Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review

Abstract

The number of people with diabetic retinopathy (DR) has increased with the increasing prevalence of diabetes mellitus worldwide, especially in developing countries. In recent years, the successful implementation of public health programs in developed countries has been thought to contribute to decreases in blindness from DR. Developing countries, however, have not seen the same improvements, and their public health interventions still face significant challenges. In this review we describe the current state of public health approaches including risk factor control, screening and treatment techniques for DR in developing countries, and suggest recommendations. While the awareness of DR is variable, specific knowledge about DR is low, such that many patients have already experienced vision loss by the time they are screened. Attempts to improve rates of screening, in particular through non-mydriatic cameras and tele-screening, are ongoing and promising, although challenges include collaboration with healthcare systems and technology failures. Laser treatment is the most readily available, with anti-VEGF therapy and vitreo-retinal surgery increasingly sought after and provided. Recommendations include the use of 'targeted mydriasis' for fundus imaging to address high rates of ungradable images, increased communication with diabetes management services to improve patient retention and mobilization of access to DR treatments.

Indian Diabetic Retinopathy Image Dataset (IDRiD): A Database for Diabetic Retinopathy Screening Research

“…Hence, diabetic patients are referred to do a regular biannual or annual follow-up and frequent consultation for the screening of their retina [9]. The elimination of preventable visual impairment is mainly dependent on the pool of expert clinicians and basic health care infrastructure essential for the treatment of the eye [10,11]. In the Indian subcontinent, against national eye care experts: population ratio of 1:107,000, in various regions this ratio is 1:9000 whereas in some other parts there is only one eye care expert for 608,000 population [12,13].…”

Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy

“…Well-trained para-professional staff may prove essential to extending DR screening to patients in all areas, especially traditionally underserved areas. Though DR disproportionately affects underserved populations,[25] the sheer number of diabetic patients precludes ophthalmologists’ ability to screen all patients while maintaining their ability to treat eye disease. Using portable non-mydriatic fundus imaging in high volume eye camps or primary care offices globally may improve access to recommended diabetic eye care and decrease DR related blindness as the robust telemedicine DR screening program has done in the United Kingdom.…”

Protective Effect of Tang Wang One Decoction on the Retinal Vessels of Diabetic Rats

“…Occludin, claudin, and junctional adhesion molecules combine to form a transmembrane protein polarity complex, which regulates the substances that go in and out of the blood vessels. This complex not only provides the necessary nutrients for the layers of the retina but also removes wastes [2]. TJ injury is the main cause of BRB damage in early DR. Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes which can degrade almost all extracellular matrix.…”