A Model for Diabetic Retinopathy Screening in Communities in Thailand - รูปแบบการคัดกรองโรคจอตาจากเบาหวานในชุมชนของประเทศไทย

บทคัดย่อ

                  The objective of this comparative study was to evaluate a pilot implementation of a diabetic retinopathy (DR) screening model that used digital retinal photography for detecting cases for referral to ophthalmologists.  Patients with diabetes in Tak province were examined using single-field digital retinal photography interpreted initially by trained paramedical personnel who captured the images and supervised by the comprehensive ophthalmologist in Tak provincial hospital. Retinal cameras used in this model were rotated to capture retinal images locally in communities in each district of the geographical areas of the provincial hospital.  The coverage of cases and prevalence of DR detected using this model in the year 2008 was compared to those detected by the comprehensive ophthalmologist performing indirect ophthalmoscopy in the same communities in the previous two years.  During five months of the fiscal year 2008, 2,290 patients with diabetes (47.8%) were digitally screened for DR; this coverage was significantly different (p < 0.01) from the same period of the previous two years.  The prevalence of non-proliferative DR, 32.1 percent, detected using this digital model was also significantly higher than 15.1 percent detected by ophthalmoscopy in the previous two years.  However, the prevalence of proliferative DR, 2.6 percent, using by this digital model was not significantly different (p = 4.8) from the prevalence detected by the ophthalmoscopy. The digital model for DR screening can cover more patients in a shorter period of time and may be able to detect more positive cases than the conventional ophthalmoscopy.  To have most patients with diabetes screened for DR for prevention of blindness, this model should be implemented nationwide as an alternative to clinical examination by ophthalmologists.

Key words:  diabetic retinopathy, digital retinal photography, community screening