title: Diabetic eye disease among adults in Fiji with self-reported diabetes.
abstract: BACKGROUND
  To characterize diabetic eye disease and its management among adults aged ≥40 years with self-reported diabetes in Fiji.
  
  
  METHODS
  During a population-based cross-sectional survey using multistage cluster random sampling, participants reported health information, including whether a doctor had diagnosed diabetes. HbA1c and visual acuity were measured. Diabetic eye disease was assessed using 90-dioptre lens dilated funduscopy.
  
  
  RESULTS
  Of those enumerated, 1381 (73.0%) participated, with 222 reporting diabetes. Twenty fundi were not examined (19 due to cataract). Of the remaining 424 eyes, 75.5% had no diabetic disease, 1.2% had proliferative retinopathy, 7.5% had active significant maculopathy and 0.7% had burnt-out/treated disease. By person, 27.2% had retinopathy and/or maculopathy in at least one eye. Mean HbA1c (9.9 ± 2.3%) for this group was significantly higher (P = 0.004) than for those without eye disease. Vision-threat occurred in at least one eye of 11.5%. Diabetes (predominantly maculopathy) caused pinhole acuity <6/18, <6/60 and <3/60 for 3.8%, 1.1% and 0.7% of eyes, respectively. No person was bilaterally blind (<6/60) due to diabetes, but 2.3% (all on oral antiglycaemics alone) were 6/60 bilaterally. Compared with recent diabetes diagnosis, diagnosis >10 years ago was predictive of any (odds ratio [OR] 8.13; 95% confidence interval [CI] 3.28-20.21; P < 0.001) and vision-threatening (OR 5.25; 95% CI 1.71-16.12; P = 0.004) eye disease. Although 80.6% claimed regular general diabetes checkups, only 36.5% recalled previous dilated ocular examination. Four eyes had received laser treatment.
  
  
  CONCLUSIONS
  There was evidence of failure of management of diabetes and its eye complications. Both need to be improved if increasing diabetes-related visual disability is to be avoided.
authors.affiliation: The Fred Hollows Foundation New Zealand, Auckland, New Zealand. grbrian@tpg.com.au
authors.forename: Garry
authors.initials: G
authors.lastname: Brian
authors.forename: Konstanze
authors.initials: K
authors.lastname: Fischer-Harder
authors.forename: Biu
authors.initials: B
authors.lastname: Sikivou
authors.forename: Mundi Qalo
authors.initials: MQ
authors.lastname: Qoqonokana
authors.forename: John
authors.initials: J
authors.lastname: Szetu
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ramke
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000208:ethnology; D005367:Fiji / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D010865:Pilot Projects; D012720:Severity of Illness Index; D014792:Visual Acuity; D000095188:Pacific Island People
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human