Andrea Pedroza-HW1

Andrea Pedroza-HW1

by Andrea Pedroza Tobias -

Diabetic retinopathy is a common complication of diabetes and one of the leading cause of blindness in Mexico. Early diagnosis and treatment of retinopathy can prevent vision loss. According to a study performed in the south of Mexico, it was estimated that 38% of people with diabetes had diabetic retinopathy. There is not information at the national level about the prevalence of retinopathy. However, these results are consistent with other small studies.  Considering the national prevalence of diabetes in Mexico is 14.4%, it is possible that 7% of the population have diabetic retinopathy. 

The American Diabetes Association recommends yearly eye examination in patients with diabetes. However, in Mexico, according to the National Health and Nutrition Survey 2012, only 8.5% of people with diabetes reported have had an ophthalmologic examination in the past year. 

Re: Andrea Pedroza-HW1

by Lina -

Hi Andrea - interesting problem you’ve described here. If I’m understanding correctly, evidence suggests that patients who are diabetic have an increased risk of developing retinopathy. It’s possible to prevent retinopathy by catching it early, which is why the American Diabetes Association recommends annual exams. Is there evidence that the “recommendation” intervention works to prevent retinopathy in the US? And if it does, do you think that the efficacy of implementing this recommendation would generalize to Mexico?

Lina

Re: Andrea Pedroza-HW1

by Timothy -

Hi Andrea,

What intervention might you propose to address this gap? Is the major problem with screening and thus interventions need to be targeted at access to eye exams? Or in upstream diabetes detection? or diabetes management?

Best,

Tim

Re: Andrea Pedroza-HW1

by Andrea Pedroza Tobias -

Hi Tim, 

Thank you for your question. I think that the intervention to prevent diabetic retinopathy have many steps. 

The first one is the early diagnosis and adequate treatment of diabetes to reduce the risk factors for DR.

Second, to increase the access to eye exams, it could be performing national campaigns of screening for early diagnosis of retinopathy, which could be done with a telemedicine system using mobile units, as the one I previously mentioned.  

However, it will continue the gap between diagnosis and treatment, I am not sure which intervention could be done. I think that it requires more studies evaluating the perceived barriers to getting treatment, especially in those with low access to health care services. 


Re: Andrea Pedroza-HW1

by Teresa Kortz -

Hi Andrea,

Do you have any sense for why people with diabetes are not receiving ophtho exams? Is it an issue of knowledge, access, willingness, availability, financial costs, opportunity costs...? Also, in Mexico is diabetes care integrated into primary care or is it delivered via specific clinics/providers? If someone is diagnosed with retinopathy, what are the options for treatment?

-Teresa

Re: Andrea Pedroza-HW1

by Andrea Pedroza Tobias -

Hi Teresa, 

Thank you for your questions. I think that the main problem is the lack of access and ophthalmologic specialists in the primary care. Diabetes patients are attended in the primary care,  but if the patient has any complication is referred to the second or third level of attention. 

Depending on the type of diabetic retinopathy, they receive follow up every 6-12 months and treatment to reduce risk factors (first level of attention), retinal photocoagulation laser (second level of attention) or surgery (third level of attention).   

Re: Andrea Pedroza-HW1

by Andrea Pedroza Tobias -

My apologies, I just realized that I didn't paste my homework complete. Here is again:


Diabetic retinopathy is a common complication of diabetes and one of the leading cause of blindness in Mexico. Early diagnosis and treatment of retinopathy can prevent vision loss. According to a study performed in the south of Mexico, it was estimated that 38% of people with diabetes had diabetic retinopathy. There is not information at the national level about the prevalence of retinopathy. However, these results are consistent with other small studies.  Considering the national prevalence of diabetes in Mexico is 14.4%, it is possible that 7% of the population have diabetic retinopathy. 

The American Diabetes Association recommends yearly eye examination in patients with diabetes. However, in Mexico, according to the National Health and Nutrition Survey 2012, only 8.5% of people with diabetes reported have had an ophthalmologic examination in the past year. 

One of the barriers of the low assessment of ocular evaluation could be the lack of equipment and specialist to perform the evaluation, and/or the lack of knowledge in the primary care about the necessity of the ophthalmologic assessment. 

To increase the access to early diagnosis of retinopathy, we developed a project, with the main objective to propose a National Screening program for prevention of eye complications of diabetes in communities with lack access to health services. 

We screened for diabetes and eye complication to 11,429 subjects from three rural communities of Mexico and 17.4% were diagnosed with diabetes. Through a telemedicine system, subjects with impaired glucose had an ocular evaluation to detect retinopathy.  The data collected was sent through a telemedicine system to the Hospital of the Association for the Prevention of Blindness in Mexico (HAPBM), where ophthalmologists conducted the diagnosis. The results were delivered to the subjects and were referred to the hospital HAPBM for treatment. However, one of the limitations of this study is that the clinic is far away from the communities (around 1 or 2 hours) and therefore, people decided not to go to the clinic. In order to increase the response rate of the population, we offered free transportation, but it was not enough to increase the response rate of the population (less than 25% of people with diabetic retinopathy attended). Furthermore, the cost of the treatment is not completely covered by the institution. Patients filled a socioeconomic evaluation in the clinic, and depending on the results, they will have to pay some percentage of the treatment, but it could be covered 100% by the institution. 

We have two main gaps in the prevention of blindness due to retinopathy in Mexico. The first is the low rates of screening for DR and diagnosis, and the second one is that once they are diagnosed, the early treatment could be jeopardized for lack of specialists or equipment, the lack of access to specialized healthcare units in the communities or the lack of health insurance that cover the treatment.