Diabetic retinopathy screening program in Southwestern Uganda

Abstract

Objectives: Between 2019 and 2045, the prevalence of Diabetes Mellitus (DM) will double; associated with
this, the burden of Diabetic Retinopathy (DR) is also expected to increase, especially in low-resourced settings.
To prevent avoidable visual impairment and blindness, early detection through screening and early treatment
are necessary. To enable access to these services, we developed the Lions Diabetic Retinopathy Project for
southwestern Uganda to serve the region including 17 Districts with eight million inhabitants.
Methods: A three-pronged strategy for mass screenings levering the existing general health system and
opportunistic screening of higher-risk population. Capacity building involved training a vitreoretinal surgeon
and allied eye care providers, installing critical infrastructure at the referral eye hospital, and acquiring equipment
for primary health centres.
Results: In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk
individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management
at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral
was long travel distance and the associated direct and indirect costs. Human resources trained included 34
ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment acquired included
a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras.
Conclusions: DR screening can be implemented in a resource-limited setting by integrating with the general
primary healthcare system. However, geographic barriers stymie delivery of therapeutic services and we need
to establish models to bring these services closer to areas with poorer access.