Digital retinopathy photography: the way forward for standardizing retinal screening in patients living with diabetes: an overview of the key challenges to care delivery in Qatar
DOI:
https://doi.org/10.18203/2320-6012.ijrms20233414Keywords:
Diabetes mellitus, DR screening, Fundal photography, Slit lampAbstract
The incidence of diabetes is rising globally with Qatar being ranked as the 3rd highest country for the prevalence of diabetes in the Middle East and North African (MENA) region. Diabetic retinopathy (DR) is the main cause of sight-threatening complications of diabetes. Significant advances in screening and treatment for DR have emerged in the last few decades with a strong impact on the accuracy and effectiveness of screening. DR being a preventable cause of blindness with early detection and interventions like laser photocoagulation and anti-vascular endothelial growth factor (anti-VEGF) treatments makes it imperative to invest in early recognition and treatment for DR. Globally screening is done by direct/indirect ophthalmoscopy or retinal photography with huge variations in early diagnosis. Studies have revealed the superiority of three-field retinal photography when compared to direct ophthalmoscopy, for DR screening, even if performed by an experienced ophthalmologist. The two most sensitive means of detection at present are digital retinal imaging and slit lamp examination post mydriasis. Both modalities require assessment by trained personnel. Digital retinal photography is extremely quick, allows the creation of permanent records and with the advent of semiautomatic nonmydriatic cameras, requires less skill as compared to the use of a slit lamp. Hence, should digital retinal photography be a preferred standardised method for retinal screening in Qatar?
References
Cho NH, Shaw JE, Karuranga S, Huang Y, Da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.
Vujosevic S, Aldington SJ, Silva P, Hernández C, Scanlon P, Peto T, et al. Screening for diabetic retinopathy: new perspectives and challenges. Lancet Diabetes Endocrinol. 2020;8(4):337-47.
Leasher JL, Bourne RR, Flaxman SR, Jonas JB, Keeffe J, Naidoo K, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010. Diabetes Care. 2016;39(9):1643-9.
Flaxman SR, Bourne RR, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Global Heal. 2017;5(12):e1221-34.
Global Burden of Disease 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Heal. 2021;9(2):e144ee160.
Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Survey Ophthalmol. 2012;57(4):347-70.
Wong TY, Mwamburi M, Klein R. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care. 2009;32:2307-13.
Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology. 2021;128(11):1580-91.
Diabetic Retinopathy Study Research Group, 1981. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. Ophthalmology. 1981;88(7):583-600.
Ferris FL. How effective are treatments for diabetic retinopathy? JAMA. 1993;269(10):1290-91.
ICO Guidelines for Diabetic Eye Care. Available at: http://www.icoph.org/dynamic/attachments/resources/icoguidelinesfordiabeticeyecare.pdf. Accessed on 15 June, 2023.
Andermann A, Blancquaert I, Beauchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull Worl Heal Organ. 2008;86(4):317-9.
Geneva: Switzerland, 2007. World Health Organization. Diabetic Retinoopathy; Disease Control and Prevention of Visual impairment in ‘VISION 2020 Global Initiative for the Elimination of Avoidable Blindness: Action Plan 2006-2011’. 2007;34-6.
Harding SP, Broadbent DM, Neoh C, White MC, Vora J. Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study. BMJ. 1995;311(7013):1131-5.
Liew G, Mitchell P, Wang JJ, Wong TY. Fundoscopy: to dilate or not to dilate? BMJ. 2006;332:3.
Early Treatment Diabetic Retinopathy Study Research Group, 1991. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics: ETDRS report number 7. Ophthalmology. 1991;98(5):741-56.
Chakrabarti R, Harper CA, Keeffe JE. Diabetic retinopathy management guidelines. Expert Rev Ophthalmol. 2012;7(5):417-39.
British Diabetic Association: Retinal Photography Screening for Diabetic Eye Disease. London, British Diabetic Association. 1997.
Hutchinson A, McIntosh A, Peters J, O'keeffe C, Khunti K, Baker R et al. Effectiveness of screening and monitoring tests for diabetic retinopathy–a systematic review. Diabetic Med. 2000;17(7):495-506.
Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010. BMJ Open. 2014;4(2):e004015.
Jones S, Edwards RT. Diabetic retinopathy screening: a systematic review of the economic evidence. Diabetic Med. 2010;27(3):249-56.
World Health Organization, 2020. Diabetic retinopathy screening: a short guide: increase effectiveness, maximize benefits and minimize harm. Available at: https://apps.who.int/iris/bitstream/ handle/10665/336660/9789289055321-eng.pdf. Accessed on 15 June 2023.
Silva PS, Cavallerano JD, Tolls D. Potential efficiency benefits of nonmydriatic ultrawide field retinal imaging in an ocular telehealth diabetic retinopathy program. Diabetes Care. 2014;37:50-5.
Olson JA, Strachan FM, Hipwell JH. A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. Diabetic Med. 2003;20:528-34.
Sharma M, Chakrabarty AS, Pavan R, Sharma R, Pratibha G. An integrated, mobile service for diabetic retinopathy in rural India. Community eye health / International Centre for Eye Health. 2011;24:17-8.
Nguyen HV, Tan GSW, Tapp RJ, Mital S, Ting DSW, Wong HT et al. Cost-effectiveness of a national telemedicine diabetic retinopathy screening program in Singapore. Ophthalmology. 2016;123(12):2571-80.
Khandekar R. Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean region. Middle East African J Ophthalmol. 2012;19(2):178.
Al Alawi E, Ahmed AA. Screening for diabetic retinopathy: the first telemedicine approach in a primary care setting in Bahrain. Middle East Afr J Ophthalmol. 2012;19(3):295.
Bener A, Zirie M, Janahi IM, Al-Hamaq AO, Musallam M, et al. Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Diabetes Res Clin Pract. 2009;84(1):99-106.
National health strategy 2018-2022. Available at: https://www.moph. gov.qa/english/strategies/National-Health-Strategy-2018-2022/ Pages/default.aspx.
Al-Thani, A.A., Farghaly, A., Akram, H., Khalifa, S., Vinodson, B., Loares, A. and Abou-Samra, A.B., 2019. Knowledge and perception of diabetes and available services among diabetic patients in the state of Qatar. Central Asian journal of global health, 8(1).
Al-Mutawaa KA, Farghaly A., Nasir R, Loares AM, Skaroni I, Al-Thani M, et al. Level of knowledge, attitude and practice towards diabetes among nationals and long-term residents of Qatar: a cross-sectional study. BMJ open. 2022;12(2): p.e052607.
www.hamad.qa. (n.d.). Diabetic Retinopathy among Most Common Eye Diseases Treated at HMC. Available at: https://www.hamad.qa/EN/news/2018/ November/Pages/Diabetic-Retinopathy-among-Most-Common-Eye-Diseases-Treated-at-HMC.aspx. Accessed on 15 June, 2023.
Elshafei M, Gamra H, Khandekar R, Hashimi MA, Pai A et al. Prevalence and determinants of diabetic retinopathy among persons≥ 40 years of age with diabetes in Qatar: a community-based survey. Eur J Ophthalmol. 2011;21(1):39-47.
