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)

Prevención primaria de la retinopatía diabética: una necesidad social actual / Primary Prevention of Diabetic Retinopathy: a Current Social Need

Las tendencias actuales en el comportamiento de la sociedad contribuyen al aumento de las personas que desarrollan retinopatía diabética, muchas de las cuales son diagnosticadas en estadios avanzados de la enfermedad cuando las posibilidades de recuperación visual son escasas. Se elaboró este ensayo con el propósito de reflexionar sobre algunos de los referentes que brindan la ciencia y la tecnología para lograr, mediante las acciones médicosociales, mayor eficacia en la prevención primaria de la retinopatía diabética. Se tuvo en cuenta el protagonismo de la atención primaria de salud en la integración de los entes sociales para el control de los factores de riesgo en el paciente diabético(AU)

Current trends in societal behavior contribute to an increase in the number of people who develop diabetic retinopathy, many of whom are diagnosed in advanced stages of the disease when the chances of visual recovery are slim. This essay was elaborated with the purpose of reflecting on some of the references provided by science and technology to achieve, through medical-social actions, greater efficacy in the primary prevention of diabetic retinopathy. The role of primary health care in the integration of social entities for the control of risk factors in diabetic patients was taken into account(AU)

Analysis of community intervention effects for diabetic eye diseases in Shanghai Xinjing community from 2016 to 2018 / 中华预防医学杂志

Objective: To analyze the effects of community-based interventions for diabetic eye diseases in Xinjing community, Shanghai from 2016 to 2018. Methods: Based on the project of "Establishment of Service Model for Comprehensive Prevention and Treatment of Diabetic Eye Diseases in Shanghai", the participants were not suffering diabetic retinopathy (DR) in Xinjing community in 2016 before interventions and received community-based interventions for diabetic eye diseases. The incidence of DR, visual acuity and awareness of DR were used as evaluation indicators to analyze the effects of interventions for diabetic eye diseases in the community. Results: A total of 537 patients were included in this study, the incidence of DR among diabetic patients in Xinjing community was 7.6% after interventions. The duration of diabetes (OR= 1.065) and HbA1c (OR= 1.090) were the risk factors of DR. Before and after the interventions, the patients with monocular low vision and binocular low vision were 27 cases (5.0%), 8 cases (1.5%), 19 cases (3.5%) and 7 cases (1.3%) respectively. After interventions, the awareness on the prevention and treatment of DR increased significantly, and the proportion of regular visits to ophthalmology examination, diet control and physical exercise also increased significantly. Conclusion: Community-based interventions for diabetic eye diseases are helpful to improve the awareness of DR prevention and control, reduce the incidence of DR.

Conhecimento dos pacientes diabéticos usuários do Sistema Único de Saúde acerca da retinopatia diabética / Knowledge of diabetic patients users of the Health Unic System about diabetic retinopathy

Resumo Objetivo: Avaliar o nível de conhecimento dos pacientes diabéticos, atendidos no Sistema Único de Saúde (SUS) na cidade de Boa Vista/Roraima, acerca da Retinopatia Diabética (RD). Métodos: Trata-se de um estudo transversal, descritivo, de caráter quantitativo, realizado através da aplicação de um questionário semi-estruturado para 150 indivíduos diabéticos, usuários do SUS, da cidade de Boa Vista - RR, durante o ano de 2017. As análises estatísticas foram realizadas utilizando os programas Microsoft Excel e EpiInfo 7®, fixando-se o nível de 5% para a rejeição da hipótese de nulidade. Resultados: Do total amostral pesquisado,76,7% dos indivíduos não possuía nenhum conhecimento sobre a RD, 19,3% tinha algum tipo de conhecimento, mas não possuía a patologia, 2,7% conhecia, possuía a RD e fazia tratamento e 1,3% conhecia, possuía a RD e não se tratava. Quanto a orientação, 40,6% dos participantes nunca recebeu nenhuma informação sobre o risco de perda da visão. Acerca do tipo de Diabetes, 44,7% dos participantes não sabia que tipo possuía, 42% relatou ter DM 2 e 13,3% DM1. Sobre o controle da glicose, 59,4% não conseguia mantê-lo. Foi evidenciada associação entre o controle da glicose e o conhecimento sobre RD, entre o tempo de instalação da DM e o conhecimento sobre RD e entre ter consultado um oftalmologista e conhecer sobre a RD. Conclusão: O nível de conhecimento sobre a RD é muito baixo, fator preocupante por tratar-se de uma das complicações mais importantes do Diabetes. Percebe-se que o sistema de saúde não está sendo eficiente como facilitador deste conhecimento.

Abstract Objective: To evaluate the level of knowledge of diabetic patients treated at the Unified Health System (SUS - Sistema Único de Saúde) in the city of Boa Vista / Roraima, about Diabetic Retinopathy (DR). Methods: This is a cross-sectional, descriptive, quantitative study conducted through the application of a semi-structured questionnaire for 150 diabetic individuals, SUS users, from the city of Boa Vista - RR, during the year 2017. Statistical analyzes were performed using the Microsoft Excel and EpiInfo 7® programs, setting the 5% level for the rejection of the null hypothesis. Results: Of the total sample, 76.7% of the individuals did not have any knowledge about DR, 19.3% had some type of knowledge, but did not have the pathology, 2.7% knew, had DR and was receiving treatment, 1,3% knew, had DR and was not receiving treatment. About orientation, 40.6% of the participants never received any information about the risk of vision loss. About the type of Diabetes, 44.7% of the participants did not know what type they had, 42% reported having DM 2 and 13.3% DM1. On glucose control, 59.4% could not maintain it. It was evidenced an association between glucose control and DR knowledge, between the time of DM installation and knowledge about DR, and between having consulted an ophthalmologist and knowing about DR. Conclusion: The level of knowledge about DR is very low, a worrying factor because it is one of the most important complications of diabetes. It is observed that the health system is not being efficient as facilitator of this knowledge.

Estudio sobre la prevención de la discapacidad visual en pacientes diabéticos del municipio Playa / Study on the prevention of visual disability in diabetic patients from Playa municipality

Objetivo: determinar el comportamiento de la discapacidad visual por retinopatía diabética en dos áreas de salud del municipio Playa. Métodos: se realizó una investigación exploratoria, observacional y descriptiva, en la que se practicó un examen oftalmológico a los diabéticos, donde se evaluó por especialistas de retina la presencia de lesiones en el fondo de ojo y su asociación con otras afecciones oftalmológicas. Resultados: las dos áreas de salud presentaron características demográficas y de la enfermedad diabética similares. Las formas no proliferativas de los dos grupos se presentaron en el 8,5 y 4,8 por ciento, no así la forma proliferativa, que fue de 2 y 2,7 por ciento. La maculopatía leve fue más frecuente que la severa en los dos grupos. La prevalencia de algún grado de retinopatía y de maculopatía fue de 13,1 y 10,6 por ciento, respectivamente. El mayor porcentaje de pacientes en los dos grupos de estudio no había sido examinado o había transcurrido más de un año de haberse realizado un fondo de ojo. Se encontró un número elevado de ojos de pacientes con catarata evidente (31,2 y 26,5 por ciento. La prevalencia de baja visión (10,9 y 11 por ciento) y de ceguera (2,9 y 2,7 por ciento) fue similar en los dos grupos, pero sus causas pueden ser reversibles, prevenibles y tratables. Conclusiones: a pesar de que la muestra fue pequeña y la prevalencia de retinopatía y/o maculopatía fue baja, se presentaron pacientes con discapacidad visual prevenible y tratable(AU)

Objective: to determine the situation of visual disability caused by diabetic retinopathy in two health areas of Playa municipality. Methods: a descriptive, observational and exploratory research study was conducted where eye exam was performed in diabetic patients to evaluate the presence of fundus oculi lesions and their association with other ophthalmological diseases. Results: it was found that the two health areas showed similar demographic characteristics and diabetic disease features. Non-proliferative forms of the two groups occurred in 8.5 and 4.8 percent whereas the proliferative form was seen in 2 percent and 2.7 percent. Mild maculopathy was more common than the severe one in the two groups of patients. The prevalence of retinopathy and maculopathy was 13.1 and 10.6 percent, respectively. The highest percentage of patients in the two study groups had not been examined or their fundus oculi test had been performed over a year ago. There was a high number of patients with evident cataract (31.2 and 26.5 percent). The prevalence rates of low vision (10.9 and 11 percent) and of blindness (2.9 and 2.7 percent) were almost the same in the two groups; however it should be borne in mind that their causes can be reversible, preventable and treatable. Conclusions: despite the small sample size and the low prevalence of retinopathy and/or maculopathy, there were patients with preventable and treatable vision(AU)

Prevención de ceguera por retinopatía diabética: ¿dónde estamos? / Prevention of blindness caused by diabetic retinopathy in Cuba, how far have we gone?

La diabetes es una de las cuatro enfermedades no transmisibles prioritarias identificadas por la Organización Mundial de la Salud, junto con la enfermedad cardiovascular, el cáncer y la enfermedad respiratoria crónica. En este siglo XXI se habla de una epidemia global de diabetes, fenómeno relacionado particularmente con la diabetes mellitus tipo II y que está teniendo lugar tanto en países desarrollados como en aquellos en vías de desarrollo. Cuba se une desde 1999 a la iniciativa Visión 2020 y desarrolla desde la propia fecha un plan de prevención de ceguera y baja visión. Hoy, donde la prevalencia de diabetes aumenta, asociada al aumento de la esperanza de vida y a los cambios en el estilo de vida, los oftalmólogos cubanos trabajamos en la prevención de la ceguera por retinopatía diabética. En esta revisión nos proponemos analizar dónde estamos en relación con la Guía práctica clínica de retinopatía diabética para Latinoamérica, publicada en el 2011(AU)

Diabetes is one of the four prioritized non-communicable illnesses identified by the World Health Organization, along with the cardiovascular illnesses, cancer and chronic respiratory diseases. The 21st century witnesses a global diabetes epidemics a phenomenon closely related to type II diabetes mellitus and taking place in both developed and developing countries. Since 1999, Cuba joined the Vision 2020 initiative and has developed a preventive program to prevent blindness and low vision. As prevalence of diabetes increases today, associated to higher life expectancy and changes in lifestyles, the Cuban ophthalmologists are working in the prevention of blindness from diabetic retinopathy. In this review we set out to analyze how far we have advanced regarding the implementation of the practical clinical guideline for diabetic retinopathy for Latin America, published in 2011(AU)

Should we start all patients with diabetic retinopathy on fenofibrates?

There remains a need for strategies that are effective in preventing diabetic retinopathy [DR] or slowing down its progression, which is safe, well-tolerated, and more effective, have a lower risk profile, easy to perform, have more predictable results with less morbidity than the current regimens. Physicians caring for diabetic patients not only need to maximize glycemic control, but also closely monitor and treat other systemic conditions. The consistency of clinical data from the fenofibrate studies showed consistent beneficial effects with fenofibrate in slowing the progression of DR. They demonstrated significant benefit on micro-vascular [i.e., retinopathy and nephropathy] outcome, possibly independent of lipid levels. Can we combine the effectiveness of the current standard procedures with the prevention and slowing down of progression of DR that fenofibrates can offer? Knowledge of the primary mode of action of fenofibrate will be useful for both physicians and patients in determining how best to use this drug as an adjunct in the management of DR and ultimately facilitating the translation of clinical trial data to clinical practice

Diabetic retinopathy and its risk factors at the university hospital in Jamaica

To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies [UHWI]. This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus [DM], type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. Statistical Package for Social Sciences [SPSS version 19.0] was used for data analysis There were 104 patients [208 eyes] recruited for this study. There were 58.6% [61/104] females [mean age 53.6 +/- 11.9 years] and 41.4% [43/104] males [mean age 61.7 +/- 12.1 years]. Type II DM was present in 68.3% [56% were females] of the patients and Type I DM was present in 31.7% [69.7% were females]. Most patients [66%] were compliant with their diabetic medications. The mean blood glucose was 11.4 +/- 5.3 mmol/L. Elevated blood pressure [>130/80] was present in 82.7% of patients. The mean visual acuity was 20/160 [logMAR 0.95 +/- 1.1]. The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy [PDR] of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 [95% confidence intervals [CI]: 1.02-3.3] for Type I DM compared to 0.74 [95% CI: 0.55-0.99] for Type II DM. PDR was more prevalent in females [Chi [2], P = 0.009] in both Type I and II DM. Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control

Best practice eye care models.

Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study

To determine the frequency of type-II Diabetes mellitus [DM] in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy [DR] in this group. Descriptive study. Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care [PHC] facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 [6.55%] known and 419 [2.18%] newly diagnosed cases. DR was seen in 460 [27.43%] of the Diabetic cases with 126 [7.51%] patients requiring urgent intervention for vision threatening complications. The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system

Eficiencia técnica de la atención al paciente con diabetes en el primer nivel / Technical efficiency in primary care for patients with diabetes

OBJETIVO: Cuantificar en un primer nivel la eficiencia técnica de la atención al paciente con diabetes y distinguir la provisión de servicios y los resultados en salud, además de reconocer las fuentes potenciales de variación. MATERIAL Y MÉTODOS: Se incluyeron insumos, actividades clínicas y resultados en salud de 47 clínicas familiares del IMSS Nuevo León. La medida de la eficiencia se realizó mediante el análisis envolvente de datos y se aplicaron modelos de regresión de Tobit. RESULTADOS: Siete clínicas fueron eficientes en cuanto a la provisión de servicios y nueve en salud; dos coincidieron en ambos aspectos. La localización metropolitana y el total de consultas favorecieron la eficiencia en relación con la provisión de servicios, cualesquiera que fueran los atributos del paciente; y la edad del médico, la eficiencia de los resultados en salud. CONCLUSIONES: El desempeño varió en una misma unidad y entre una y otra; algunas fueron eficientes para suministrar servicios y otras para mejorar la salud. Las fuentes de variación también difirieron. Se recomienda incluir ambos productos en el estudio de la eficiencia en diabetes en el primer nivel.

OBJECTIVE: To quantify the technical efficiency of diabetes care in family practice settings, characterize the provision of services and health results, and recognize potential sources of variation. MATERIAL AND METHODS: We used data envelopment analysis with inputs and outputs for diabetes care from 47 family units within a social security agency in Nuevo Leon. Tobit regression models were also used. RESULTS: Seven units were technically efficient in providing services and nine in achieving health goals. Only two achieved both outcomes. The metropolitan location and the total number of consultations favored efficiency in the provision of services regardless of patient attributes; and the age of the doctor, the efficiency of health results. CONCLUSIONS: Performance varied within and among family units; some were efficient at providing services while others at accomplishing health goals. Sources of variation also differed. It is necessary to include both outputs in the study of efficiency of diabetes care in family practice settings.

Retinopatia diabética e gestação / Diabetic retinopathy during pregnancy

A retinopatia diabética (RD) é uma importante morbidade causada pelo diabetes mellitus e está entre as principais causas de perda visual. Os riscos de perda visual e cegueira pela RD são substancialmente reduzidos com a detecção precoce, quando as alterações irreversíveis na retina ainda não estão presentes. A importância dessa complicação e, muitas vezes, a ausência de sintomas no início do quadro impõem a necessidade de investigação preventiva das pacientes de risco. A gestação tem sido considerada um fator de risco para o desenvolvimento e progressão da retinopatia e pode causar sérias implicações para a gestante, embora os efeitos podem variar em diferentes pacientes e populações. O mau controle glicêmico, diabetes de longo prazo, gravidade da retinopatia no período antecedendo a gestação, hipertensão e mudanças do fluxo retiniano coexistentes são determinantes que contribuem com o agravamento da RD durante a gestação. Os autores realizam uma revisão sobre o tema, objetivando atualizar o leitor quanto à possibilidade de progressão da retinopatia diabética em gestantes, os fatores de risco que a determinam, sua prevenção e tratamento.

Diabetes mellitus: una epidemia mundial / Diabetes mellitus: a global epidemic

La diabetes es una epidemia en desarrollo que aumentará los próximos años. Se muestran una revisión a evidencia clínicos del aumento de la prevalencia de diabetes que asociado al aumento de expectativa a vida, aumentará el riesgo de pérdida visual y ceguera en la población. Otros estudios clínicos, demuestra lo beneficioso del tratamiento adecuado de una diabetes así como el tratamiento precoz de una retinopatía disminuye el riesgo de una pérdida visual. Por toda esta evidencia es necesario organizar un sistema a cuidado ocular que desarrolle estrategias para detectar y tratar una retinopatía diabética evitando una perdida visual, dentro de un programa nacional de manejo de la diabetes. Se resumen algunas recomendaciones entregadas en reporte de Diabetes mellitus de la OMS.

Diabetes is an evolving epidemic disease that will increase in the upcoming years. A clinic evidence review about the increase in diabetes prevalence is showed This fact, besides the increased span of life will increase the risk of visual loss and blindness in the population. Other clinical studies show the benefits of an adequate treatment of diabetes, as well as the early treatment of diabetic retinopathy diminishes the risk of visual loss. Because of this amount of evidence, it is necessary to organize a visual care system and to develop strategies to detect and treat diabetic retinopathy, avoiding visual loss, included in a national program of diabetes. management. Some recommendations of a recent report of OMS about diabetes are summarized.

Día mundial de la visión: campaña contra la ceguera por retinopatía diabética: octubre de 2004, Guayaquil – Ecuador / World vision day: campaign of blindness due to diabetic retinopathy: October/2004, Guayaquil – Ecuador

La proyección mundial de la diabetes mellitus para el año 2020 será de 330 millones de personas con diabetes4,18. La retinopatía diabética (RD) es una complicación crónica altamente específica de la diabetes mellitus (DM), y es responsable del 86 de la ceguera cuando el paciente cursa con retinopatía diabética proliferativa. En el Ecuador con una prevalencia estimada en el 3, existirían más de 360.000 personas con esta enfermedad en muchos casos sin diagnosticar, por lo que se realizó una campaña preventiva contra la ceguera por retinopatía diabética a nivel de Guayaquil, invitando a instituciones de salud tales como: Ministerio de Salud Pública, I.E.S.S, Junta de Beneficencia de Guayaquil, Fuerzas Armadas y otras entidades sanitarias para promover esta acción comunitaria. El objetivo de la campaña es determinar el estado actual de la retina respecto al factor de riesgo duración y tipo de la diabetes mellitus, como aporte en el día mundial de la visión para concienciar a los pacientes con diabetes de su cuidado oftalmológico y fomentar la cultura de prevención3. Materiales y métodos: El estudio transversal obtenido de una muestra aleatoria de 806 pacientes personas con diabetes distribuidos en diferentes centros hospitalarios para la pesquisa de retinopatía diabética en la ciudad de Guayaquil, realizada en octubre de 2004. Difusión mediante prensa escrita, radio y televisión se convocó a las personas diabéticas a participar en la campaña a que acudan a las diferentes instituciones. Resultados: el total de ojos examinados durante la campaña fue de 1.612, para una cobertura de 806 pacientes. La muestra presentó una distribución heterogénea por sexos (73 mujeres) con una proporción de 3:1 con respecto a los hombres (27). La muestra estratificada según los hospitales por concurrencia tuvo una distribución de 62 para el hospital “Teodoro Maldonado Carbo”.

World projection of diabetes mellitus for the year 2020 is 330 millions of diabetic éticos. Diabetic retinopathy (DR) is a highly specific chronic complication of diabetes mellitus (DM), and is liable of 86 of blindness when the patient has proliferative diabetic retinopathy. In Ecuador with an estimated prevalence of 3, there would be more than 360.000 people with this desease, not diagnosed in many cases, which is the reason why a preventive campaign against blindness due to diabetic retinopathy was carried out in Guayaquil, involving health institutions such as: Ministry of Public Health, I.E.S.S, Junta de Beneficencia de Guayaquil, Armed Forces and other health organizations to stimulate this communal action. the objective of the campaign is to set the current state of the retina regarding the risk factor, duration and diabetes mellitus type, as a contribution to the World Vision Day to make diabetic patients aware of his/her ophtalmological care and foster a preventive culture. Materials and methods: the transverse study from a random simple of 806 diabetic patients assigned to different hospitals for detection of diabetic retinopathy in Guayaquil, carried out in october/2004. Spreading through written media, radio and TV, diabetic people were summoned to take part in the campaign going to the hospitals. Results: All the eyes examined in the campaign were 1,612, (806 patients). The sample showed a heterogeneous sex distribution (73 female and 27 male), a 3:1 ratio female/male. The distribution of the stratified sample according to the attendance to the hospitals was as follows: 62 for “Teodoro Maldonado Carbo” hospital.