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Cited by 8Retinal Diseases and TreatmentsOphthalmology and Visual Impairment StudiesRetinal Imaging and Analysis

Evaluating the effectiveness of opportunistic eye screening model for people with Diabetes attending Diabetes clinic at Mnazi Mmoja hospital, Zanzibar

Open access
Omar, Fatma J, Sheeladevi, Sethu, Rani, Padmaja Kumari, Ning, Geng, Kabona, George·2014·BMC Ophthalmology
DOI 10.1186/1471-2415-14-81PMC PMC4078096
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Abstract

BACKGROUND: Diabetes and its related microvascular complications like Diabetic retinopathy are showing an alarming rise in developing countries like Zanzibar. Objective of the present study is to evaluate the impact of integrating eye screening for all subjects attending the diabetes clinic at Mnazi Mmoja Hospital in Zanzibar and to estimate the prevalence of visual impairment and diabetic retinopathy among the subjects. METHODS: This is a cross sectional study involving 356 randomly selected patients who had attended the diabetes clinic between July and August 2012. All subjects underwent comprehensive eye examination including fundus evaluation after dilatation by a cataract surgeon and an ophthalmologist, independently. Data was collected using the designated questionnaire and analysed using the SPSS software. Blindness and visual impairment was defined as presenting VA <3/60 and <6/18 to 6/60 in the better eye respectively and DR was graded using the International classification of Diabetic Retinopathy severity grading scale. RESULTS: A total of 356/967 subjects were recruited in a duration of 2 months; 176 (49.4%) were male and the mean age was 52.21 (SD 15.3). Targeted eye screening of diabetics showed that 231/356 (65%) of the subjects had eye problems, including potentially blinding conditions that required immediate intervention in contrast to the existing self reported referral where only 10% of an average of 200 diabetics underwent eye checkup in a year. The prevalence of visual impairment was 20.2%; 95% CI: 16.4-24.7 and blindness in 9.3%; 95% CI: 6.7 -12.7. The prevalence of DR was 28.3% and sight-threatening DR was reported in 9%. Among the DR cases, 30% had sight threatening DR including 28% macular edema, 2% severe NPDR and PDR. Multivariate analysis showed a higher risk for any DR in older subjects >50 years (OR: 2.19; 95% CI: 1.14 - 4.25) and in females (OR: 1.92; 95% CI: 1.07 - 3.44). CONCLUSION: Opportunistic DR screening model achieved higher yield of identification of visual impairment and DR compared to the yield of 10% of existing self reported Diabetic eye screening model at Zanzibar. Integration of eye screening at diabetes clinics helps in early identification and provision of appropriate treatment for reducing blindness due to diabetes.

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  • Sight-threatening diabetic retinopathy is most commonly defined as severe non-proliferative DR, proliferative DR, or clinically significant macular edema.

    “Sight-threatening diabetic retinopathy (STDR) is most commonly defined as severe non-proliferative DR (NPDR), proliferative DR (PDR), or clinically significant macular edema (CSME) [8, 10, 11, 13, 14, 21, 33]”

    From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [13]

    The Methods section defines sight-threatening retinopathy as severe NPDR, PDR, or macular edema. It does not specify clinically significant macular edema or establish that this is the most common definition, so the cited paper supports the categories only at a broader level. (LLM, conf=0.87)

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  • Image acquisition was often performed by trained non-physician staff, while final grading was typically carried out by ophthalmologists or retinal specialists in 22 out of 30 studies.

    “Image acquisition was often performed by trained non-physician staff (technicians, optometrists, nurses, paramedics), while final grading was typically carried out by ophthalmologists or retinal specialists (22/30 studies) [8–13, 15, 16, 18, 21, 22, 24, 26, 27, 30–37]”

    From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [13]

    The Methods describe examinations by a non-ophthalmologist cataract surgeon and an ophthalmologist, and the Discussion says the ophthalmologist’s assessment was the gold standard for diabetic-retinopathy grading. But this study used indirect ophthalmoscopy rather than image acquisition; the Discussion says fundus photography would have been ideal. As a single study, it also does not establish the cited 22-of-30 count. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The International Clinical Diabetic Retinopathy severity scale was the most commonly utilized severity scale, used in 15 out of 30 studies.

    “Various severity scales are used to classify diabetic retinopathy (DR), with the International Clinical Diabetic Retinopathy (ICDR) severity scale being the most commonly utilized in 15 out of 30 studies [9, 11–13, 15, 18, 21–23, 32, 34–36].”

    From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [13]

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Authors
Omar, F. J., Sheeladevi, S., Rani, P. K., Ning, G., & Kabona, G.
Affiliations
L V Prasad Eye Institute (IN)
Corresponding author
Rani, Padmaja Kumari
ORCID
Venue
BMC Ophthalmology
Publisher
Springer Science and Business Media LLC
Published
2014-06-24
Volume
14
Issue
1
Pages
81-81
ISSN
1471-2415 (ISSN-L)
DOI
10.1186/1471-2415-14-81
PMC
PMC4078096
OpenAlex
W2001143438
Cited by
8
References
26
Citations by year
2025: 2 · 2023: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2014: 1
FWCI
0.31
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Ophthalmology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
Keywords
diabetic retinopathy, diabetes clinic, visual impairment, blindness, diabetic macular edema, prevalence, screening effectiveness, risk factors, Zanzibar, access to eye care, fundus examination, dilated eye examination, sex differences, diabetic microvascular complications
MeSH terms
Adolescent, Adult, Blindness, Child, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Female, Humans, Male, Mass Screening, Middle Aged, Ophthalmoscopy, Retrospective Studies, Severity of Illness Index, Tanzania, Visual Acuity, Reproducibility of Results, Incidence, Prevalence, Young Adult

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