Elderly Patients with T2DM Should be Periodically Screened for Diabetic Retinopathy and its Complications to Reduce Visual Morbidity - A Study from Slums of Western India

Abstract

Purpose: To evaluate the risk groups in a population with type 2 diabetes mellitus (T2DM) for target ophthalmic screening. Sight-threatening diabetic retinopathy (STDR) (macular edema and proliferative retinopathy) can be managed appropriately and treated with laser if timely intervention is followed . Several studies have shown that older age group and longer duration of T2DM increases visual morbidity.More so, the limited access to health care services in slums makes them a vulnerable population who are at risk of losing their eye sight.

Methods: The present study is an ongoing population based cross-sectional study Door to door survey of households was performed in these non randomly selected areas where the residents > 40 yrs of age were included in the study. Eligible subjects were enumerated for type 2 diabetes mellitus (T2DM). Ophthalmic evaluation was performed in these subjects and seven field standard photography of each subject was obtained adapting ETDRS protocol & graded by a single person. The proportion of eyes with vision-threatening diabetic retinopathy, and that of eyes in which visual loss could be prevented were identified.

Results: Four hundred and seventy subjects with T2DM were analysed: mean age 55.7 years, 215 males (45.7%); 78 had diabetic retinopathy; one had proliferative retinopathy, and 16 had macular edema (22.1%). None of these patients had been seen by ophthalmologists prior to their visit to the screening camp. DR was found to be significantly associated in higher age group, 50-60 yrs (p = 0.04) and for above 60 yrs (p=0.03). No association was observed between sight threatening DR and Hypertension and Obesity.

Conclusions: Patients with older age group had DR, emphasising the point that patients who are elderly, who hopefully should have longer duration of T2DM, should be under constant ophthalmic surveillance to prevent the morbidity of DR in a population. Availability of appropriate health care services for detection should be made in the underprivileged population in order to achieve treatment efficacy by timely intervention to reduce the visual morbidity.

Keywords: 499 diabetic retinopathy • 688 retina