Screening for diabetic retinopathy by indigenous health workers

J. E. Keeffe, C. A. McCarty, M. J. Doyle

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose. The indigenous population of Australia (Aboriginal and Torres Strait Islanders - ATSI) have ten times the prevalence of impaired vision and at least double the prevalence of diabetes in comparison with the non-ATSI population. The aim is to determine the effectiveness of local ATSI people in identifying and referring people with impaired vision to plan the eye care needs of their communities. The focus of the project is diabetes-related eye disease. Methods. ATSI people from one rural community have been trained in the use of the non-mydriatic retinal camera, to test visual acuity and to obtain blood samples to measure the level of glycosylated haemoglobin (HbAlc). All people over the age of 5 years have visual acuity tested; people £30 years have HbAlc tested; and all diabetics have retinal photographs taken. Results. To date, 98% (185/189) of the community members have participated in the vision screening. One hundred and two eyes of 52 people have been photographed with the non-mydriatic retinal camera; 87% are of diagnostic quality. The majority of people with diabetes (83%, 5/29) are NIDDM. Diabetic retinopathy is evident in 14% of people with diabetes. The mean HbAlc was 8.5 (SD=2.1) in ATSI people with diabetes and 5.4 (SD = 0.5) in ATSI people without diabetes. Controlling for the presence of diabetes, the mean HbAlc level is no different between the ATSI community and a random sample of three rural (primarily Caucasian) Victorian communities (p = 0.97). Conclusions. The indigenous health workers have attained skills to identify people in need of eye care services. The relatively low prevalence of diabetic retinopathy in people with diabetes may be due to the reduced life expectancy of ATSI people. Despite the greater prevalence of diabetes in ATSI, the HbAlc levels in people with and without diabetes were similar in both populations.

Original languageEnglish (US)
Pages (from-to)S236
JournalInvestigative Ophthalmology and Visual Science
Volume38
Issue number4
StatePublished - Dec 1 1997

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