Diagnostic accuracy of non-mydriatic fundus camera for screening of diabetic retinopathy: A hospital based observational study in Pakistan.

OBJECTIVE: To determine the diagnostic accuracy of non-mydriatic fundus camera for the detection of diabetic retinopathy. METHODS: The cross-sectional study was conducted at Al Ibrahim Eye Hospital, Karachi, from January to May 2015, and comprised patients with type 2 diabetes who were screened for diabetic retinopathy. Single 45° fundus image focussed at macula was obtained and labelled using non-mydriatic fundus camera by a trained optometrist. Photos were labelled as positive (diabetic retinopathy present), negative (no diabetic retinopathy) or unreadable. The pupil was then dilated and fundi were examined by ophthalmologist with slit-lamp and fundus lens. Results of fundus examination were labelled as positive, negative or invisible/indecisive. Results of ophthalmologist were taken as the standard reference to evaluate sensitivity and speci?city for detecting diabetic retinopathy with non-mydriatic fundus camera. SPSS 20 was used for data analysis. RESULTS: Total eyes screened numbered 2970 related to 1485 patients. Diabetic retinopathy was found in 646(21.8%) eyes, 485(20.9%) photographs were unreadable and 1839(57.3%) were normal. Ophthalmologist on slit lamp bio-microscopy labelled 736(25%) eyes as positive for diabetes retinopathy, 335(15%) as indecisive and 1899(60%) as normal. The sensitivity of non-mydriatic fundus camera was 400/556 (72%) while specificity was 1548/1794 (86.3%). Positive predictive value and negative predictive value were 400/646 (62%) and 1548/1704 (90%) respectively. The level of agreement was moderate (k=0.0551) for optometrist compared to ophthalmologist. False positive diagnosis by optometrist numbered 78/1839 (4.24%) and false negative was 123/646(19%). CONCLUSIONS: Non-mydriatic fundus camera was found to be a reliable screening tool for detecting and referral diabetic retinopathy cases to ophthalmologist for further evaluation and management.

Prevalence of diabetic retinopathy in Pakistan; A systematic review.

OBJECTIVES: Primary aim was to review the literature on the prevalence of diabetic retinopathy (DR) and Vision threatening diabetic retinopathy (VTDR) in Pakistan. METHODS: A search of the bibliographic databases (Medline, Pub med, and Google scholar) was conducted from 1990 to March 2017. Articles about prevalence of DR and VTDR in Pakistan were retrieved and scrutinized. The studies satisfying the inclusion/exclusion criteria were considered for detail review. RESULTS: Forty one articles on prevalence of DR were traced out. Exclusion and inclusion criteria were met in 29 studies. In selected studies (29), pooled Prevalence of DR was found to be 28.78% with a variation of 10.6% to 91.3%. Out of 29 studies, DR was classified in 19 studies. Pooled Prevalence of VTDR in these 19 studies was found to be 28.2% (variation of 4% to 46.3%) of patient with retinopathy and 8.6% of all diabetics. CONCLUSION: A great variation in the values of DR and VTDR was observed in this study. Researchers suggest a community based study with uniform methodology to find out a comparable value of prevalence of DR and VTDR in all provinces of Pakistan.

Visual outcome of laser treatment in diabetic macular edema: Study from an Urban Diabetes Care Center.

OBJECTIVE: To determine the visual outcome of laser treatment in clinically significant macular edema. METHODS: This interventional and qausi experimental study was carried out at Diabetic Association of Pakistan (DAP) during January 2011 and December 2012. Approval was taken from Research Ethical Committee of Isra Postgraduate Institute of Ophthalmology. Records of 925 eyes of 464 patients with "Clinical Significant macular edema" (CSME), treated with laser photocoagulation were analyzed. Best-corrected visual acuity (BCVA) at the time of presentation and at the last follow up, minimum of one year and maximum of 45 months was recorded and compared. SPSS version 20.0 was used to analyze the data. RESULTS: Diabetic retinopathy was found in 20.3% (1777) of 8742 diabetic attending DAP Hospital" amongst whom 39.6% (705) had Sight threatening diabetic retinopathy. Laser was advised in 96.4% (680) individuals, accepted by 70.5% (480) individuals. Amongst 960 eyes of 480 patients who accepted laser, 925 eyes had clinically significant macular edema and 35 eyes had PDR who are not included in this study. Amongst 925 eyes with CSME, Grid laser was done in 913 eyes (99%) and focal laser was done in 12 eyes (1%). After a follow up of 12 to 45 months, it was found that best corrected visual acuity had declined in 2.4% (22) eyes, stabilized in 67% (619) eyes and improved in 30.7% (284) eyes. One line improvement on Snellen's chart was fond in 21.3% (197) eyes, 2 lines in 8% (74) eyes, 3 lines in 1.2% (12) eyes and 4 lines in one (0.1%) eye with p-value of 0.000. CONCLUSION: Laser therapy is an effective treatment in stabilizing/improving the vision in diabetic macular edema particularly at those centers where only Argon Laser is available and OCF, FFA facilities do not exist.

Age-related cataract and its types in patients with and without type 2 diabetes mellitus: A Hospital-based comparative study.

OBJECTIVE: To determine the frequency and types of age-related cataract in type 2 diabetic patients compared to non-diabetics. METHODS: This comparative, cross-sectional study was carried out at Al-Ibrahim Eye Hospital, Karachi, from July 2014 to June 2015, and comprised both diabetics and non-diabetics. All patients were selected from the out-patient department and had their full ocular examination done, including retinal screening of diabetic patients with non-mydriatic fundus camera. The criterion for diagnosis of cataract was sufficiently advanced lens opacity that caused impaired vision/un-gradable images. Cataract was classified on a morphological basis into cortical, nuclear, posterior sub-capsular and mixed types. RESULTS: Of the 49,384 patients, 4,556(9.2%) were diabetics and 44,828(90.8%) were non-diabetics. Among the diabetics, cataract was found in 1,956(42.9%) compared to 7,050(15.7%) in non-diabetics. Adjusted odds ratio (95% confidence interval) between the two groups was 4.40 (range: 4.11-4.71) (p<0.001). Male-to-female adjusted odds ratio (95% confidence interval) was 2.05 (range: 1.95-2.15) (p<0.001). Nuclear sclerosis was the commonest type in 2,123(46.6%) cataract cases in diabetics whereas posterior sub-capsular cataract was the commonest type in 14,480(32.3%) cases among the non-diabetics. CONCLUSIONS: Cataract was four times more common in diabetics and twice more frequent in men. Nuclear sclerosis was the commonest type of cataract in diabetic patients.

An assessment of knowledge, attitude and practices (KAP) towards diabetes and diabetic retinopathy in a suburban town of Karachi.

OBJECTIVE: To assess the Knowledge, Attitude and Practices (KAP) towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town (BQ), Karachi. METHODS: An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of (BQ) Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data. RESULTS: Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 (39.2%) had diabetes. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate respondents. Male's Mean Knowledge score (7.61 ± 6.600) was better than female's (5.46 ± 6.21) with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 ± 2.57. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. CONCLUSION: Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes.