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The Official Scientific Journal of Delhi Ophthalmological Society
Prevalence Of Diabetic Retinopathy In Jorhat District Of Assam
Sagarika Das, Narayan Bardoloi, Sandip Sarkar 
Chandraprabha Eye Hospital, Jorhat, Assam, India
Corresponding Author:
Sandip Sarkar 
MS
Fellow,
Chandraprabha Eye Hospital, 
Jorhat, Assam, India
Email id: sandipagmc@gmail.com
Published Online: 30-APR-2018
DOI: http://dx.doi.org/10.7869/djo.351
Abstract
Aims:- To find the prevalence of diabetic retinopathy (DR) in a project named “Community Based Diabetic Retinopathy” initiated to study the diabetics in a city of population 1.2 lacs. 

Methods:- After initial survey, mapping was done where spots were identified to organize weekly diabetic retinopathy (DR) camps. The target population was sensitized by home to home visit, placing of canopies and posters prior to the camps. On the day of camp, people above 40 years were subjected for Random blood sugar (RBS) estimation besides routine eye check up. The known diabetics and those detected on that day were examined with indirect ophthalmoscopy (IDO) by ophthalmologists.

Results:- A total of 5596 persons were examined in 50 weekly camps in one year. 1172 diabetic patients were screened, out of which 66 were found to have retinopathy. Only 6 underwent treatment. Prevalence of DR was found to be 1.17% (M= 0.69%, F=0.48%) in the entire data set and 5.63% among the diabetics. 

Conclusion:- Prevalence of DR in our project was much less than other population based studies across the nation.
Keywords : diabetic retinopathy, screening, awareness
Introduction

Diabetic retinopathy (DR) is the leading cause of legal blindness among the working aged adults.1 According to the WHO, 31.7 million people were a?ected by diabetes mellitus (DM) in India in the year 2000. It is estimated to rise to 79.4 million by 2030, the largest number in any nation in the world. Nearly all the patients with T1DM and the majority of those with T2DM are affected by some form of DR after 20 years of disease duration and 50% may develop sight-threatening DR.2-4 The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) reported that the incidence of diabetic macular edema (DME) is 29% in T1DM over a period of 25 years and 25.4% among those with T2DM requiring insulin.5 A pooled analysis from 35 studies worldwide (from 1980 to 2008) evaluating more than 20000 people with DM reported an overall prevalence of any DR of 34.6% (95% confidence interval) (CI, 34.5–34.8), proliferative DR (PDR) of 6.96% (CI, 6.87–7.04), DME of 6.81% (CI, 6.74–6.89), and sight-threatening DR of 10.2% (CI, 10.1–10.3).6 

We initiated a project named “Community Based Diabetic Retinopathy” (CBDR) to study the diabetics in the city of Jorhat with a population of 1.2 lacs. The goal of CBDR is to prevent blindness due to diabetic retinopathy in the service areas. It is a process of providing comprehensive diabetic retinopathy services to the community which include prevention, promotion, curative & rehabilitation components through a quality driven service delivery system. With technical Partnership with Operation Eyesight Universal (OEU) in 2016 the CBDR project started. Based on need analysis, the Jorhat Town within 20 kms radius from Chandraprabha Eye Hospital (CPEH) was selected as the area for intervention for the CBDR project (Figure 1).



Recruitment for Project Cordinator (PC) was conducted in the month of January 2016. Recruitment and final selection for Field Executive was completed the month of April. The First Module and Second Module Training was completed completed along with the final selection of Field Executives in the month of April. Year of implementation was 2016. Team was selected by the year of advertisement in the local newspaper and were trained at CPEH. We selected the target area as Jorhat urban. The survey duration continued for 17 days, we made 4 survey groups (2 F/Es each group), did social mapping and divided the whole area into 4 clusters. The survey mainly focussed on individuals, apartments, hospitals, schools, clubs, pharmacies, laboratories, etc. Health education and creating awareness in the society was the prime goal of our programme. This was done by placing of canopies, house to house visits motivating people for the need of eye examination routinely, distribution of pamphlets and placing of posters and banners in public places like railway stations, bus stops, public gathering and street light areas (Figure 2).



Materials and Methods

A population based cross sectional study of diabetic patients was conducted as an initiative of the CPEH in collaboration with Operation Eyesight Universal from April 2016. The study protocol was approved by institutional ethics committee (IEC) of Chandraprabha Eye Hospital and followed the tenects of the declaration of Helsinki. Informed consent was obtained from all participants. A total of 5596 people from 50 camps were screened for diabetes in the community. People above 40 years were subjected for random blood sugar estimation, blood pressure monitoring, routine eye check up. Those diagnosed to have refractive error, cataract and other eye diseases were managed accordingly. Initial screening was carried out by random blood sugar examination. A value of >=140 mg/dl of blood sugar was considered positive for diabetes. The known diabetics and those detected on that day were dilated with Tropicamide 0.8% with Phenylephrine hydrochloride 5% combination. One-eyed and known glaucoma patients were excluded. They were then examined with indirect ophthalmoscopy by an ophthalmologist (Figure 3). 



Results

A total of 5596 patients were screened in 50 camps in a period of one year from April, 2016 to April, 2017. The total number of diabetics were 1172 (20.94%), out of which 1008 were known diabetics and 164 suspect, i.e. those detected on the day of screening. Diabetic retinopathy(DR) was found in 66 patients. Among them, 16 (24.24%) were in 41-50 years age group, 20 (30.30%) in 51-60, 22 (33.33%) in 61-70 and 8 (12.12%) in 71-80 years age group (Table 1). A male preponderance was found with 39 (59.1%) males and 27 (40.9%) females (Table 2). On grade wise distribution of DR cases, we found mild NPDR to be in 38 cases (57.5%), moderate NPDR 29 in (43.9%), severe NPDR 3 in (4.5%), high risk PDR 1 in (1.5%) and PDR 2 in (3%) (Table 4). Patients who needed immediate treatment were 8, out of which 6 (75%) underwent treatment (Table 5). In our study, we found the prevalence to be 1.17% (M= 0.69%, F=0.48%) in the entire data set and 5.63% among the diabetics (Table 5).






Discussion

India is a subcontinent with variations in diet, lifestyle, and ethnicity. The level of health literacy and access to health care also varies across the country. Over the past decades, many cross sectional studies have been conducted to ascertain the prevalence of DR in the diabetic population in various regions of the country and world. In India, the previous studies to calculate prevalence were by Raman et al. (18.1%), Rema et al. (17.6%), Namperumalsamy et al. (10.6%), Narendran et al. (26.2%) and Dandona et al. (22.58%).7-11 Patients with better access to medical treatment for DM live longer, hence have higher chance of DR and living with it: adding to the prevalence. In our study, we found the prevalence to be 1.17% (M= 0.69%, F=0.48%) in the entire data set and 5.63% among the diabetics which is very low as compared to other studies done across the nation. Like in many other studies, males were more affected. The issues of gender bias and social barriers to treatment are known to exist, modifying access to screening and treatment. 

We believe that looking at a high street, a neighbourhood park, or a restaurant can tell us much about the health and resilience of a community. Everyday life of city streets and neighbourhoods nowadays have been confined to late night parties, fast food, sedentary lifestyle which have great impact on the health of people living in it. The city life life of Jorhat is very simple. People remain indoors, have food at home and have to work hard to earn a livelihood. Restaurants and markets are closed by 7-8 pm. Most of them prefer cycling as their means of transport. All these factors may help people live a healthy lifestyle and may contribute to the low prevalence in a city of Jorhat.

Conclusion

Since the launch of the program in 2016, we have successfully completed 80 camps. Community participation is the key to success for any awareness or screening model. Our field executives play an important role in motivating diabetics to attend screening camps. Stickers containing diabetic retinopathy awareness messages were displayed at railway stations, public transport systems and post offices targeting approximately 1.2 lacs people. Weekly review meetings among the team members and visits by funding cum monitoring teams assists in keeping the targets in focus. Our program included an extensive awareness program, besides screening for diabetes and diabetic retinopathy.

References
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  2. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984; 102:520-6. 
  3. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984; 102:527–32. 
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  8. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: The Chennai urban rural epidemiology study (CURES) eye study, I. Invest Ophthalmol Vis Sci 2005; 46:2328 33.
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Sagarika Das, Narayan Bardoloi, Sandip SarkarPrevalence Of Diabetic Retinopathy In Jorhat District Of Assam.DJO 2018;28:25-28
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Sagarika Das, Narayan Bardoloi, Sandip SarkarPrevalence Of Diabetic Retinopathy In Jorhat District Of Assam.DJO [serial online] 2018[cited 2018 Aug 17];28:25-28. Available from: http://www.djo.org.in/articles/28/4/Prevalence-Of-Diabetic-Retinopathy-In-Jorhat-District-Of-Assam.html
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