First presentation of diabetic patients to ophthalmology clinic [A survey in two peripheral hospitals in Jordan]

Objectives: To assess the presentation of patients diagnosed already to have Diabetes Mellitus [DM], in terms of source of referral, eye condition on first visit, and minimal awareness of diabetic eye complications and treatment

Methods: Ninety-five patients [all patients visiting the clinic for the first time and found to be diabetics] attending the ophthalmology clinic and diagnosed to be diabetics during a period of 3 months [April-June 2009] were included in the study. A questionnaire was filled by patients. Items asked about the duration since the patients were diagnosed to have Diabetes Mellitus, cause of presentation to ophthalmology clinic [including referral from other clinics], knowledge about blood sugar and blood pressure control effect on retinal complications of Diabetes Mellitus as well as Laser effect on the eye

Results: More than a third [35%] of the patients visited the eye clinic after more than 11 years of DM. Quarter [25%] of them presented in the latest stage of diabetic retinopathy [proliferative diabetic retinopathy PDR]. Despite that a high percentage [67%] was followed up by internists, their eye complaint was the major cause for them to come to clinic rather than referral from the DM treating doctor for regular check up. The majority know the effect of blood sugar level but not hypertension on the diabetic retinopathy. Most of them lack adequate knowledge about Laser

Conclusion: All doctors dealing with diabetic patients especially those practicing in peripheral hospitals should establish a fixed protocol of sending the diabetic patients for eye check up routinely at the time of diagnosis of DM. Dietician and educators are mandatory compliment to diabetes clinics. Media and local institutes should be involved more actively in spreading education and advice for the continuously increasing number of diabetic patients

How aware diabetic retinopathy patients about diabetes mellitus

The aim of this survey was to evaluate how aware diabetic patients about some facts of their chronic disease. A questionnaire was given to 169 diabetic [Type 2] patients presenting to the retina clinic in King Hussein Medical Center over a period of three months [1st of April 2012 till 1st of July 2012]. The questions were read and answered by the patient or read for him by accompanying person or nurse. General information was collected: age, residence, type and duration of treatment. Questions were asked about how they joined the retina clinic, frequency of visits to endocrinologist and ophthalmologist, mode and satisfaction with management and how they check and control their blood sugar level. This study included 169 patients, 58.6% were females and 41.4% were males, with the mean age of 61.9 years. The mean duration of diabetes was 15.9 years and 75% were using insulin. Mean of follow up period was 3.3 years. Ischemic heart disease was found in 21.3% of the patients, 35% were hypertensive, 13.6% were smokers, 11.2% suffer from diabetic foot and 9.5% had renal impairment. Thirty-nine percent were sent to ophthalmologist by the internist, 28% by a general practitioner, 32% advised by non-medical others, and 37% visited the clinic because of ocular/visual complaint. The main factor blamed for diabetic retinal changes was the duration of diabetes. More than half of the patients believed that no other diseases affect the diabetic retinal changes. Less than a quarter of the patients could mention at least one extraocular organ affected by diabetes mellitus. Eighty percent of the patients were compliant to their clinic appointments. More than half depended on symptoms rather than blood test to judge their diabetes mellitus control. Forty-six percent thought they have a controlled diabetes mellitus, 54% of them were satisfied with the laser treatment they received, while only 31% of the uncontrolled diabetes mellitus group were happy with the laser. Only 29% gave an acceptable range of fasting blood sugar when asked about the normal level, while 55.6% did not know about HbA1c. Eating habits were blamed by 55.6% for disturbed blood sugar level, but 28.3% could not find a reason for it. A large proportion of patients were not well educated about their disease. This mandates a national campaign to enlighten diabetics as well as non-diabetics about this prevalent disease, since educating diabetic patients about their chronic disease is mandatory to decrease the severity of complications, postpone or even prevent them

Efficacy of ketotifen fumarate 0.025% eye drops in treatment of vernal keratoconjunctivitis

This prospective hospital-based study has been conducted to evaluate the efficacy of ketotifen fumarate 0.025% eye drops in controlling the signs and symptoms of vernal keratoconjunctivitis and to compare its effect with that of commonly used combination of eye drops for vernal keratoconjunctivitis both in mild and severe cases. A total of 20 patients [40 eyes] who came to the outpatient clinics at the ophthalmology department at King Hussein Medical Center were selected during the period between January 2004 and May 2004. They were diagnosed to have vernal keratoconjunctivitis with no other ocular or systemic pathologies that might affect the results. Two groups of medications were used; ketotifen for the right eye and naphazoline with antazoline and sodium cromoglycate for the left eye. Steroids were used for both eyes at the beginning to establish a primary control and added if needed later. The patients were followed up and given scores for their signs and symptoms on the first visit and on each follow up visits, which were distributed over a period of 6 weeks. Further division of the population into two subgroups of mild and moderate-severe groups as the behavior of the drugs differs in each group of the two. Generally, similar behavior of the disease was noticed in the two groups of medications, particularly in the mild cases where ketotifen alone could achieve a satisfactory final result as that of the combination of sodium cromoglycate and naphazoline with antazoline. The improvement was noticed in all signs and symptom studied [itching, watery discharge, redness photophobia, hyperemia, papillae and corneal signs of vernal keratoconjunctivitis]. In mild cases, there was no significant difference between the two groups of medications [p>0.05]. Steroids could be avoided in the mild cases. In the severer cases, ketotifen alone was not enough in controlling the signs and symptoms and steroids were needed at frequent intervals. In severe cases the improvement was significantly better in the group using ketotifen fumarate in the symptoms of watery discharge and redness, and in the hyperemia sign [p<0.05], while other symptoms and signs improved in both groups of medications without significant difference [p>0.05]. The use of ketotifen is of an advantage over the combination of naphazoline 0.025% with antazoline 0.5%, and sodium cromoglycate 4% as it is only one bottle with a lower frequency of instillation, thus the compliance would be better, although it almost has the same price as the other two combined. The use of ketotifen is convenient for patients with mild symptoms as a solo drug after few days of steroids. In the severe cases, ketotifen alone could not be used without frequent intervals of steroids, although a significant improvement in this group was noticed over the group of combined medications in watery discharge and redness symptoms and hyperemia sign

Ophthalmic emergencies during the festive period in aqaba-South Jordan

A retrospective hospital-based study was conducted in Princess Haya Military Hospital. The aim was to evaluate the emergency eye cases during the feast vacation in Aqaba. We chose four feast vacations during the years 2001 and 2002, counting 20 days, and compared the emergency cases during these days with those seen on other randomly chosen 20 days during these two years. The cause and type of ocular trauma were studied. One hundred seventy nine cases were treated. The traumatic to non-traumatic ratio was 4.3:1 and the traumatic cases had a pediatric to adult ratio of 1.8:1 vs. 1:3.9 in the non-traumatic cases. Males were significantly more involved than females. During the non-festive period, the total number of emergency cases was 56 cases; the traumatic to non-traumatic ratio was 1:1.3. The traumatic pediatric to adult cases ratio was 1:1.7 vs. 1:1.5 in the non-traumatic cases During the festive period the hugest group was adult mate traumata. cases The highest number of patients during the feast had corneal foreign body as a single problem The highest number of admissions was due to hyphema. Children's toys were at the top of the list as a source of traumatic eye emergencies; and tile most common traumatic toy was tile air-powered gull. The emergency room and staff should be prepared for this increase in the number and the type of cases during tile feast vacations. Community education concerning prevention of domestic injuries is needed