Sight-threatening diabetic retinopathy at presentation to screening services in Fiji.

PURPOSE: To report the spectrum of retinopathy at first presentation to photoscreening services, to determine the proportion of patients that present with sight-threatening diabetic retinopathy (STDR), and to raise awareness of the burden of diabetic eye disease in Fiji. METHODS: This retrospective observational cohort study used data from the initial visit of all new patients presenting to the diabetes retinal screening service at the Pacific Eye Institute in Fiji over the 3-month period between July and September 2012. Patients were assessed using a detailed questionnaire regarding diabetes type, duration of disease, medications, complications and co-morbidities, and blood sugar control. Patients subsequently underwent non-mydriatic fundus photography according to Pacific diabetes retinal screening guidelines. Images were graded at the time of acquisition, and data were entered onto a computerized database. For the purposes of this study, information regarding retinopathy grading, visual acuity and patient demographics was used. RESULTS: A total of 522 new patients were screened over the 3-month period. STDR was observed in 27% of patients, with 15% observed to have bilateral STDR. Diabetes control was generally poor. Blindness and visual impairment were observed in 2.7% and 6.7% of the cohort, respectively. CONCLUSION: Severe and advanced diabetic retinopathy was present in this population presenting to screening. This was observed 4 years after the formal expansion of the screening services and reflects the high prevalence of diabetes in the population. The need for increased public awareness and greater resource allocation into diabetes and its complications is emphasized.

Childhood visual impairment in Fiji.

OBJECTIVE: To establish the prevalence and causes of low vision and blindness in children aged 0 to 15 years in Fiji using existing data and new surveys. Method Childhood visual impairment data on both low visual acuity (<20/60-20/400) and blindness (<20/400) were obtained from existing records at hospital clinics, the school, an outreach service for visually impaired children, primary school screening records, and surveys in high schools and schools for children with multiple disabilities. Crude prevalence was derived and, using 5-year age range and age at onset of vision loss, the probable prevalence per 1000 children was calculated. RESULTS: A total of 81 children were identified; causes were established for 70 children, showing that 69% had unavoidable causes of vision loss (retinal, 39.7% and cortical, 15.5%), with the avoidable cause of low vision and blindness mainly being cataract (15.5%). Probable prevalence was 1.134 per 1000 children (95% confidence interval [CI], 1.115-1.153), with low vision, 0.774 per 1000 children (95% CI, 0.758-0.790) and blindness, 0.36 per 1000 children (95% CI, 0.349-0.371). The rate of severe visual impairment (<20/200) was 0.522 per 1000 children (95% CI, 0.509-0.535), only half of the total vision loss. CONCLUSIONS: Both the low to moderate prevalence and mainly unavoidable causes of visual impairment indicated that Fiji, a developing country, has prevalence and causes of visual impairment similar to more resourced, industrialized countries.