title: A simple integrated primary health care based model for detection of diabetic retinopathy in resource-limited settings in Pakistani population.
abstract: OBJECTIVE
  To find out prevalence of Diabetic Retinopathy in general population of three districts in Pakistan.
  
  
  METHODS
  A community based cross-sectional survey was conducted in three large districts of Pakistan namely Rawalpindi in Punjab, Peshawar in Khyber Pakhtoonkhwa and Hyderabad in Sindh between January 2013 and August 2015. Lady Health Workers identified individuals at high risk for diabetes based on pre-defined criteria. High risk population was tested for dysglycemia. Fundoscopic evaluation for evidence of DR was performed in all individuals with a random blood glucose >190mg/dl. Individuals with the evidence of DR were referred to affiliated tertiary care ophthalmology departments.
  
  
  RESULTS
  A total of 42,629 individuals reported at the project sites and 63% (n=26,859) were female. Fifty one percent (n=21,989) individuals met high risk criteria. Out of these 21,989 individuals, dysglycemia was found in 3,869 (17.6%). Fundoscopy showed evidence of DR in 1,042 (27%) individuals. Amongst high risk population, dysglycemia was significantly more common in females as compared to males. The frequency of DR in dysglycemic patients was comparable across both gender groups.
  
  
  CONCLUSIONS
  The prevalence of DR in Pakistani population is alarmingly high. This preventable cause of blindness is largely undiagnosed in our population and a simple integrated model based on primary health care facilities can help identify and treat a large population of DR patients.
authors.affiliation: Prof. Ali Jawa, MD, MPH, DABIM, FACE. Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, Pakistan.
authors.forename: Ali
authors.initials: A
authors.lastname: Jawa
authors.affiliation: Muhammad Zaman Khan Assir, FCPS. Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, Pakistan.
authors.forename: Muhammad Zaman Khan
authors.initials: MZ
authors.lastname: Assir
authors.affiliation: Syed Hunain Riaz, FCPS. Wilshire Cardiovascular and Endocrine Center of Excellence (WILCARE), Lahore, Pakistan.
authors.forename: Syed Hunain
authors.initials: SH
authors.lastname: Riaz
authors.affiliation: Rashin Chaudhary, MPH. Fred Hollows Foundation, Islamabad, Pakistan.
authors.forename: Rashin
authors.initials: R
authors.lastname: Chaudhary
authors.affiliation: Farooq Awan, MPH, M.COM, MBA. Fred Hollows Foundation, Islamabad, Pakistan.
authors.forename: Farooq
authors.initials: F
authors.lastname: Awan
authors.affiliation: Prof. Javed Akram, MD, MRCP, FRCP, FRCP, FACP, FACC, FASIM. Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, Pakistan.
authors.forename: Javed
authors.initials: J
authors.lastname: Akram
keywords: Blindness; Diabetes Mellitus; Diabetic Retinopathy; Lady Health Workers; Pakistan