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Keywords:

  • diabetes;
  • diabetic maculopathy;
  • diabetic retinopathy;
  • Fiji;
  • Indian;
  • Melanesian

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.

Conclusion:  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.