title: Screening in Primary Care for Diabetic Retinopathy, Maculopathy and Visual Loss in South Africa.
abstract: OBJECTIVE
  The aim of the study was to determine the prevalence of diabetic retinopathy, maculopathy and visual loss in primary care patients and to identify associated risk factors.
  
  
  METHODS
  We conducted a cluster randomised trial at primary care clinics in the Tshwane district in South Africa. Grades of retinopathy and maculopathy (with fundus camera) and visual acuity (Snellen chart) were assessed and, using mobile screening and teleophthalmology, clinical and biochemical testing was conducted to obtain information about glycaemic control and microvascular complications.
  
  
  RESULTS
  The prevalence rates for any retinopathy, preproliferative retinopathy and proliferative retinopathy were 24.9, 19.5 and 5.5%, respectively. The prevalence rates of diabetic maculopathy, observable maculopathy and referable maculopathy were 20.8, 11.8 and 9.0%, respectively. The presence of retinopathy was associated with high body mass index, systolic blood pressure, being on insulin treatment, high HbA1c and the presence of neuropathy. High systolic blood pressure, being on insulin treatment, high HbA1c level and high low-density lipoprotein cholesterol level as well as the presence of albuminuria were significant in predicting any diabetic maculopathy. Laser photocoagulation was given to 8.3% of patients from the mobile unit and 12% of patients were referred to the nearest hospital with an outpatient eye clinic for follow-up treatment of various other eye conditions. Using the WHO categories, the study found that 78.1% of diabetes patients had normal vision, 19.3% were visually impaired and 2.2% were severely impaired or blind.
  
  
  CONCLUSIONS
  High prevalence rates for diabetic retinopathy, maculopathy and visual loss were found and associations were identified.
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Webb
authors.forename: Paul
authors.initials: P
authors.lastname: Rheeder
authors.forename: Polla
authors.initials: P
authors.lastname: Roux
mesh_terms: D000419:Albuminuria / Q000453:epidemiology; D001766:Blindness / Q000453:epidemiology*; D001794:Blood Pressure; D015992:Body Mass Index; D016000:Cluster Analysis; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D012164:Retinal Diseases / Q000453:epidemiology*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D015354:Vision, Low / Q000453:epidemiology*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human