Diabetic retinopathy screening in type 2 diabetics in a health area of ​​the metropolitan area

Abstract

Costa Rica has a population of 4 million and an estimatedprevalence ofDiabetes mellitus type 2 of 6% . T h i srepresents around 130,000 diabetic patients in the wholec o u n t r y. It is known that the chronic complications ofdiabetes have a great impact in the quality of life of thesepersons. Diabetic rethinopathy is one of the most important;if it is not diagnosed early and treatment, it can lead to lossof vision. The prevalence of this pathology and how well it isapproached by the Costa Rican Health System is unknown.The objective of this study is to find out how the Health Areaof Desamparados 3, an urban-marginal comunity of themetropolitan area, has coped with this complication up ton o w, and to determinewith aretinopathyscreeningintervention an estimate of its prevalence.The medical records of 572 diabetics where checked,searching for the results of eye fundoscopic examination inthe last two years. Those patients that had no previous eyeexaminationwere dilated and examined by experienceclinicians. Ninety three percent of the patients had had noeye test in the last two years, even worse, 89% had no eyeexamination intheir medical records at all. After thescreening intervention, a funduscopic exam was obtained in345 patients (60.3%). Of these, 27% had diabetic retinopathy;16.5% had basic non proliferative, 8.7% had severe nonproliferative and 2.3% had with proliferative retinopathy.Thirty patients had severe non proliferative retinopathy thatneeded fotocoagulation intervention on urgent basis. Threehad macular oedema that needed urgent treatment. Access tohospitals oftalmologic facilities for the studied area waslimited, having waiting lists up to three months.73Tamizaje de retinopatía diabética/ Laclé A et alThis study showed that diabetic retinopathy is not beingdiagnosed because ophtalmics funduscopic examination isnot being done, not only in primary care but also in patientsthat arecontroled athospital level.The screeningintervention was well accepted by the patients, but thereferral of these patients to the hospitals is not wellcoordinated.To achieve near universal coverage for patiets withs thiscomplication, the screening method has to be communitybased and the point of delivery within easy reach of thepopulation. Many different modalities of screening are inuse, depending on local availability of facilities. Costa Ricahas to seek the best way to achieve total coverage, and webelieve its has the capacity of doing so.