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Leo DP Cubillan, Em-Em Lamento, Lilibeth Manganip, Gary L. Yau, Jennifer K Sun, Lloyd P Aiello, Paolo Sandico Silva; Epidemiologic Assessment of Avoidable Blindness and Diabetic Retinopathy in the Philippines. Invest. Ophthalmol. Vis. Sci. 2017;58(8):837.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the prevalence of avoidable blindness using Rapid Assessment of Avoidable Blindness with Diabetic Retinopathy (RAAB+DR) tool in Region 3 (Central Luzon) Philippines.
The study was conducted in Region 3 with total land area of 22,014.63 km2 and population of 11,218,177. Households within clusters were selected through compact segment sampling. Participants underwent visual acuity (VA) screening and diagnosis of cause of visual impairment (VI) by an ophthalmologist. Nonmydriatic ultrawide field 200° retinal imaging was performed on all subjects. Subjects with diabetic mellitus (previously diagnosed or HbA1c ≥ 6.5%) were assessed using dilated direct and/or indirect ophthalmoscopy. Results of the DR section are discussed in a separate paper.
A total of 1750 subjects were identified and 1440 (82.3%) evaluated. Demographics were 533 (37.0%) male, mean age 62.4±8.9, HbA1c 6.4±1.8, VA >=6/12 in 1090(75.7%) and diabetes present in 377(26.2%). Based on presenting vision, 16(0.9%) were blind (<3/60), 35(2.0%) had severe VI (<6/60-3/60, SVI), 160(9.1%) had moderate VI (<6/18-6/60, MVI) and 214(12.2%) had early VI (<6/12 – 6/18, EVI). Leading causes of blindness were cataract (60%), uncorrected refractive error (EOR), cataract surgery complications, DR and other posterior diseases (10% each). Causes of VI (SVI, MVI, EVI) were untreated cataract (78.3%,75.0%,52.1%), EOR (4.3%, 14.4%,37.1%), and posterior segment diseases (8.7%,3.8%,2.9%). Causes of blindness and VI were categorized by intervention:  treatable (EOR, uncorrected aphakia, untreated cataract), 89.3%;  preventable (by ophthalmic services: cataract surgical operation, glaucoma, DR), 6.4%;  avoidable (treatable and preventable causes), 95.7% and  other posterior segment causes (glaucoma, DR, ARMD, others), 8.6%. Cataract surgical coverage (CSC) was high at 98.4% (blind), 85.1% (SVI) and 55.3% (MVI). Major barriers to cataract surgery when bilateral VA<6/60 was due to cataract were no perceived need (33.3%), cost (33.3%) and fear (20%).
Region 3, an underserved area in the Philippines, still has a significant prevalence of blindness (0.9%) and visual impairment (2%) with majority of causes avoidable. In this setting, the RAAB+DR is an effective tool for determining and potentially monitoring of implemented eye care programs that address avoidable causes of blindness.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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