1. Diabetic Retinopathy module for RAAB 5 David Yorston Sarah Polack Hannah Kuper Hans Limburg

2. Why assess DR in RAAB?

3. Diabetes – a growing problem Source: International Diabetes Foundation, 2011

5. Diabetic retinopathy Cataract 39% Refractive error 18% Glaucoma 10% ARMD 7% CO 4% DR 4% Trachoma 3% Childhood 3% Other 11%

6. Few countries with population based DR prevalence data

7. What this will tell us DR module provides estimates of: Prevalence of diabetes Prevalence of DR and sight threatening DR in people with diabetes and in general population Coverage of DR examinations among people with known diabetes Levels of glycaemic control among people with diabetes ….among people aged 50+ years ….to be used to inform service planning

8. Results from Chiapas, Mexico Results Prevalence of diabetes20% Prevalence of DR among diabetics40% Prevalence of sight threatening DR among diabetics23% Proportion of diabetic participants with previous eye exam47% Proportion of diabetic participants with poor glycaemic control (RBG≥200mg/dl) 73%

9. Methods

10. 1. Obtain informed written consent Explain (participant information sheet): – Purpose of study – Procedures involved – Risks (affect of dilation on vision) – Participation is voluntary – Confidentiality Consenting participants must sign/thumb-print consent form To be done when first arrive at the household

11. 2. Assess diabetes (section H) Ask about previous diagnosis Test random blood glucose Diabetes: Previous diagnosis and/or RBG ≥200mg/dl Known diabetes: Previous diagnosis (regardless of current RBG) Newly diagnosed diabetes: No previous diagnosis, but RBG ≥200mg/dl

12. 3. Ask questions to people with known diabetes (section I) Age of diagnosis Diabetes treatment Diabetic eye exam

13. 4. Dilated eye examination of all people with diabetes (section J) Dilated examination with direct & indirect ophthalmoscope

14. Diabetes classification ‘Have you ever been told by a doctor /nurse that you have diabetes, sugar in your urine or high blood sugar’ RBG levelClassificationAction No1-199mg/dlDoes not have diabetesFinish! No200+ mg/dlHas newly diagnosed diabetesComplete section H only Yes1-199mg/dlHas known diabetesComplete sections I & J Yes200+ mg/dlHas known diabetesComplete sections I & J YesRefuses RBG testHas known diabetesComplete sections I & J NoRefuses RBG testUnknown statusFinish!

15. Obtain informed consent Diabetes assessment Known ‘diabetes’No ‘diabetes’ Finish! Newly diagnosed ‘diabetes’ Ask questions about diabetes Dilate pupils Fundus examination Standard RAAB protocol

16. However! Standard RAAB: – 4-5 days training; cost 20-40,000 US$ RAAB + DR – 5-7 days training; cost 40-100,000 US$ – Prevalence of diabetes >20% in people 50+ – 1 team: 35 persons/day; 2 teams 60/day – Requires DR specialists and equipment – Special trainer for DR

17. Downloads of RAAB 5 will soon be available at: www.ICEH.org Thank you!www.ICEH.org