Mash B., Powell D., du Plessis F., van Vuuren U., Michalowska M., Levitt N.
Division of Family Medicine and Primary Care, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, W Cape, South Africa; Eye Care Services, Cape Town Metropolitan District Health Services, South Africa; Cape Town Metropolitan District Health Services, South Africa; Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa
Mash, B., Division of Family Medicine and Primary Care, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, W Cape, South Africa; Powell, D., Eye Care Services, Cape Town Metropolitan District Health Services, South Africa; du Plessis, F., Eye Care Services, Cape Town Metropolitan District Health Services, South Africa; van Vuuren, U., Cape Town Metropolitan District Health Services, South Africa; Michalowska, M., Cape Town Metropolitan District Health Services, South Africa; Levitt, N., Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa
Background and aims. In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness, and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time such a service has been evaluated in an African primary care context. Methods. The service was implemented as an operational research study at three community health centres and data were collected to evaluate the operational issues, screening, reporting and referral of patients. Results. Out of 400 patients screened 84% had a significantly reduced visual acuity, 63% had retinopathy (22% severe non-proliferative, 6% proliferative and 15% maculopathy), 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% of cases for cataracts, in 7% for laser treatment and in 4% for other specialist services. Repeat photography was needed in 8% and urgent follow-up in 12%. A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system. Conclusion. Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10 000 patients a year.
adult; article; cataract; controlled study; diabetic retinopathy; disease severity; feasibility study; female; follow up; health care quality; health center; human; low level laser therapy; major clinical study; male; medical specialist; mobile fundal camera; ophthalmoscopy; patient referral; pilot study; primary medical care; retina maculopathy; screening test; South Africa; visual acuity; Adult; Diabetic Retinopathy; Diagnostic Techniques, Ophthalmological; Equipment Design; Female; Follow-Up Studies; Fundus Oculi; Humans; Incidence; Male; Mass Screening; Middle Aged; Photography; Pilot Projects; Primary Health Care; Reproducibility of Results; Retina; South Africa