Rapid assessment of avoidable blindness and diabetic retinopathy in Republic of Moldova.

OBJECTIVE: To evaluate the prevalence and causes of blindness and visual impairment, the prevalence of diabetes mellitus and diabetic retinopathy among people aged ≥50 years in the Republic of Moldova using Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy ('RAAB+DR') techniques. MATERIALS AND METHODS: 111 communities of people aged ≥50 years were randomly selected. In addition to standard RAAB procedures in all people with diabetes (previous history of the disease or with a random blood glucose level >11.1 mm/L (200 mg/dL)), a dilated fundus examination was performed to assess the presence and the degree of diabetic retinopathy using the Scottish DR grading system. RESULTS: 3877 (98%) people out of the 3885 eligible people were examined. The prevalence of blindness was 1.4% (95% CI 1.0% to 1.8%). The major causes of blindness and severe visual impairment were untreated cataract (58.2%), glaucoma (10.9%), and other posterior segment causes (10.9%). The estimated prevalence of diabetes was 11.4%. Among all people with diabetes, 55.9% had some form of retinopathy, and sight threatening diabetic retinopathy affected 14.6%. CONCLUSIONS: The RAAB+DR survey in the Republic of Moldova established that untreated cataract is the major cause of avoidable blindness in rural areas. This needs to be tackled by expanding the geographical coverage of cataract surgical services.

[Diabetic retinopathy, practical value of classification]. / Retinopatia diabetica, valoarea practica a clasificarii. (Reviu de literatura).

THE AIM: In this work will be exposed the modern classification of diabetic retinopathy (DR). The aim is to familiarize ophthalmologist, endocrinologist and therapeutic doctors with the newest and unique tendency of diagnosis of this pathology. MATERIALS AND METHODS: It was effectuated a special literature (recent edited, post 2000) study. The DR classification evolution was studied and the last and to the most common accepted classification the attention was attracted. RESULTS AND DISCUSSIONS: The unique in our days validated classification is ETDRS (Early Treatment Diabetic Retinopathy Study). One of recent appeared classifications is ALFEDIAM (Association de Langue Francaise pour l'Etude du Diabete et des Maladies Metaboliques) in 1996, derived and simplified from ETDRS classification, in this moment is utilized in France. Non proliferative diabetic retinopathy (NPDR) can be mild, moderate or severe. Proliferative diabetic retinopathy can be early, moderate, severe, complicated. Maculopathy classification by Brescnic adopted in 1983 include focal macular edema, diffuse macular edema, ischemic maculopathy. CONCLUSIONS: ALFEDIAM classification, derived and simplified from the unique international validated classification of DR on our days ETDRS is accessible to all ophthalmologists, and their collaboration with endocrinologist and therapist doctors. The use of ALFEDIAM classification give the possibility of interaction of effectuated work with the materials of international literature.