Effectiveness of remote screening for diabetic retinopathy among patients referred to Mozambican Diabetes Association (AMODIA): a retrospective observational study

Acta Diabetol. 2022 Apr;59(4):563-569. doi: 10.1007/s00592-021-01834-3. Epub 2022 Jan 16.

Abstract

Aims: Diabetes represents a growing public health problem in sub-Saharan Africa, where diabetic retinopathy (DR) is a major cause of permanent visual loss. We reported the results of a remote screening of DR among urbanized Mozambican people with diabetes.

Methods: We retrospectively collected retinal images and clinical characteristics from 536 patients screened for DR in Maputo (Mozambique), over a period of 2 years (2018-2019). Retinal photographs were captured, digitally stored, and scored locally and by an expert ophthalmologist in Italy remotely.

Results: The overall prevalence of DR was 29% with sight-threatening forms accounting for 8.1% of that number. Inter-reader agreement between the local and the Italian ophthalmologists was poor (k < 0.2). Patients with DR were older, had a longer duration of disease, worse glycaemic control, and a higher prevalence of comorbidities. In the multivariate logistic regression analysis, HbA1c, diabetes duration, and coronary heart disease (CHD) were associated with DR.

Conclusion: Prevalence of DR among urbanized Mozambican patients was similar to that observed in Western countries. Telediagnosis might partially overcome the paucity of local ophthalmologists with experience in DR.

Keywords: Diabetes; Mozambique; Remote screening; Retinopathy.

Publication types

  • Observational Study

MeSH terms

  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Diabetic Retinopathy* / diagnosis
  • Diabetic Retinopathy* / epidemiology
  • Diabetic Retinopathy* / etiology
  • Humans
  • Mass Screening / methods
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Vision Disorders