Estrategia para la prevención de la retinopatía diabética en la atención primaria de salud / A Strategy for the Prevention of Diabetic Retinopathy in Primary Healthcare

Introducción: La retinopatía diabética puede prevenirse con el óptimo control de la diabetes mellitus; sin embargo, la constante llegada de pacientes con diagnóstico de retinopatía diabética avanzada a los centros oftalmológicos apunta a la insuficiente prevención primaria de esta enfermedad. Objetivo: Proponer herramientas prácticas vinculadas a los principales factores de riesgo que pueden ser controlados o modificados en pacientes diabéticos para lograr una prevención primaria de la retinopatía diabética más efectiva. Métodos: Se consultaron artículos referentes a la prevención de la retinopatía diabética en la atención primaria de salud durante los meses de noviembre-diciembre de 2020 y enero de 2021; publicados en diversas revistas e indexados en las bases de datos PubMed, SciELO, Medscape; otros textos afines, páginas web y blogs del año 2010 en adelante. Las sintaxis empleadas fueron retinopatía diabética, prevalencia y prevención de retinopatía diabética, prevención primaria, complicaciones oculares de la diabetes mellitus y factores de riesgo de la retinopatía diabética. Conclusiones: La adición de nuevas estrategias al control o modificación de los principales factores de riesgo en los pacientes diabéticos constituye una alternativa para perfeccionar la prevención primaria de la retinopatía diabética(AU)

Introduction: Diabetic retinopathy can be prevented with the optimal control of diabetes mellitus; however, the constant arrival of patients with a diagnosis of advanced diabetic retinopathy to ophthalmologic centers points to insufficient primary prevention of this disease. Objective: To propose practical tools related to the main risk factors that can be controlled or modified in diabetic patients to achieve a more effective primary prevention of diabetic retinopathy. Methods: Articles concerning the prevention of diabetic retinopathy in primary healthcare were consulted, covering the months of November-December 2020 and January 2021, published in various journals and indexed in the PubMed, SciELO and Medscape databases; together with other related texts, websites and blogs from 2010 onwards. The used syntaxes were retinopatía diabética [diabetic retinopathy], prevalencia y prevención de retinopatía diabética [prevalence and prevention of diabetic retinopathy], prevención primaria [primary prevention], complicaciones oculares de la diabetes mellitus [ocular complications of diabetes mellitus] and factores de riesgo de la retinopatía diabética [risk factors for diabetic retinopathy]. Conclusions: The addition of new strategies to the control or modification of the main risk factors in diabetic patients is an alternative to perfect primary prevention of diabetic retinopathy(AU)

Estudio de prevalencia de retinopatía diabética en pacientes diabéticos tipo 2 de la comuna de Puerto Montt y sus factores asociados / Frequency of diabetic retinopathy and associated factors in Puerto Montt, Chile

BACKGROUND: Diabetic retinopathy (DR) is an important cause of decreased visual acuity, whose prevalence has increased between 1990 and 2020. In Chile the prevalence of diabetic retinopathy was estimated at 24.8%. AIM: To assess the prevalence of DR in a southern Chilean city. MATERIAL AND METHODS: From a database of diabetic patients attending primary health care centers at Puerto Montt, Chile, 196 patients with DR and 392 patients without DR, matched by age and presence of chronic complications, were chosen for this case-control study. RESULTS: The prevalence of DR in the database of diabetic patients was 33.3%. glycated hemoglobin, the frequency insulin use, systolic blood pressure, HDL cholesterol, microalbuminuria, and proteinuria were significantly worse in cases. A multivariate analysis showed that retinopathy is much more likely to occur when the variables insulin use, neuropathy, and microalbuminuria concur. CONCLUSIONS: DR was associated with worse metabolic parameters and the presence of neuropathy in this case control study.

Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde / Color retinography as a means of screening for diabetic retinopathy in the tertiary hospital of Unified Health System

RESUMO Objetivo Avaliar o impacto da triagem de retinopatia diabética de paciente diabéticos realizada com retinografia colorida. Métodos Estudo retrospectivo, de caráter descritivo, avaliando laudos de retinografias realizadas desde a implementação do protocolo da triagem de retinopatia diabética de paciente diabéticos acompanhados no Ambulatório de Endocrinologia de um hospital terciário do Sistema Único de Saúde, de maio de 2018 até maio de 2020. Resultados Realizaram retinografia 727 pacientes diabéticos, que tinham entre 14 e 91 anos, sendo a maioria com 60 anos ou mais (53,2%), do sexo feminino (68%) e brancos (87,6%). Não apresentavam retinopatia diabética 467 (64,2%) pacientes, 125 (17,2%) tinham retinopatia diabética não proliferativa, 37 (5,1%) retinopatia diabética não proliferativa grave e/ou suspeita de edema macular, 65 (8,9%) retinopatia diabética proliferativa, 21 (2,9%) suspeita de outras patologias, e as imagens de 12 (1,7%) pacientes eram insatisfatórias. Foram considerados de alto risco (aqueles com retinopatia diabética não proliferativa grave e/ou edema macular, retinopatia diabética proliferativa ou imagem insatisfatória) 114 (15,68%) pacientes. Conclusão O rastreio de retinopatia diabética com retinografia colorida possibilitou a detecção de pacientes diabéticos de alto risco que necessitavam atendimento com brevidade, permitindo o acesso deles à consulta oftalmológica e diminuindo a morbidade da doença relacionada ao tratamento tardio. Os demais foram encaminhados à Atenção Primária para regulamentação, por meio do Sistema de Regulação.

ABSTRACT Objective To evaluate the impact of diabetic retinopathy (DR) screening using color retinography in diabetic patients. Methods Retrospective descriptive study, evaluating reports of all retinographs performed since the implementation of the protocol for screening for diabetic retinopathy in diabetic patients followed up at the endocrinology outpatient clinic of a tertiary hospital of the Unified Health System, from May 2018 to May 2020. Results 727 diabetic with age range from 14 to 91 years old, the majority being 60 years old or older (53.2%), female (68%) and white (87.6%), patients underwent retinography. Of the patients, 467 (64.2%) did not have DR, 125 (17.2%) had non-proliferative DR, 37 (5.1%) had severe non-proliferative DR and/or suspected macular edema, 65 (8.9%) had proliferative DR, 21 (2.9%) had suspicion signs of other pathologies and 12 (1.7%) had unsatisfactory images. A total of 114 (15.68%) patients were considered at high risk (those with severe non-proliferative NP and/or EM, proliferative DR or poor image) and were referred for comprehensive ophthalmic evaluation. Conclusion The screening of RD with color retinography enabled the detection of high-risk diabetic patients who needed assistance sooner and enabled their access to ophthalmologic consultation, which decreased disease morbidity. The others were referred to primary care for regulation through the Regulation System (SISREG).

Retinopatía Diabética en Chile: un reporte cuantitativo de la proporción de diabéticos con fondo de ojo anual / Coverage rates of eye fundus examinations among Chilean patients with diabetes mellitus

Background: Timely eye fundus examinations are essential to prevent the consequences of retinopathy among patients with type 2 diabetes mellitus. Aim: To assess the coverage rate (CR) of eye fundus examination in the Chilean diabetic population, between 2011 and 2019. Material and Methods: Analysis of monthly statistical summaries of the Cardiovascular Health Program published online by the Chilean Ministry of Health. The number of patients aged 15 years or more with a diagnosis of Type 2 diabetes mellitus and the number of those who had an eye fundus examination within the same year, were obtained. Data was analyzed at a national and regional level. Results: The national eye fundus examination CR was 19.1% in 2011. In 2016, the figures became significantly higher, reaching 32.5%. In 2019, the highest value of 36.5% was recoded although not significantly different from 2016. The highest average annual CR was observed in Ñuble Health Service (49.5%), and the lowest in Central Metropolitan Service (15%). The highest CR positive absolute and relative variation between 2011 and 2019 was observed in Viña del Mar Quillota Health Service (38.9 and 489% respectively), and the lowest negative variation was observed in Araucania Norte Health Service (-8.42 and -24.21% respectively). Conclusions: There is a low eye fundus examination CR in Chile, with important differences between regional health services.

Prevalencia de la discapacidad visual en el adulto diabético en Cuba / Prevalence of visual impairment among adult diabetics in Cuba

Objetivo: Describir la discapacidad visual del diabético de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos donde se tomaron todos los diabéticos conocidos o no con discapacidad visual. Resultados: La prevalencia de cualquier tipo de discapacidad visual en el diabético es de 25,4 por ciento (21,8-28,9). El riesgo de desarrollar discapacidad visual moderada, grave y ceguera es de 19,4 por ciento (16,5-22,3), 2,8 por ciento (1,0-4,6) y 3,2 por ciento (1,5-4,8) respectivamente. La catarata es la primera causa de discapacidad. El riesgo de discapacidad visual en el diabético es similar para uno y otro sexo y se incrementa con la edad. Las coberturas de tratamiento son bajas. Conclusiones: En Cuba, alrededor de un cuarto de los diabéticos tienen algún riesgo de discapacidad visual. El diabético tiene mayor riesgo de discapacidad visual moderada; sin embargo, el riesgo de discapacidad visual grave y de ceguera es el mismo para toda la población de 50 años y más de edad. La catarata y la retinopatía diabética son las causas más frecuentes de discapacidad visual en el diabético. Se evidencian dificultades con la atención oftalmológica, que incluye el examen y la cobertura de tratamiento de la catarata y del láser para la retinopatía diabética(AU)

Objective: Describe visual impairment among diabetics aged 50 years and over, and the coverage of ophthalmological care in Cuba in the year 2016. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. The data obtained from the questionnaires were transferred to a database of visually impaired known and unknown diabetics. Results: Prevalence of any sort of visual impairment among diabetics is 25.4 percent (21.8-28.9). Risk of developing moderate visual impairment, severe visual impairment or blindness is 19.4 percent (16.5-22.3), 2.8 percent (1.0-4.6) and 3.2 percent (1.5-4.8), respectively. Cataract is the leading cause of impairment. Risk of visual impairment among diabetics is similar in the two sexes and increases with age. Treatment coverage is low. Conclusions: In Cuba, about one fourth of the diabetics are at some risk of visual impairment. Diabetics are at a higher risk of moderate visual impairment. However, the risk of severe visual impairment and blindness is the same as for the population aged 50 years and over. Cataract and diabetic retinopathy are the most common causes of visual impairment among diabetics. Difficulties were found in ophthalmological care, including examination and treatment coverage for cataract and laser therapy for diabetic retinopathy(AU)

Caracterización epidemiológica y clínica de pacientes con retinopatía diabética / Clinical and epidemiological characterization of diabetic retinopathy patients

Objetivo: Caracterizar los pacientes con retinopatía diabética desde el punto de vista epidemiológico y clínico. Métodos: Se realizó un estudio descriptivo y transversal en el Centro Oftalmológico de Santiago de Cuba, desde octubre del año 2017 hasta octubre de 2019, en una población de 42 pacientes diabéticos tipo 2. Resultados: Predominaron los pacientes con tiempo de diabetes mellitus mayor de 10 años, y edades de 55 años o más (60,0 por ciento); el mayor porcentaje correspondió al color de piel negra (66,7 por ciento ); la agudeza visual mayor de 0,6 se presentó en el 49,4 por ciento de los casos; la retinopatía diabética proliferativa fue la más presentada con 55,9 por ciento. Hubo predominio, además, de los valores de hemoglobina glicosilada por encima del 7 por ciento y de la normoalbuminuria con 46,7 y 66,7 por ciento, respectivamente, en ambos grupos. Conclusiones: Los valores elevados de hemoglobina glicosilada y la normoalbuminuria se asocian, desde el punto de vista clínico, a la retinopatía diabética proliferativa(AU)

Objective: Characterize diabetic retinopathy patients from a clinical and epidemiological point of view. Methods: A descriptive cross-sectional study was conducted of 42 type 2 diabetic patients at Santiago de Cuba Ophthalmology Center from October 2017 to October 2019. Results: A predominance was found of patients who had had diabetes mellitus for more than 10 years and were aged 55 years or over (60.0 percent); black skin color prevailed with 66.7 percent; visual acuity above 0.6 was present in 49.4 percent of the cases, and proliferative diabetic retinopathy was the most common type (55.9 percent). In both groups glycosylated hemoglobin values above 7 percent prevailed, whereas normal albuminuria was predominant with 46.7 percent and 66.7 percent, respectively. Conclusions: High glycosylated hemoglobin and normal albuminuria values are clinically associated to proliferative diabetic retinopathy(AU)

Prevalência e fatores de risco para retinopatia diabética em pacientes diabéticos atendidos por demanda espontânea: um estudo transversal / Prevalence and risk factors of diabetic retinopathy in patients with diabetes seen by unscheduled demand: a cross-sectional study

RESUMO Objetivo: Estimar a prevalência da retinopatia diabética em pacientes diabéticos de uma capital brasileira e correlacioná-la com fatores de risco presentes na população estudada. Métodos: Estudo observacional transversal, realizado a partir do relatório de atendimentos prestados em mutirão ocorrido em 2018. O relatório foi preenchido pelos médicos oftalmologistas durante a campanha, com informações referentes a sexo do paciente, idade, classificação do diabetes mellitus, tempo de doença, uso de insulina, índice de massa corporal, hábitos de vida (tabagismo e atividade física) e história de hipertensão arterial sistêmica, dislipidemia, infarto agudo do miocárdio e acidente vascular cerebral, além de exame clínico oftalmológico realizado na ação. Resultados: Dentre os 219 participantes do estudo, a prevalência da retinopatia diabética foi de 31,96%. As variáveis que se apresentaram como fator de risco com significância estatística foram sexo masculino, idade de 51 a 70 anos, mais de 10 anos de diabetes mellitus, insulinoterapia, índice de massa corporal ≥40kg/m2 e história prévia de infarto agudo do miocárdio. Atividade física mostrou-se como fator protetor significativo. Conclusão: Estudos populacionais ao longo dos anos comprovaram a variabilidade geográfica na prevalência da retinopatia diabética justificada pela diferente exposição aos fatores de risco. Dentro de tal conjuntura, ressalta-se o quão fundamental é o conhecimento das características regionais, de modo a orientar as políticas de saúde pública, permitindo atuar com impacto na redução das estatísticas de cegueira evitável.

ABSTRACT Objective: To estimate the prevalence of diabetic retinopathy in patients with diabetes, from a Brazilian capital city, and to correlate with the risk factors present in the studied population. Methods: A cross-sectional observational study, based on the report of care provided by a campaign, in 2018. The report was filled out by ophthalmologists during the joint effort, with information on patient's gender, age, classification of diabetes mellitus, duration of illness, use of insulin, body mass index, lifestyle (smoking and physical activity), history of hypertension, dyslipidemia, myocardial infarction, stroke, and the clinical ophthalmic examination. Results: Among the 219 study participants, the prevalence of diabetic retinopathy was 31.96%. The variables considered risk factors with statistical significance were male sex, age 51-70 years, diabetes mellitus for over 10 years, insulin therapy, body mass index ≥40 kg/m2, and previous history of myocardial infarction. The physical activity proved to be a significant protective factor. Conclusion: Over the years, population studies have proven the geographical variability in prevalence of diabetic retinopathy justified by different exposure to risk factors. Therefore, knowledge of regional characteristics is crucial and emphasized in the text, since it can guide public health policies, aiming to have an impact on reduction of preventable blindness statistics.

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual / Association between diabetes mellitus and eye diseases in people with visual impairment / Asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual

Objetivo: verificar associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual. Método: estudo transversal com 51 pessoas com diabetes e deficiência visual, em um centro de reabilitação visual do interior paulista, que participaram de entrevista estruturada, em 2018. Utilizou-se os testes: Kolmogorov Smirnov, Regressão de Poisson, Regressão de Logística Binária, e Correlação de Spearman. Resultados: a maioria das pessoas era cega e relatou que a retinopatia diabética, o glaucoma e a catarata foram causa da deficiência visual; com tempo de diagnóstico do diabetes acima de 109 meses. A catarata apresentou um nível de correlação baixa (r=0,280 e p=0,047), e a retinopatia diabética um nível de correlação moderada (r=0,565 e p=0,000), considerando o tempo de diagnóstico do diabetes. Conclusão: associação estatisticamente significante entre o tipo de diabetes e a retinopatia, e correlação estatisticamente significante entre o tempo de diagnóstico do diabetes, a catarata e a retinopatia diabética.

Objective: to verify the association between diabetes mellitus and eye diseases in people with visual impairment. Method: this cross-sectional study involved 51 people with diabetes and visual impairment at a Visual Rehabilitation Center in São Paulo, who participated in a structured interview in 2018. The tests used were: Kolmogorov Smirnov, Poisson Regression, Binary Logistic Regression, and Spearman Correlation. Results: most participants were blind, reported that diabetic retinopathy, glaucoma and cataracts were the causes of their visual impairment, and had been diagnosed with diabetes over 109 months earlier. Cataract returned a low level of correlation with time with diagnosis of diabetes (r = 0.280 and p = 0.047), and diabetic retinopathy, moderate correlation (r = 0.565 and p = 0.000). Conclusion: a statistically significant association was found between type of diabetes and retinopathy, and statistically significant correlations between the time diagnosed with diabetes, cataracts and diabetic retinopathy.

Objetivo: verificar la asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual. Método: este estudio transversal involucró a 51 personas con diabetes y discapacidad visual en un Centro de Rehabilitación Visual en São Paulo, quienes participaron en una entrevista estructurada en 2018.Las pruebas utilizadas fueron: Kolmogorov Smirnov, Regresión de Poisson, Regresión Logística Binaria y Spearman Correlación. Resultados: la mayoría de los participantes eran ciegos, informaron que la retinopatía diabética, el glaucoma y las cataratas eran las causas de su discapacidad visual y habían sido diagnosticados con diabetes más de 109 meses antes. La catarata devolvió un bajo nivel de correlación con el tiempo con el diagnóstico de diabetes (r = 0,280 yp = 0,047) y la retinopatía diabética, correlación moderada (r = 0,565 yp = 0,000). Conclusión: se encontró asociación estadísticamente significativa entre tipo de diabetes y retinopatía, y correlaciones estadísticamente significativas entre el tiempo de diagnóstico de diabetes, cataratas y retinopatía diabética.

Análisis bibliométrico de la retinopatía diabética en revistas médicas cubanas: un producto de información con valor agregado / Bibliometric analysis of diabetic retinopathy in Cuban medical journals: an information product with added value

Los estudios métricos sobre la producción científica constituyen productos de información útiles a las comunidades académicas; sin embargo, no existen abundantes indagaciones que cuantifiquen y evalúen las fuentes que publican trabajos sobre retinopatía diabética. Este trabajo se propuso determinar la producción científica sobre retinopatía diabética publicada en revistas médicas cubanas entre los años 1970 y 2017. Se realizó una revisión bibliográfica a partir de la identificación en los registros de los términos [adultos - retinopatía diabética]. Se utilizó el gestor de referencias bibliográficas Zotero, para recuperar y analizar los metadatos de cada artículo seleccionado; Microsoft Excel para la tabulación de los resultados y Mindjet mindManager (2010), para la elaboración del mapa conceptual. Se seleccionaron 56 artículos relacionados con la temática después de aplicados los criterios de inclusión y exclusión. La producción científica de la retinopatía diabética publicada en revistas médicas cubanas se concentra en los últimos 10 años. El peso de la distribución de los artículos recae en revistas que pertenencen a Institutos Nacionales. Asimismo, la tendencia de los tipos de trabajos se concentra en investigaciones originales de carácter descriptivo, estudios de caso y artículos de revisión; y en menor cuantía los estudios de cohortes, analíticos y experimentales(AU)

Metric studies about scientific production are information products useful to academic communities. However, not many inquiries are available which quantify and evaluate the sources publishing papers about diabetic retinopathy. The present study was aimed to determine the scientific production about diabetic retinopathy published in Cuban medical journals in the period 1970-2017. A bibliographic review was conducted based on identification of records of the terms [adults - diabetic retinopathy]. Retrieval and analysis of the metadata for each paper selected was performed with the bibliographic reference manager Zotero, while Microsoft Excel was used for tabulation of results and Mindjet MindManager (2010) to develop the conceptual map. A total 56 papers about the study topic were selected upon application of inclusion and exclusion criteria. Scientific production about diabetic retinopathy published in Cuban medical journals is concentrated in the last ten years. Most of the papers were found to have been published by journals sponsored by national institutes. Regarding paper types, most were original studies of a descriptive nature, case studies and review papers, and to a lesser degree cohort, analytic and experimental studies(AU)

Frecuencia y severidad de retinopatía diabética en pacientes con diabetes mellitus tipo 2 en el Instituto Regional de Oftalmología / Frequency and severity of diabetic retinopathy in patients with type 2 diabetes mellitus at the Regional Institute of Ophthalmology

RESUMEN Para determinar la frecuencia y el grado de severidad de retinopatía diabética (RD) en pacientes con diabetes mellitus (DM) tipo 2 se realizó un estudio descriptivo transversal en 3239 pacientes del Instituto Regional de Oftalmología de la ciudad de Trujillo, región La Libertad, Perú. Previa dilatación pupilar, personal entrenado tomó dos fotografías de cada ojo, centrado en mácula y nervio óptico. La frecuencia de RD fue de 25,9 % con mayor proporción en varones con RD (28,2%) y en aquellos con más de 10 años de enfermedad por DM (49,0%). La mayoría de pacientes tuvieron retinopatía diabética no proliferativa (RDNP) leve a moderada (79,3%), el 10,1% tuvo RDNP severa y el 10,6 % RD proliferativa. Concluimos que la RD se presenta en uno de cada cuatro pacientes y alrededor del 20% en grados avanzados. Es preciso ampliar la cobertura de tamizaje desde el momento del diagnóstico de DM e implementar medidas preventivas como el control metabólico y el examen periódico del fondo de ojo.

ABSTRACT In order to determine the frequency and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (MD), a cross-sectional descriptive study was conducted in 3,239 patients of the Regional Institute of Ophthalmology in the city of Trujillo, La Libertad region, Peru. After pupil dilation, trained personnel took two photographs of each eye, centered on macula and optic nerve. The frequency of DR was 25.9%, with a higher proportion in men with DR (28.2%) and in those with more than 10 years of MD disease (49.0%). Most patients had mild to moderate non-proliferative diabetic retinopathy (NPDR) (79.3%); 10.1% had severe NPDR, and 9.7% had proliferative DR. We conclude that DR occurs in one in four patients and about 20% in advanced degrees. There is a need to expand screening coverage from the time of diagnosis of DM and to implement preventive measures such as metabolic control and periodic ocular fundus exam.

Retinopatía diabética y edema macular diabético: prevalencia en una población de atención primaria de Antofagasta / Diabetic retinopathy and diabetic macular edema: prevalence in a family health care center of Antofagasta

INTRODUCCIÓN: La Retinopatía Diabética (RD) es una complicación microangiopática de la diabetes y una de las principales causas de ceguera a nivel mundial. La principal complicación de la RD es el edema macular diabético (EMD). El objetivo de este trabajo es determinar la prevalencia de RD y sus subtipos, así como de EMD en una población de pacientes diabéticos de la atención primaria (APS) de Antofagasta. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal realizado en una población de 380 pacientes diabéticos diagnosticados y tratados en siete centros de APS de Antofagasta sometidos a control anual de tamizaje de RD mediante retinografía. Se analizó sexo, edad, presencia de RD y subtipos y EMD. RESULTADOS: Se encontró prevalencia de RD de 19.21%. Dentro de este grupo la mayoría (60.27%) fueron hombres y el rango de edad predominante fue 40-64 años con 60.27%. El subtipo más frecuente fue la RD no proliferativa moderada con 45.21% y la prevalencia de EMD fue de 1.84%. CONCLUSIONES: La RD es una complicación prevalente y prevenible, por lo que es necesario mejorar los programas de control metabólico y métodos de screening. Este estudio aporta nuevos datos a la escasa literatura nacional sobre el tema.

INTRODUCTION: Diabetic retinopathy (DR) is a diabetic microangiopatic complication and the leading cause of blindness worldwide. The principal complication of DR is diabetic macular edema (DME). The objective of this study is to determine the prevalence of DR and their subtypes, as well as DME in a primary health care (PC) diabetic population of Antofagasta. ;ATERIAL AND METHODS: This is a transversal descriptive study carried out in a population of 380 diabetic patients diagnosed and treated in Antofagasta's seven PC centers, who underwent an anual retinography for DR screening. The factors analyzed were sex, age, presence of RD and their subtypes, and DME. RESULTS: We found a RD prevalence of 19.21%. In this group, the majority were men and the age group of 40-64 years showed the highest prevalence. The more frequent subtype (45.21%) was moderate non-proliferative DR, and the prevalence of DME was 1.84%. CONCLUSIONS: RD is a prevalent and preventable complication, and metabolic control programs and screening methods must be improved. This study contributes new data to the scarse national literature of this topic.

Tamizaje en el diagnóstico y prevalencia de retinopatía diabética en atención primaria / Coverage of a screening program and prevalence of diabetic retinopathy in primary care

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.

Fatores de risco e incidência da retinopatia diabética / Risk factors and incidence of diabetic retinopathy

RESUMO Objetivo: Conhecer a incidência da RD, assim como avaliar os fatores de riscos na amostra em estudo. Métodos: Avalia da incidência e os fatores de risco da RD (tempo de doença e presença de HAS em pacientes com diagnóstico de RD atendidos no ambulatório de retina de um hospital oftalmológico de referência em Goiás para pacientes do Sistema Único de Saúde, no período de julho de 2015 a dezembro de 2015 totalizando 6 meses. Resultados: Do total de 160 pacientes avaliados no ambulatório de Retina, 15% apresentaram diagnóstico de retinopatia diabética. Em relação ao tempo da doença 35% dos pacientes, que tiveram indicação de fotocoagulação ou injeção intravítrea de inibidores do fator de crescimento do endotélio vascular, apresentavam DM há mais de 20 anos. Quanto à coexistência de HAS, 16 pacientes (66%) também apresentavam hipertensão arterial sistêmica. Conclusão: Conclui-se com o presente estudo que existe importante necessidade de avaliação de pacientes, quanto à presença de RD, além de forte associação entre a RD, e os fatores de risco avaliados no presente estudo: HAS, tempo do diagnóstico do diabetes mellitus e o controle glicêmico.

ABSTRACT Objective: The present study aims to evaluate the incidence, and risk factors of diabetic retinopathy( disease duration and the presence of hypertension). Methods: This is a field study, retrospective with quantitative approach.The study population was patients diagnosed with diabetic retinopathy in the period of july 2015 to december 2015. The collection of the data was made through analysis of medical records, it was analyzed the following data : time of diagnosis of diabetes mellitus, presence or absence of systemic hypertension Results: The overall incidence of diabetic retinopathy was 24 new cases in thesis months of analysis. Of wich a total of 66%( 16 patients) had systemic arterial hypertension and 46% had inefficient glycemic control. It was observed that 66% of the patients had indication for photocoagulation laser or intravitreal injection of anti-angiogenic and among those, 35% had diabetes for over 20 years. Conclusion: There was a strong relation between severe diabetic retinopathy, the duration of disease, systemic hypertension and bad glycemic control, with a poor outcome for disease. It also concludes that there is a significant need for assessment of diabetic patients for the presence of DR.

Retinal diseases in a reference center from a Western Amazon capital city / Doenças retinianas em um centro de referência de capital estadual na Amazônia Ocidental

ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.

RESUMO Objetivo Descrever as doenças de retina encontradas em pacientes que aguardavam tratamento para doenças retinianas em um hospital terciário de Rio Branco, Acre, Brasil. Métodos Foi realizado um exame oftalmológico compreendendo biomicroscopia com lâmpada de fenda, mapeamento de retina e ultrassonografia ocular. Os pacientes foram classificados de acordo com o status fácico e a doença retiniana que acometia o olho de maior gravidade. Resultados Foram atendidos 138 pacientes. A média de idade foi de 51,3 anos. A distribuição de diabetes foi de 35,3% e de hipertensão arterial foi de 45,5%. Catarata esteve presente em pelo menos um dos olhos em 23,2%. Tiveram o exame da retina possibilitado 129 pacientes. As principais doenças retinianas detectadas foram descolamento de retina regmatogênico (n=23; 17,8%) e retinopatia diabética (n=32; 24,8%). Dos 40 pacientes avaliados em função do diabetes, 13 (32,5%) apresentavam retinopatia ausente ou estágios iniciais de retinopatia e necessitavam apenas de acompanhamento. Conclusão A principal doença retiniana foi a retinopatia diabética, uma causa de cegueira evitável que pode ser acompanhada à distância, nos estágios iniciais, por meio de estratégias de telemedicina. A telemedicina pode ser uma importante ferramenta no acompanhamento de doenças retinianas em localidades remotas no Brasil.

Prevalencia de trastornos visuales y su relación con la funcionalidad en adultos mayores / Prevalence of visual disorders and their relationship with functionality of the older adults

Objetivo: determinar la relación entre los trastornos visuales y el grado de funcionalidad en los adultos mayores. Métodos: estudio observacional, transversal y descriptivo, realizado en la Clínica de Especialidades Churubusco, de la Ciudad de México. Muestra no probabilística en pacientes mayores de 60 años quienes acudieron al Servicio de Consulta Externa de Oftalmología para su valoración. Se identificaron patologías oculares y se determinó la funcionalidad para las actividades básicas e instrumentales de la vida diaria, por medio del Índice de Barthel y la Escala de Lawton y Brody, respectivamente. Se utilizaron las pruebas de U de Mann Whitney y Kruskall-Wallis. Nivel de significancia 0,05 y programa estadístico SPSS versión 18. Resultados: el promedio de edad fue de 70,94 años. El 70,1 por ciento correspondió al sexo femenino. Prevalecieron el glaucoma (62,8 por ciento), las cataratas (32,3 por ciento), la retinopatía diabética (15,1 por ciento) y la degeneración macular relacionada con la edad (13,3 por ciento). En relación con las comorbilidades, el 45,6 pr ciento de los pacientes reportó diabetes mellitus, de los cuales el 33 por ciento presentó retinopatía diabética. Al relacionar los trastornos oculares y la funcionalidad se obtuvo significancia estadística entre las actividades instrumentadas de la vida diaria con retinopatía diabética (p= 0,009) y con degeneración macular (p= 0,037). Conclusiones: la retinopatía y la degeneración macular relacionada con la edad afectan la realización de las actividades instrumentales de la vida diaria en los adultos mayores, por lo que es importante el diagnóstico y el tratamiento oportuno, sobre todo en pacientes con factores de riesgo como la diabetes mellitus(AU)

Early diagnosis of diabetic retinopathy in primary care / Diagnóstico temprano de retinopatía diabética en el primer nivel de atención

Objective: To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México. Methods: Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed. Results: In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women. Conclusions: The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.

Objetivo: Evaluar el impacto de una estrategia para la detección temprana de Retinopatía Diabética en pacientes con Diabetes Mellitus tipo 2 (DM2) en Quintana Roo. Métodos: Estudio Transversal, observacional, prospectivo, analítico. En Ocho unidades de primer nivel de atención de la delegación Norte del Estado de Quintana Roo, México del Instituto Mexicano del Seguro Social. Se diseñó un programa de detección oportuna de retinopatía diabética en 376,169 adultos, se realizó el diagnóstico de 683 casos de DM2, de forma aleatoria se asignaron 105 pacientes a quienes se les practicó oftalmoscopia directa en un hospital de segundo nivel. Se realizó la determinación del grado de retinopatía diabética y edema macular. Resultados: En la muestra predominaron las mujeres: 55.2%, edad promedio de 48+11.1 años, el 23.8% presentó algún grado de DR, 28.0% con retinopatía diabética no proliferativa leve (DRnPL), 48.0% moderada (DRnPM), 16.0% Severa (DRnPS) y el 8.0% presento Retinopatía diabética proliferativa (DRP). Los mayores de 30 años tuvieron 2.8 veces más riesgo de desarrollar DR, OR 2.8; IC95%: 0.42-18.0 al igual que las mujeres OR= 1.7; IC95%: 1.02-2.95. Conclusiones: La realización de programas dirigidos a la detección oportuna de enfermedades incapacitantes como la retinopatía diabética tienen impacto en la salud de los derechohabientes, la vinculación efectiva entre los sistemas de atención primaria y segundo nivel ofrecen resultados favorables para la salud de los pacientes.

Encuesta de ceguera y deficiencia visual evitable en Panamá / Survey on avoidable blindness and visual impairment in Panama

OBJETIVO: Determinar la prevalencia de ceguera y deficiencia visual en adultos de 50 años o más de Panamá, identificar sus principales causas y caracterizar la oferta de servicios de salud ocular. MÉTODOS: Estudio poblacional transversal mediante la metodología estándar de evaluación rápida de ceguera evitable. Se seleccionaron 50 personas de 50 años o más de cada uno de 84 conglomerados escogidos mediante muestreo aleatorio representativo de todo el país. Se evaluó la agudeza visual (AV) mediante una cartilla de Snellen y el estado del cristalino y del polo posterior por oftalmoscopía directa. Se calculó la cobertura de cirugía de catarata y se evaluó su calidad, así como las causas de tener AV < 20/60 y las barreras para acceder al tratamiento quirúrgico. RESULTADOS: Se examinaron 4 125 personas (98,2% de la muestra calculada). La prevalencia de ceguera ajustada por la edad y el sexo fue de 3,0% (intervalo de confianza de 95%: 2,3-3,6). La principal causa de ceguera fue la catarata (66,4%), seguida del glaucoma (10,2%). La catarata (69,2%) fue la principal causa de deficiencia visual (DV) severa y los errores de refracción no corregidos fueron la principal causa de DV moderada (60,7%). La cobertura quirúrgica de catarata en personas fue de 76,3%. De todos los ojos operados de catarata, 58,0% logró una AV < 20/60 con la corrección disponible. CONCLUSIONES: La prevalencia de ceguera en Panamá se ubica en un nivel medio con respecto a la encontrada en otros países de la Región. Es posible disminuir este problema, ya que 76,2% de los casos de ceguera y 85,0% de los casos de DV severa corresponden a causas evitables.

OBJECTIVE: Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, identify their main causes, and characterize eye health services. METHODS: Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged > 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. RESULTS: A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refractive errors were the main cause of moderate visual impairment (60.7%). Surgical cataract coverage in individuals was 76.3%. Of all eyes operated for cataract, 58.0% achieved visual acuity < 20/60 with available correction. CONCLUSIONS: Prevalence of blindness in Panama is in line with average prevalence found in other countries of the Region. This problem can be reduced, since 76.2% of cases of blindness and 85.0% of cases of severe visual impairment result from avoidable causes.

Achados epidemiológicos e alterações oftalmológicas em diabéticos atendidos em hospital geral secundário / Epidemiological and ophthalmological findings in diabetic patients examined in a general hospital

Objetivo: Avaliar a associação entre alterações no exame oftalmológico, características epidemiológicas e controle metabólico em pacientes diabéticos. Métodos: Estudo transversal. Foram selecionados consecutivamante os diabéticos atendidos durante 2011 em um hospital secundário. Todos os pacientes responderam questionário e foram submetidos a exame oftalmológico. Resultados: Foram estudados 103 pacientes, dos quais 72 (69,9%) eram do sexo feminino e 66 (64%) da cor branca. A média de idade foi de 59 (+/- 9,21) anos. Sessenta e quatro por cento dos participantes referiram renda aproximada de até 1 salário mínimo, 58,2% tinham ensino fundamental incompleto, 75,7% com história de diabetes familiar, 45,6% informaram realizar controle metabólico regular, 54,3% não observavam cuidados nutricionais, 28% usavam insulina, 99% eram diabéticos do tipo-2. Ao exame, 72,8% apresentaram acuidade visual corrigida de 20/40. Foram estatisticamente significativas as relações entre complicações retinianas e o uso de insulina (OR=8,3; p=0,003) e da baixa acuidade visual com o uso de insulina (OR=5,48, p=0,021) e a idade (OR=11,8; p=0,003). Também foi observada relação entre a baixa de visão com escolaridade, idade e baixa renda Conclusão: Na população analisada, predominantemente de baixa renda e escolaridade, a condução inadequada da doença foi expressiva, o que se associou com a presença de complicações retinianas, reforçando a necessidade de adoção de medidas mais amplas para melhorar as estratégias de controle e prevenção do diabete mellitus. .

Objective: To evaluate the association between epidemiological and ophtalmological findings in diabetic patients. Methods: Cross-sectional study. We selected consecutively diabetic patients examined during 2011 which responded to a questionnaire and examination. Results: The sample comprised 103 patients, of whom 72 (69.9%) were female, 66 (64%) were Caucasian, average age 59 (+/- 9,21) years, 64% reported minimum wages, 58.2% did not finish elementary school, 75.7% reported family history of diabetes, 45.6% reported regularly perform metabolic control, 54.3% did not receive special nutritional care. On examination, 72.8% had visual acuity of 20/40. There was a significant association between retinal complications and insulin usage (OR=8,3; p=0,003), and between low visual acuity and age (OR=11,8; p=0,003) and insulin (OR=5,48, p=0,021), as well with lower education and income. Conclusion: In this low-income and low-education population, glycemic control was poor, and related to the development of diabetic retinopathy and the consequent low vision. These findings emphasize the need to adopt broader strategies to improve control and prevention of diabetes mellitus. .

Análisis de los pacientes con diabetes controlados a nivel primaria en el Servicio de Salud Concepción / Analysis of diabetic patients controlled at primary level in Concepcion Health Service

To evaluate diabetic patients in control in Concepcion Health Service, evaluating coverage, metabolic control and complications. Material: A retrospective analysis of the statistical record of 2011 (REM) using the CIE-10 classification was done. Estimation is performed with the National Health Survey of 2010. Results: 26,638 patients are controlled, achieving a 67.9 percent coverage (point estimate based on the National Health Survey of 2010), being lower in the group between 15 and 44 years old (34 percent). 38.4 percent had good metabolic control (HbA1C less than 7) and 20.8 percent poor control (HbA1C greater than 9). According to age, the group over 65 had better control and the group between 15 and 44 years worse control. The complication described was diabetic foot (51.9 percent), retinopathy (5 percent) and nephropathy (4.6 percent). Discussion: The prevalence of diabetes is increasing every year in Chile. There is acceptable coverage and early diagnosis, but still are poorly controlled cases and require a multifactorial management that begins with a self-care of their diabetes...