Prevalence and severity of diabetic retinopathy at first presentation to vitreoretinal services in Bhutan: a 3-year national study

• Published in: Japanese journal of ophthalmology 2023-05, Vol.67 (3), p.287-294
• Main Authors: Rai, Bhim Bahadur, Essex, Rohan W., Morley, Michael G., Bernstein, Paul S., van Kleef, Joshua P., Maddess, Ted
• Format: Article
• Language: English
• Subjects: Acuity; Bhutan - epidemiology; Clinical Investigation; Clinical significance; Comorbidity; Cross-Sectional Studies; Demography; Diabetes; Diabetes Mellitus; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - epidemiology; Edema; Female; Humans; Hypertension; Macular Edema - diagnosis; Male; Medicine; Medicine & Public Health; Ophthalmology; Prevalence; Regression models; Retinopathy; Retrospective Studies; Urban areas; Urban environments; Visual acuity
• ISSN: 0021-5155; 1613-2246
• DOI: 10.1007/s10384-023-00989-6

Purpose To determine the prevalence and severity of diabetic retinopathy (DR) at first presentation among diabetic patients attending national vitreoretinal (VR) services in Bhutan Study design Retrospective cross-sectional study Methods We included all diabetic patients in Bhutan who presented for retinal evaluation for the first time over a 3-year period (2013–2016). Data including demography, clinical details, diagnostic tests, and clinical staging of DR were analyzed. Results A total of 843 diabetic patients, aged 57.2 ± 12.0 (range 18–86) years, were enrolled. The majority were male (452, 53.6%; cumulative frequency [cf] 391, 46.4%; P = .14) and from urban settings (570, 67.6%; cf 273; 32.4%) and did not have modern schooling (555, 65.8%). Hypertension was the most common systemic comorbidity (501, 59.4%). The prevalence of DR was 42.7%, with mild nonproliferative DR (NPDR) being the most common type (187, 51.9%), followed by moderate NPDR (88, 24.4%) and proliferative DR (45, 12.5%). In addition, 120 patients had clinically significant macular edema (CSME), with a prevalence of 14.2%. Best-corrected visual acuity (BCVA) of 6/60 or worse occurred in 231 eyes (13.7%), and 41 patients (4.86%) had BCVA of 6/60 or worse bilaterally due to DR/CSME. A logistic regression model indicated that the major determinant of DR was the duration of diabetes, the odds rising by 1.27× with each year of disease ( P < .0001). Conclusion The prevalence of DR, including CSME, was high. Although a national DR screening program is established in Bhutan, there is a need to accelerate health education, community screening, and referral systems to reduce the prevalence of DR and CSME.