1. Diabetic Retinopathy (DR) screening programme in Urban area-Lessons learned.
Kuldeep Dole,
Sucheta Kulkarni, Madan Deshpande,Nilesh Kakade,
H.V.Desai Eye Hospital
&
Rishi Raj Borah ,
ORBIS International,India

2. Diabetic Retinopathy Screening Programme- SAVE YOUR SIGHT
Goal
Reducing morbidity and disability and improve
quality of life for persons with diabetic Retinopathy.
Objectives
To generate awareness about Diabetic Retinopathy.
To identify patients with Diabetic Retinopathy by
screening diabetics in the hospital and community .
To provide appropriate Management of Diabetic Retinopathy.

3. Knowledge , Attitude, Practice Survey
Awareness creation
Knowledge , Attitude, Practice Survey
Materials and media development
Communication Strategies

4. HOARDINGS

5. EXHIBITIONS
PBMA’S H.V.DESAI EYE HOSPITAL

6. POSTER ON PUBLIC TRANSPORT

7. Rally on world diabetes day

8. GROUP MEETINGS-CORPORATES

9. ONE TO ONE COUNCELLING

10. Screening Services Training a team(clinical and programme)
Equipments procured
Opportunistic and organized screening activities- diabetic clinic and camps were arranged
Protocols developed
Data collection and analysis

11. Diabetic Clinic - HBP training

12. Outreach Camp

13. Knowledge about Risk of DR Knowledge about Treatment of DR
KAP survey
Community
Paramedics
Doctors
Knowledge about DR
46.8 %
76.3 %
95 %
Knowledge about Risk of DR
0.4 %
49.5 %
92.5 %
Knowledge about Treatment of DR
2.5 %
68.8 %
57 %

14. Analysis of effective communication strategy
Media
 Responses  %
Mass media 35
36.10%
Papers-advertisement 28
28.90%
Pamphlets 1 1%
T.V. 5
5.10%
One to one publicity 97
In Pune urban area use of mass media to create awareness was effective to increase the enrollment 14 14

15. Opportunistic screening : Diabetic Clinic
Year
2009
2010
2011 DM
1914 
2935
3697  DR
490 (26.2%)
523 (18.5%)
407(11%)
Sight threatening DR
255 (13.6%)
281(10%)
189 (5.9%)
The diabetic clinic enrolled more patients with diabetes for screening and the number of persons with sight threatening diabetic retinopathy decreased over the years due to awareness campaign in the project area.
Instead of focusing attention in identifying persons with diabetes by home visits efforts should made in the community to increase awareness about need of retina examination to prevent blindness due to diabetic retinopathy as it is more cost effective option .
DR examination cost /patient
Rs.64.19

16. Organized screening-Camps
No of camps
Total DM DR
Sight
Threat-
ening
Eye camps –Cataract
109
8246
907
(11%)
151
(16.6%) 56
(6.17%)
Health checkup camps including eye
375
18757
1149
(6.1%)
145
(12.6%) 27
(2.3%)
DR camps
Community supported 8
654
169
(25.8%) 37
(21.9 %) 13
(7.7%)
Physician
supported 61
2068
(100%)
341
(16.5%) 70
(3.4%)
Camp activity was helpful for DR screening in the community. This activity was more effective when it was held with physician support and organizations involved with diabetes care
Camps held mainly for cataract detection were also helpful in DR detection as we emphasized on comprehensive eye examination but dedicated DR camps detected more retinopathy .

17. Treatment Laser treatment cost /sitting /patient Rs.1001.82 Total
Total
LASER VR
Anti-VEGF
2009
584
463
(79.28%) 43
(7.36%) 78
(13.36 %)
2010
658
516
(78.42 %) 54
(8.21 %) 88
(13.37%)
2011
625
413
(66.08%)
103
(16.48%)
109
(17.44%)
2492
1867
249
278
The capacity of screening programme should be strengthened by training a team to provide all investigations and treatment procedures. This helps in providing comprehensive DR management services
The treatment services should provide all the services including intravitreal injections and vitrectomy surgery to improve credibility of the screening programme.
The treatment services should have support of laboratory services and physician as control of diabetes and other risk factors play vital role in outcome of treatment
Laser treatment cost /sitting /patient Rs

18. Compliance to Treatment
Total pt 84
Treatment completed
40 (47.6 %)
Treatment not completed
44 (52.4 %)
Laser treatment not completed
25 (56.8 %)
PPV and Intrvitreal injection not completed
19 (43.2 %)
Poor compliance to treatment was a major problem .
Distance ,repetitive treatment, lack of understanding of the disease process in spite of counseling ,expectation of better outcome and cost were the major reasons for poor compliance.
Dedicated programme personnel for awareness creation and programme documentation are needed to improve compliance .

19. Lessons learned Undiagnosed DR Networking
DR screening services at various levels Awareness creation ,
Media campaign
Networking with Physicians
,NGO working for DM
Complex treatment
Team Approach
Capacity building – support of Lab and Physician
Poor compliance to treatment
Counseling
Dedicated counselor-good documentation
Low level of Awareness
Health Education
Awareness campaign – Dedicated personnel
Unaffordable cost
To subsidies
Cross subsidize

20. Acknowledgment Dr.G V Rao ,Mehnaz Riaz–ORBIS India
Dr.Pravin Narwadkar-Project manager
Mr.Vishnu Gaikwad
Mr.Jitesh Kharat
All the doctors and staff of H.V.Desai Eye Hospital

21. Lions’s Juhu Community Ophthalmology Institute PBMA’s H. V
Lions’s Juhu Community Ophthalmology Institute PBMA’s H.V.Desai Eye Hospital 93 Tarwade vasti,Mohammadwadi,Hadapsar Pune Phone