royal Medical Services in Amman, Jordan. A questionnaire was employed to collect patients' demographic data, level of adherence, and factors associated with medication adherence. The inclusion criteria include the following: age above 20 years, diagnosis of glaucoma, currently under medical treatment, and willingness to participate in the study. Exclusion criteria include the following: patients who were hospitalized for glaucoma treatment, patients who had unstable medical conditions, and any patients for whom ophthalmologists had determined that they should be excluded for any other reasons.

RESULTS

Almost half (47.1%) of the patients adhered to their personal glaucoma medications, and the most frequent cause of nonadherence was forgetfulness (39.9%), whereas the least common was stopping the drug after feeling better (7.0%).

CONCLUSION

Proper patient education and explanation of the seriousness of medication adherence and its association with treatment outcomes, along with assisting old and disabled patients when applying ophthalmic medications, may positively improve the adherence of patients to glaucoma and other related visual impairment medications.

The Effect of Visual Impairment and Its Severity on Vision-Related and Health-Related Quality of Life in Jordan: A Comparative Cross-Sectional Study

Purpose

To assess the effect of visual impairment (VI), its severity, and ocular diseases on vision-related and health-related quality of life (QoL) in Jordan.

Patients and Methods

A comparative, cross-sectional, hospital-based study was conducted among a group of 278 patients with VI aged ≥ 18 years, and age and sex-matched control group of 278 individuals with no VI. An interviewer administered the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) to all participants.

Results

All the mean VFQ-25 subscales scores, physical component scale (PCS) and the mental component scale (MCS) of the SF-12 were significantly lower in patients with VI compared to controls with no VI. The VFQ-25 subscales (except general health and ocular pain), PCS, and MCS scores significantly decreased with more severity of VI. In the adjusted multivariate analysis, lower level of education (p=0.013), male sex (p=0.016), and the presence of cerebrovascular disease (p=0.019) were significantly associated with lower VFQ-25 composite scores in visually impaired patients compared to controls. Ocular disease duration of >5 years and progressive VI were significantly associated with lower VFQ-25 composite scores (p= 0.026 and p<0.001) respectively, in patients with VI. Glaucoma had a significantly larger reduction in mean scores of all the VFQ-25 subscales, and the PCS of the SF-12 compared to all other ocular diseases.

Conclusion

Both VI and increasing severity of impairment were associated with reduced vision-related and health-related quality of life in adult Jordanians. Glaucoma patients and less educated people were particularly affected. Routine assessment of QoL in visually impaired patients and improving referral protocols to vision rehabilitation services is recommended to improve the QoL in those patients.

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.

Status of Health-care Systems for Diabetes Mellitus and Diabetic Retinopathy in Jordan: Stakeholders and Health-care Providers Survey

PURPOSE

The purpose of the study was to evaluate the status of health services for diabetes mellitus (DM) and diabetic retinopathy (DR) in Jordan in terms of availability and accessibility by interviewing people engaged with health-care process including decision makers, professional providers, and community representatives.

METHODS

This is a qualitative study where participants were invited to respond by direct interview to a standard questionnaire that is validated by the World Health Organization (WHO), "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire casts out of the WHO Health Systems Framework concept, assessing the presence of programs, guidelines, health technology and workforce, health promotion, and financing of DM and DR care in Jordan.

RESULTS

Forty-two participants were included. DM is considered as priority in Jordan, but no programs are implemented. National guidelines are present for DM but not for DR. Networking should be improved between different disciplines caring for DM and DR. Human resources for DM and DR care were found insufficient and inadequately distributed. Health technology is only present in major cities and central hospitals. There is no nationwide data on disease burden nor a screening program for DR. More collaborated efforts should be spent on health education and raising awareness among people living with diabetes about the risk of DR.

CONCLUSION

Advanced DM and DR care is not accessible to most people. Programmatic efforts from the government and NGOs must formulate a national action plan to reduce the human and financial impact of the disease in Jordan.

Meandered and muddled: a systematic review on the impact of air pollution on ocular health

From the years 1970-2023, a systematic overview of the diverse consequences of particulate matter on eye health and a disease classification according to acute, chronic, and genetic are presented using the PubMed, Research Gate, Google Scholar, and Science Direct databases. Various studies on medical aspects correlate with the eye and health. However, from an application perspective, there is limited research on the ocular surface and air pollution. The main objective of the study is to uncover the relationship between eye health and air pollution, particularly particulate matter, along with other external factors acting as aggravators. The secondary goal of the work is to examine the existing models for mimicking human eyes. The study is followed by a questionnaire survey in a workshop, in which the exposure-based investigation was tagged based on their activity. This paper establishes a relationship between particulate matter and its influence on human health, leading to numerous eye diseases like dry eyes, conjunctivitis, myopia, glaucoma, and trachoma. The results of the questionnaire survey indicate that about 68% of the people working in the workshop are symptomatic with tears, blurred vision, and mood swings, while 32% of the people were asymptomatic. Although there are approaches for conducting experiments, the evaluation is not well defined; empirical and numerical solutions for particle deposition on the eye are needed. There prevails a broad gap in the arena of ocular deposition modeling.

Predictors of glaucoma knowledge and its risk factors among Jordanian patients with primary open angle glaucoma at a tertiary teaching hospital: A cross-sectional survey

PURPOSE OF STUDY

To assess and compare glaucoma knowledge between Jordanian patients with glaucoma and non-glaucoma ophthalmic patients.

METHODS

A cross-sectional survey was developed after an extensive literature search to investigate glaucoma-related knowledge among participants with glaucoma visiting the Jordan University Hospital clinics from October 2021 to February 2022. Responses were compared to a sample of ophthalmic participants with eye conditions other than glaucoma visiting the ophthalmology clinics at the same time frame.

RESULTS

A total of 256 participants filled out the survey, of which 53.1% were diagnosed with glaucoma while 46.9% had ophthalmic conditions other than glaucoma. Our sample of participants is characterized by a mean age of 52.2 ± 17.8 years and a male-to-female ratio of 1.04:1. Overall, participants with glaucoma were more aware of their disease than participants with other ophthalmic conditions. Compared to their ophthalmic non-glaucoma counterparts, those diagnosed with glaucoma face significantly more daily life difficulties due to their ophthalmic disease (p <0.001). Results of the independent sample t-test demonstrate that participants with glaucoma have significantly higher knowledge scores (p <0.001) and were able to recognize more glaucoma symptoms than their non-glaucoma counterparts (p = 0.002). Similarly, those with a positive family history of glaucoma displayed higher knowledge (p = 0.005). Multivariate linear regression demonstrates that family history of glaucoma, higher symptom recognition score, reliance on ophthalmologists, and the internet for glaucoma-related information are positive predictors of higher knowledge scores.

CONCLUSION

We have demonstrated that both glaucoma and non-glaucoma ophthalmic patients display average levels of glaucoma knowledge. Raising awareness through various interventions may improve the lifestyles of patients with glaucoma and alleviate the economic burden associated with treating the disease.

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.

The Scope of Optometry Practice in Jordan

SIGNIFICANCE

The scope of optometry practice varies worldwide. Although the scope of optometry practice in Jordan is regulated, discrepancies exist in the services that optometry professionals provide.

PURPOSE

This study aimed to document the scope of optometry practice in Jordan and to describe the services that optometry professionals provide, as well as to inform regulatory bodies and educators about the current situation of optometry practice and areas that require development.

METHODS

A cross-sectional study was conducted using a questionnaire completed by optometry professionals working across Jordan. The questionnaire items cover the services and the tests they perform.

RESULTS

Of the 714 participants, 57.8% were female and 42.2% were male, with a median age of 29 years. Participants were unevenly distributed across Jordan, with the majority working in the major cities and at optical centers (81.5%). Most participants were described as "refractionists." The most frequently provided services were basic optometric examinations, followed by community eye care services. Ocular medications were not prescribed by any participant. Reasons for not providing services were mainly attributed to license/profession regulations constraints and the service(s) not being part of the job description. About one-half of the participants have the knowledge to diagnose adnexal and anterior segment disorders.

CONCLUSIONS

Optometry professionals in Jordan can provide more services if the scope of practice is expanded to match their knowledge and skills. Moreover, their nomenclature as refractionists does not represent the range of services they provide that extend beyond refraction. The concern is that optometric services are not reachable by many Jordanian populations because of the inequality of the distribution of professionals. Thus, advocacy to expand the scope of practice in Jordan is recommended.

Preferred Surgical and Anesthesia Techniques for Cataract Surgery in Jordan

Purpose

To study the current practices in Jordan regarding cataract surgical procedures and anesthesia trends for cataract surgery.

Methods

A cross-sectional survey of members of the Jordanian Ophthalmology Society was conducted in October 2020. The questionnaire included questions about participants' demographics, the preferred surgical techniques for cataracts, the preferred anesthesia technique for cataract surgery, the factors which affect the choice of anesthesia technique, the use of sedation, who gives the anesthesia, if there is an anesthesia-trained person who observes the patient during cataract surgery, and the changing trends towards anesthesia between the surgeons.

Results

More than half of the respondents (59.1%) had been in practice for more than 5 years. The preferred method for routine cataract was phacoemulsification for most participants (98.4%). For mature cataract, phacoemulsification was the preferred method for 61.4% of participants. More than half (55.1%) used topical with intracameral anesthesia for phacoemulsification. Two thirds of the participants (66.3%) performed retrobulbar anesthesia for extracapsular cataract surgery. In the majority of cases (86.6%), the respondent themself is the one who administers the anesthesia. No sedation was used before surgery in 62.6% of cases. Two thirds of the respondents (70.1%) reported that they had an anesthesia-trained person monitoring the patient during surgery. Patient cooperation was the most important factor (70.9%) affecting the surgeon's choice of anesthesia technique followed by surgeon skill and experience (57.5%).

Conclusion

Presently, phacoemulsification is the preferred surgical technique for cataract in Jordan. Topical with intracameral anesthesia is the most common anesthesia for phacoemulsification while retrobulbar anesthesia is the most common for extracapsular cataract extraction.

The Causes and Frequency of Monocular and Binocular Blindness in Adults Applying to the Health Committee of a University Hospital in Central Anatolia

Objectives:

The aim of this study was to investigate the frequency of blindness and the pathologies that cause blindness in the Konya province of Turkey.

Materials and Methods:

The records of individuals over 18 years of age who applied to the health committee of Meram School of Medicine Hospital between January 2015 and December 2018 were evaluated retrospectively.

Results:

After reviewing the records of 4,268 applicants, a total of 222 applicants were included in the study (159 patients with monocular blindness, 63 patients with binocular blindness). The most common causes of monocular blindness were optic atrophy (13%), amblyopia (11%), and phthisis bulbi (10%). The most common causes of binocular blindness were retinitis pigmentosa (28%), proliferative diabetic retinopathy (13%), and unoperated cataract (11%). The frequency of monocular blindness was 3.7% (95% confidence interval [CI]: 3.2-4.3%) and binocular blindness was 1.5% (95% CI: 1.1-1.9%) in the sample. The frequency of blindness increased with age, with a positive correlation between mean age and blindness (p=0.002). Monocular blind applicants had a significantly lower mean age than binocular blind applicants (48.8±13.3 vs. 55.0±13.1 years, p=0.002) and binocular blind women had a significantly higher mean age than binocular blind men (62.7±16.0 vs. 53.2±11.7 years, p=0.023). The prevalence of monocular and binocular blindness was significantly higher in men than women (p=0.032).

Conclusion:

The results of this study show that many of the pathologies that cause blindness are preventable or treatable, and that blindness is associated with age.

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

OBJECTIVES

To 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.

DESIGN

Population-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.

SETTINGS

Sohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.

PARTICIPANTS

4078 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 OUTCOMES

The prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.

RESULTS

The 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.

CONCLUSION

The 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.

The relationship between aldose reductase gene C106T polymorphism and the severity of retinopathy in Type 2 diabetic patients: A case-control study

Background:

Hyperglycemia over-activates glucose reduction to sorbitol by aldose reductase (ALR) leading to osmoregulation disruption and cellular damage that cause diabetic complications. We investigated the association of C106T polymorphism of ALR2 gene with the severity of diabetic retinopathy (DR) in Jordanian Type 2 diabetic patients in this case-control study at the Ophthalmology clinic of the National Centre of Diabetes, Endocrinology, and Genetics.

Materials and Methods:

A total of 277 subjects participated in the study (100 diabetics without retinopathy, 82 diabetics with retinopathy, and 95 controls). Blood samples were withdrawn followed by DNA extraction. C106T polymorphism was examined by polymerase chain reaction followed by restriction fragment length polymorphism and gel electrophoresis. Statistical analysis was performed by SPSS software using analysis of variance, multiple logistic regression or Chi-square test.

Results:

The CT and TT genotypes were significantly more prevalent in DR patients than those without DR (CT 50% vs. 38%, TT 16.7% vs. 8%, P = 0.02 and 0.01, respectively). DR patients had T allele more frequently than those without it (41.7% vs. 27%, P = 0.007). Diabetics without retinopathy showed similar genotype and allele frequency to those of nondiabetic controls. No correlation between CT/TT genotypes and the severity of DR in affected subjects was found (χ²: 3.049, P = 0.550).

Conclusion:

C106T polymorphism increased the risk to develop retinopathy in Jordanian Type 2 diabetic patients. T allele of ALR2 was associated with DR. The severity of DR did not show an association with this polymorphism.

Attitudes and Awareness Towards Diabetic Retinopathy Among Patients with Diabetes in Amman, Jordan

PURPOSE

This study aimed to investigate the attitudes and awareness about the development of retinopathy among the patients suffering from diabetes in Amman, Jordan.

METHODS

A questionnaire was distributed among patients with diabetes visiting internal medicine and endocrinology clinics in a tertiary hospital, in addition to a primary health care center in Amman. The questionnaire inquired about retinopathy awareness, history of screening for retinopathy, and awareness about retinopathy treatment. The patients were also asked about risk factors and preventive measures for diabetic retinopathy management.

RESULTS

A total of 303 patients were recruited in the study. Majority of the patients (77%) had their HbA1c levels tested at least once since diagnosis, and most of them (60%) do it regularly. However, 86% of patients reported an A1c >6.5%. Two thirds of patients are not aware about retinopathy being a recognized complication of diabetes. Lower level of education, female sex, younger age, and shorter duration of diabetes mellitus were associated with less awareness.

CONCLUSION

The study concluded that majority of patients with diabetes were aware of diabetes management. However, the sample population indicated less awareness of diabetic retinopathy. Hence, more educational efforts are needed to further boost patients' awareness about diabetic retinopathy.

Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey

Purpose:

The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar.

Methods:

A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district.

Results:

A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively.

Conclusion:

To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.

Awareness and knowledge about glaucoma among patients attending outpatient clinics of Jordan University Hospital

PURPOSE

To evaluate the level of awareness and knowledge about glaucoma among Jordanians and determine the relationship between glaucoma knowledge and selected variables.

METHODS

This was a descriptive and cross-sectional study conducted at a central hospital. Face-to-face interviews were performed to obtain sociodemographic data and information about glaucoma from Jordanian participants attending different outpatient clinics of Jordan University Hospital (JUH). A convenient sample of 488 participants aged 16 years and above were recruited. Consent form was signed by each participant before starting the interview.

RESULTS

The mean age of the study population was 45.71 ± 15.44 years, ranging 16 to 89 years. There were 163 (33.4%) females and 325 (66.6%) males. 81.6% of participants had heard of glaucoma. Only 34.2% of participants defined glaucoma correctly. 52.4% of participants had a low level of knowledge about glaucoma. The main source of information was from family members, relatives, and friends (66.6%); however, this source inversely influenced the level of knowledge.

CONCLUSIONS

The results of this study indicate a high level of awareness of glaucoma among Jordanians but low-to-average knowledge about it. Health education programs should be activated at all levels of health- and eye-care services to increase knowledge about glaucoma and prevent the irreversible loss of vision due to the second main cause of blindness worldwide.

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.

The Frequency and Causes of Blindness in a Rural Region of Central Anatolia of Turkey

Objective

This study aimed to evaluate the frequency and primary causes of blindness in adults aged 18 years and more in Sarıkaya rural region of Yozgat, Turkey, to contribute to the epidemiologic information about blindness in our country.

Materials and Methods

Patients who were examined between October 2016 and March 2017 in Sarıkaya State Hospital, Clinic of Ophthalmology, were prospectively investigated. Demographic and ophthalmic examination data, presented visual acuities (VA), primary causes of blindness, and monocular blindness were recorded. Blindness was defined as presented visual acuities (VA) definition of World Health Organization criteria.

Results

A total of 3423 participants, aged 18-96 years, were examined. Among them, 1887 participants (55%) were female and 1536 (45%) were male. The frequency of blindness was 1.5% (95% CI: 1.1%-2.0%); and cataract was the primary cause of blindness (42%). Age-related macular degeneration (21%) and uncorrected refractive error (13%) were the next main causes of blindness. The frequency of monocular blindness was 4% (95% CI: 3.8%-5.2%), and cataract (27%) followed by phthisis bulbi/evisceration (13%) and glaucoma (12%) were the leading causes of monocular blindness.

Conclusion

In this rural region of Central Anatolia, the primary cause of blindness and monocular blindness was an unoperated cataract. The patterns of age-specific causes of blindness are variable, but most of them are avoidable or treatable. Thus, awareness should be increased in societies, and people should be prevented from blindness with health-care programs in rural regions of developing countries.

Rural–urban disparities in the prevalence of diabetes and diabetic eye complications in Hungary

Background

To examine the rural–urban differences in the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary.

Methods

105 clusters of 35 people aged 50 years or older were randomly selected. Standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module was performed. Participants were classified as diabetic if they had a previous diagnosis of DM or a random blood glucose level ≥200 mg/dl. Each individual with DM who agreed underwent dilated fundus examination and DR grading.

Results

The prevalence of DM was higher in rural (21.8%) than in urban (18.6%) areas (p = 0.016). The prevalence of DR did not differ significantly between rural and urban areas in DM cases. Blindness (0.9% vs. 0.1%; p = 0.048) and blindness due to DM (0.3% vs. 0.0%; p = 0.021) in diabetic participants was significantly more common in rural than in urban areas. Diabetic eye screening coverage was significantly lower in rural than in urban areas (p ≤ 0,007).

Conclusion

Based on our results and the high rate of blindness and blindness due to DR in rural areas, primary eye care should be improved and a telemedical eye screening program should be undertaken, especially concentrating on rural areas.

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.

Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review

Poorly controlled Type-2 diabetes is considered a significant public health problem and associated with adverse outcomes in Jordan. This review focuses on barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan. The aim was to identify the extent of Type-2 diabetes and the influence of knowledge, perceptions and sociocultural factors on adherence to the diabetes management plan. Thirty-two studies were included in the literature review. The high prevalence rate of poorly controlled Type-2 diabetes is associated with many negative consequences among patients in Jordan. Despite the publication of research findings that have shown the importance of adherence to diet, physical activity, medications, monitoring blood glucose and foot care, the level of adherence is still unsatisfactory among patients in Jordan. This review also identified that social, cultural and religious factors influence diabetes management. These factors highlighted the overwhelming influence of socio-cultural factors and lifestyles as determinants of patients' health and health behaviors. For example, the influence of family, friends and culture on herbal use and food preferences that patients make on a daily basis and during social gatherings. A holistic approach incorporating patient-centered care could usefully be incorporated into educational programs to improve the understanding of patients' health and information needs. The importance of factors beyond the individual level in terms of social, cultural, organizational and policy influences such as food habits, religious beliefs and lack of continuity of care were identified as key factors which influence adherence to the diabetes management plan. Recognition of multiple determinants of patients' health among health care professionals may expand the scope of interventions to seek to modify social norms and values and improve patient outcomes.

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.

Visual impairment and blindness in Hungary

AIM

The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe.

DESIGN

A cross-sectional population-based survey.

METHODS

A sample size of 3675 was calculated using the standard Rapid Assessment of Avoidable Blindness (RAAB) software in Hungary. A total of 105 clusters of 35 people aged 50 years or older were randomly selected with probability proportionate to size by the Hungarian Central Statistical Office. Households within the clusters were selected using compact segment sampling. Visual acuity (VA) was assessed with a Snellen tumbling E-chart with or without a pinhole in the households.

RESULTS

The adjusted prevalences of bilateral blindness, SVI, MVI and EVI were 0.9% (95% CI: 0.6-1.2), 0.5% (95% CI: 0.2-0.7), 5.1% (95% CI: 4.3-5.9) and 6.9% (95% CI: 5.9-7.9), respectively. The major causes of blindness in Hungary were age-related macular degeneration (AMD; 27.3%) and other posterior segment diseases (27.3%), cataract (21.2%) and glaucoma (12.1%). Cataract was the main cause of SVI, MVI and EVI. Cataract surgical coverage (CSC) was 90.7%. Of all bilateral blindness in Hungary, 45.5% was considered avoidable.

CONCLUSION

This study proved that RAAB methodology can be successfully conducted in industrialized countries, which often lack reliable epidemiologic data. The prevalence of blindness was relatively low, with AMD and other posterior segment diseases being the leading causes, and cataract is still a significant cause of visual impairment.

The Giant Geriatric Syndromes Are Intensified by Diabetic Complications

By 2015, diabetes has affected more than 415 million people over the world. It is anticipated that 640 million adults will suffer from diabetes in 2040. The elongation of the life expectancy, as the result of better general health care, extends also the time when diabetic complications may develop together with other senility-specific problems. The Giant Geriatric Syndromes (Geriatric Giants) have been qualified by the original Nascher's criteria defined more than 100 years ago, but they are becoming more and more relevant in connection with the aging of societies. The criteria comprise the older age, commonness of the health problem, multifactorial etiology, functional or cognitive impairment, worsened outcome, and increased morbidity and mortality. We described the impact of diabetes on Geriatric Giants including cognitive dysfunction, depression, malnutrition, incontinence, falls and fractures, chronic pain, and the loss of senses. The association of diabetes with Geriatric Giants reveals as a vicious circle with the background of neurovascular complications. However, diabetes influence on the incidence of cancer in elderly was also discussed, since neoplastic diseases associate with Geriatric Giants, for example, chronic pain and depression. The knowledge about these aspects of functional decline in geriatric population is crucial to improve patient care.

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.

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

Objectives:

To determine the prevalence and causes of blindness and diabetic retinopathy (DR) in Jazan district, Southern Saudi Arabia.

Methods:

Using the standardized Rapid Assessment for Avoidable Blindness (RAAB) and DR cross-sectional methodology, 3800 subjects were randomly selected from the population of ≥50 years of age in Jazan, Saudi Arabia between November 2011 and January 2012. Participants underwent screening comprised of interview, random blood glucose test, and ophthalmic assessment including visual acuity (VA) and fundus examination. Among participants with VA <6/18 in either eye, the cause(s) of visual impairment was determined. Participants were classified as diabetic if they had previous diagnoses of diabetes, or random blood glucose >200 mg/dl. Diabetic participants were assessed for DR using dilated fundus examination. All data were recorded using the RAAB + DR standardized forms.

Results:

The prevalence of bilateral blindness <3/60 was 3.3% (95% confidence interval [CI]: 2.74 - 3.90). Cataract was the leading cause of blindness (58.6%); followed by posterior segment diseases (20%), which included DR (7; 3.3%). The prevalence of diabetes mellitus (DM) was 22.4%, (95% CI: 21.09 - 23.79), among them; 27.8% had DR. The prevalence of sight-threatening DR was 5.7%.

Conclusion:

The prevalence of DM and the corresponding proportion of DR in this region is lower than that reported in other regions of Saudi Arabia. However, the prevalence of blindness not related to DR is relatively higher than the other studies.

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.

Diabetes epidemic sweeping the Arab world

The prevalence of type-2 diabetes mellitus (T2DM) has increased dramatically during the last 2 decades, a fact driven by the increased prevalence of obesity, the primary risk factor for T2DM. The figures for diabetes in the Arab world are particularly startling as the number of people with diabetes is projected to increase by 96.2% by 2035. Genetic risk factors may play a crucial role in this uncontrolled raise in the prevalence of T2DM in the Middle Eastern region. However, factors such as obesity, rapid urbanization and lack of exercise are other key determinants of this rapid increase in the rate of T2DM in the Arab world. The unavailability of an effective program to defeat T2DM has serious consequences on the increasing rise of this disease, where available data indicates an unusually high prevalence of T2DM in Arabian children less than 18 years old. Living with T2DM is problematic as well, since T2DM has become the 5^th leading cause of disability, which was ranked 10^th as recently as 1990. Giving the current status of T2DM in the Arab world, a collaborative international effort is needed for fighting further spread of this disease.

Diabetes and diabetic retinopathy in people aged 50 years and older in the Republic of Suriname

BACKGROUND/AIMS

Population-based surveys on diabetes and diabetic retinopathy (DR) are necessary to increase awareness and develop screening and therapeutic programmes. The aim was to estimate the prevalence of DR in older adults of different ethnic backgrounds in Suriname.

METHODS

Fifty clusters of 60 people aged ≥50 years were randomly selected with a probability proportional to the size of the population unit. Eligible people were randomly selected through compact segment sampling and examined using the Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy (RAAB + DR) protocol. Participants were classified as having diabetes if they: were previously diagnosed with diabetes; were receiving treatment for glucose control; had a random blood glucose level >200 mg/dL. These participants were dilated for funduscopy, assessed for DR following the Scottish DR grading protocol and evaluated for ethnicity and DR ophthalmic screening frequencies.

RESULTS

A total of 2806 individuals was examined (response 93.6%). The prevalence of diabetes was 24.6%. In these patients any type of DR and/or maculopathy occurred in 21.6% and sight-threatening DR in 8.0%. Of the known diabetics, 34.2% never had an eye examination for DR and in 13.0% the last examination was >24 months ago. The prevalence of diabetes was significantly higher in Hindustani people compared with other major ethnic groups.

CONCLUSIONS

The prevalence of diabetes and diabetics without regular DR control in people aged ≥50 years in Suriname was higher than expected. The uptake for special services for DR has to be expanded to decrease patient delay and DR-induced blindness.