Dr. Lokesh Jain, J09551, Dr. Garima Jain
Due to increase in diabetic population diabetic retinopathy is becoming important cause of visual impairment in India. Fortunately, with early detection and timely treatment vision loss and blindness due to diabetic retinopathy are almost entirely preventable. However, many people with diabetic retinopathy remain completely asymptomatic and unaware that their vision is under threat. A successful program to combat any disease in the community relies on the awareness of the community on that disease.
There is not much data available in this regard from the Indian sub-continent especially rural population. In a study done in the southern India it was found that the awareness that diabetes can cause diabetic retinopathy is present in only 28.8% of the urban population. Further awareness concerning the different treatment modalities for the diabetic retinopathy is also expected to be low among paramedical personnel and community.
A lack of knowledge concerning the need for screening, especially in the absence of symptoms is a major barrier to regular screening for many people with diabetes.
This study was done to find out the best possible method for increasing the level of awareness in the community about Diabetic retinopathy screening and treatment.
Material and Methods:
In this study all the screening cum treatment camps organized between November 2009 to December 2014 for Diabetic Retinopathy are included. All the camps were organized in the Rural areas of Baghpat District of Uttar Pradesh. The date of Camp was decided at least two weeks before and publicity started which included banners placed at prominent places stating Venue and day of camp. In addition announcement made at the place of gatherings like religious venues,schools and Panchayats..
On the day of camp team comprising Retina Specialist, Optometrist, Nurse, Field coordinator, project coordinator, Counselors would reach the Venue in the mobile van fitted with portable Fundus Angiography Machine (OIS USA) and Frequency Double Green Laser with LASER Indirect Ophthalmoscope(LIO) Delivery System .All the patients attending the screening camp had detailed examination including Blood Sugar Checkup with Glucometer if above 30years or with any of the risk factors and Best Corrected Visual Acuity done by Snellen chart at 6 meters. Those found to be diabetic were advised to go dilated Fundus Examination with +20 Diopter Lens and Binocular Indirect Ophthalmoscope. Suspected patients with shallow anterior chamber on torch light examination were not dilated and called at base hospital for further evaluation and not included in the study. The details of the diabetic patients were noted in the prescribed Performa and those requiring Angiography or laser photocoagulation were done there itself and others were advised for follow up as per schedule.
All the three main approaches to awareness creation activities were followed these were Mass approach, Group approach and Individual approach. Posters depicting the effects of diabetes and diabetic retinopathy were developed .Pocket Calendars with basic information about the nature of diabetic retinopathy and its potential visual implications were developed. Articles about the disease and its prevention were regularly given in newspaper by organizing Press conferences, seminars and lectures for medical and para medical personnel were also organized. Special days like World Diabetes Day were celebrated in schools and painting competitions were held and Walk for Awareness of Diabetes also organized.
Patient interaction sessions at the camp site involved short presentation on Diabetes Mellitus and Diabetic Retinopathy followed by Question and Answer sessions.
The Booklet containing detailed information about the stages of disease, diagnostic procedures and treatment including lasers and surgical procedures and ideal follow up schedule were also distributed.
Individual counseling session to provide specific, detailed information to increase knowledge, change attitudes and alter incorrect practice were also held. A pamphlet containing information stressing the importance of early detection and illustrations showing the effects of diabetic retinopathy and brief information on diagnosis and treatment was developed in vernacular language.
In spite of all these we were not getting the desired response. So we developed a educational video in which a protagonist who is based in a rural is chosen as he is irregular in his treatment and follow up. All the procedures were shown in detail to allay the apprehension of the target audience who might need the same later. The importance of follow ups has also been emphasized as the patients do not turn for follow ups after first sitting of Laser photocoagulation. The movie also touches upon the sensitive topic of quacks exploiting the innocent villagers. The movie ends on the positive note in which the protagonist learns from his mistake and in turn educates and motivates his fellow villagers highlighting the need for regular check up. This movie was made to run in the cable TV network at regular intervals and was also shows in the camps site so that more and more people got aware about the disease and need for screening and regular follow up.
Results:
A total of 22540 patients were screened in 140 camps held between November 2009 to December 2014.Out of these 4680(20.76%) patients were found to be diabetic. 2202(47.05%) out of 4680/ 9.76% out of 22540 had some degree of diabetic retinopathy. 1602(72.7%) out of 2202/ 34.23% out of 4680 diabetic patients or 7.1% out of 22540 patients screened required Laser Photocoagulation.
First 45 camps were held between November 2009 to November 2010 and next 95 camps were held between December 2010 to December 2014.
In first 45 camps were all the conventional methods of awareness were used 6765 were screened and 641(9.47%) were found to be diabetic. Diabetic retinopathy was found in 209 (32.6%) /3.08% out of 6765 and 123 (58.85%)/19.18% out of 641 or 1.8% out of 6765 patients underwent Laser photocoagulation.
In next 95 camps in which Educational movie was also shown in addition to all the other conventional methods of awareness 15775 were screened out of which 4039(25.6%) were found to be diabetic and 1993(49.34%)out of these / 12.63% out of 15775 have some degree of retinopathy and 1479(74.20%) out of these/ 36.61% out of 4039 / 9.37 % out of 15775 underwent Laser photocoagulation.
Our results showed that a new approach of movie showed significant increase in DM patients and 17% increase in patients opting for Laser Treatment.
Discussion:
Diabetic Retinopathy is a major cause of blindness with public health implications in India1. Prevalence of Diabetic Retinopathy in South India among people over 50 years of age was found to be 1.3% in one Study1 and is going to increase exponentially in the coming decades. Awareness that diabetes can cause diabetic retinopathy is present in only 28.8% of urban population in southern India. Without awareness of the disease it is impossible for any individual to aid the cause of preventing blindness from diabetic retinopathy in the community. Awareness creation is there fore necessary as one of the first steps in any program aimed at reducing Diabetic Retinopathy
In a study done in Chengamanad panchayat of Ernakulam district in Kerala district which has health care indices and high literacy rates almost at par with developed countries it was found that there is lack of awareness2.These factors highlight the need for population based diabetic retinopathy awareness and prevalence detection studies in developing studies.
People vary so widely in their socio-economic conditions,traditions, beliefs,attitudes and level of knowledge that uniform communication approach is not viable. A mixture of different approaches must be developed depending on the local circumstances and we have to constantly evolve new methods of screening and awareness.
Reference:
- Narendran V,John R.K,Raghuram A,Raveendran RD,Nirmalan P.K,Thulasiraj RD.Diabetic retinopathy among self reported diabetics in southern India ,a population based assessment.J.ophthalmol 2002;86:1014-8.
- Chengamanad diabetic retinopathy awareness study.Presented in Kerala society of ophthalmic surgeons annual meeting held at Thiruvananthapuram.Dec.2005
- Kumar A,Diabetic blindness in India:THE EMERGING SCENARIO.Indian J. Ophthalmol 1998;46:65-6.
- Lalit Dandona et al. Population based assessment of diabetic retinopathy in urban population of southern India.J.ophthalmol 1999;83:937-40.
- R Varma et al.Los Angles Latino eye study. Ophthalmol 2006;7:1298-1306.
- Klein R,Klein BEK,Moss SF et al.Visual Impairment in diabetes.Ophthalmology 1984;91:628-38.
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