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Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 50-52

Rate of diabetic retinopathy among the diabetic patients with a best corrected visual acuity of 6/9 or better

1 Department of Surgery, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
2 Council of Ophthalmology, Sudan Medical Specialization Board, Sudan
3 Council of Ophthalmology, Sudan Medical Specialization Board, Khartoum, Sudan

Date of Web Publication17-Dec-2015

Correspondence Address:
Rawya Abdelhadi Diab
U of K, Faculty of Medicine, P.O. Box: 102
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1858-6538.172096

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Background: Diabetic retinopathy is one of the leading causes of blindness worldwide, broadly it is defined as a complication of diabetes that affects the retina; by damaging its blood vessels, which at first may be symptomless, though eventually can lead to serious and sight-threatening complications like hemorrhages, macular edema, and even blindness.
Aim: The study aimed at detecting the presence of diabetic retinopathy in the diabetic patients having a best corrected visual acuity “BCVA” of 6/9 or better, attending Retina Clinic in Elsaiem Eye Hospital, to prove a hypothesis' that states: diabetic patients with a BCVA of 6/9 or better are unlikely to have a diabetic retinal complications, and if found they rarely need intervention.
Results: Six hundred and eighteen eyes were included in the study; 59.2% of the eyes with BCVA 6/9, 75.6% of the eyes with BCVA of 6/6, and 86.2% of the eyes with BCVA 6/5 were found to have neither diabetic retinopathy nor maculopathy.
Conclusion: As it can be stated out of the results; the better the visual acuity than 6/9 the lesser the prevalence of diabetic retinopathy, so visual acuity “among other factors” could be considered as one of the simple screening methods or predictors of the diabetic retinopathy that is of great importance in developing countries with minimal facilities and resource-poor settings.

Keywords: Best correct visual acuity, blindness, diabetes, diabetic retinopathy, maculopathy

How to cite this article:
Salim MA, Diab RA, Elshafie SA. Rate of diabetic retinopathy among the diabetic patients with a best corrected visual acuity of 6/9 or better. Albasar Int J Ophthalmol 2015;3:50-2

How to cite this URL:
Salim MA, Diab RA, Elshafie SA. Rate of diabetic retinopathy among the diabetic patients with a best corrected visual acuity of 6/9 or better. Albasar Int J Ophthalmol [serial online] 2015 [cited 2023 Sep 27];3:50-2. Available from: https://www.bijojournal.org/text.asp?2015/3/2/50/172096

  Introduction Top

Diabetes is a common metabolic disorder with a worldwide prevalence of 8.3% and is the leading cause of visual loss.[1] Diabetic retinopathy may be the most common microvascular complication of diabetes.[2]

Many researches were done and were being done aiming at understanding the mechanisms of occurrence of diabetic retinopathy, finding ways of prevention and early detection, and also at finding the most effective ways of the intervention of treatment and even curability.

Objectives and justifications

This study generally aims at reporting on the prevalence of diabetic retinopathy among eyes of diabetic patients with a best corrected visual acuity of 6/9 or better and

to prove that a visual acuity could be one of the good methods of simple screening.

According to the early diabetic retinopathy study, patients with a visual acuity of better than 6/12 and having diabetic changes, usually will be observed, and given advice regarding controlling their diabetes strictly, lifestyle modifications, and controlling the other risk factors; an intervention is mostly indicated when the best corrected visual acuity is less than 6/12. Based on that, a diabetic patient with a visual acuity of 6/9 or better is usually not expected to have diabetic retinopathy or maculopathy, and even if found to have, the patient will not need intervention directly, and they will be referred to the diabetes clinic to control the blood sugar and other comorbid disease, hence these patients will not get benefit from attending the retina specialized clinic, expect in specific circumstances.

Literature review

Diabetes is a significant, worldwide burden that has dramatically increased in recent years with no evidence of the trend abating.[3] The global epidemic of diabetes is a serious and a major health care concern that results in reduced life expectancy and increased morbidity due to disease-specific micro- and macro-vascular complications.[4] Diabetic retinopathy is a common and specific microvascular complication of diabetes and remains the leading cause of preventable blindness in working-aged people.[5]

A positive association between visual acuity and diabetic retinopathy is pointed out by Klein K, et al. (2010) and other reviews as more visual loss is associated with more severe retinopathy.[6] In another hospital-based cross-sectional study, conducted from October 2004 to October 2006 at the Department of Ophthalmology of the Douala General Hospital, Cameroon, they found that the degree of visual impairment was increased with the severity of retinopathy (P < 0.0001), as well as that of maculopathy (P < 0.0001).[7]

As the retina clinic are sometimes overloaded, there are ongoing researches to find screening methods to filter the cases ending up by referring the patient whom need to be seen by the retina specialist. The most updated method of screening now is the teleretinal imaging, and researchers are now evaluating the efficiency of teleretinal images. In a study done to assess the accuracy of a technology-assisted eye exam in the evaluation of referable diabetic retinopathy and concomitant ocular diseases, they concluded that there was a moderate-to-substantial agreement between a technology-assisted eye TAE exam and a comprehensive eye exam for referable ocular findings in patients with diabetes. Ungradable exams were a frequent marker of ocular pathology. Teleretinal imaging may be a useful evaluation for both diabetic and nondiabetic ocular conditions.[8]

  Materials and Methods Top

Study design

Retrospective study.

Study area

Retina Clinic, Elsaiem Eye Hospital, Madani, Gezira State, Sudan, 2007 – July 2014.

Study population

Diabetic patients with a BCVA of 6/9 or better whom are attending retina clinic.

Exclusive criteria

  • Nondiabetic patients
  • Diabetic patients with a visual acuity of worse than 6/9 in both eyes.

Best corrected visual acuity was examined using Snellen charts; fundus examination was done “after giving dilating drops” by the 90D lens and slit lamp biomicroscopy.

Classification (National screening committee recommendations for grading and management of retinopathy)[9]

  • R: “Retinopathy”
  • R0: No diabetic retinopathy “DR”
  • R1: DR but not R2 or R3
  • R2: Presence of IRMA, venous bleeding, venous loops, multiple deep round retinal hemorrages in four quadrants “± CWS”
  • R3: Presence of proliferative DR
  • M: “Maculopathy”
  • M0: No Maculopathy
  • M1: Presence of exudates within 1DD of center of fovea; circinate or group of HE within the macula; thickening within 1DD of center of fovea; MA or hemorrhage within 1DD of center of fovea
  • P: “Laser”
  • P0: No laser scars
  • P1: Grid focal or panretinal photocoagulation.

  Results Top

Six hundred and eighteen eyes were included in this study; 233 eyes with BCVA of 6/9, 189 eyes with BCA of 6/6, and 196 eyes with BCVA of 6/5.

Of the 233 eyes with BCVA of 6/9, 138 “59.2%” were found to have no DR or maculopathy, and 95 “40.8%” were found to have different degrees of retinopathy and/or maculopathy; as follows: 29 “12.4%” R1, 6 “2.5%” R2, zero “0.0%” R3, 25 “10.7%” M1, 21 “8.5%” R1M1, 11 “4.7%” R2M1, and 3 “1.2%” R3M1.

Of the 189 eyes with BCVA 6/6, 143 “75.6%” were found to have no DR or maculopathy and 46 “24.4%” were found to have different degrees of retinopathy and/or maculopathy; as follows: 17 “8.9%” R1, 8 “4.2%” R2, zero “0.0%” R3, 3 “1.5%” M1, 10 “5.2%” R1M1, 6 “3.1%” R2M1, and 2 “1%” R3M1.

Of the 196 eyes with BCVA of 6/5, 169 “86.2%” were found to have no DR or maculopathy and 27 “13.8%” were found to have different degrees of retinopathy and/or maculopathy; as follows: 10 “5.1%” R1, 3 “1.5%” R2, 1 “0.5%” R3, 9 “4.5%” M1, 1 “0.5%” R1M1, 3 “1.5%” R2M1, and zero “0.0%” R3M1.

  Conclusions and Recommendations Top

A best corrected visual acuity of 6/9 or better in a diabetic patient could be a predictive clue that possibly there are no retinal impairments, a simple cost-effective way of screening that is of great value, especially in developing countries and remote areas.

There is genuine need to promote the role of the primary health centers, so only selected patients “those who are really in need to be seen and will really get benefit” shall attend and get the service in retina clinic by the retina specialist, so that the resources of the clinic not to be unreasonably wasted, as well as the efforts of the working staff personnel.

It is hoped that an agreement to signed with the insurance companies to develop an insurance system that organizes and regulates the patient's follow-ups, so that the patients will be obligated to their scheduled visits and should be aware that it is not allowed to be incompliant and miss the scheduled visits; this in the long-term will help avoiding serious complications which have a poorer prognosis, and in addition, usually cost a lot to be managed than a regular checkups and early interventions.

Telemedicine programs have to be revolutionized with a well-trained, well equipped staff to help in providing service by filtering the cases, starting by simple screening methods, “i.e., visual acuity, etc.,” in the hope of ever continuing upgrading of the system with the introduction of the most updated facilities like teleretinal imaging and other sophisticated methods, to keep in pace with and even compete the international standards.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kwak SH, Park KS. Genetic studies on diabetic microvascular complications: Focusing on genome-wide association studies. Endocrinol Metab (Seoul) 2015;30:147-58.  Back to cited text no. 1
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008;26:77-82. Available from: http://www.clinical.diabetesjournals.org/content/26/2/77.full. [Last accessed on 2015 Dec 11].  Back to cited text no. 2
Tapley JL, McGwin G Jr., Ashraf AP, MacLennan PA, Callahan K, Searcey K, et al. Feasibility and efficacy of diabetic retinopathy screening among youth with diabetes in a pediatric endocrinology clinic: A cross-sectional study. Diabetol Metab Syndr 2015;7:56.  Back to cited text no. 3
Maghbooli Z, Pasalar P, Keshtkar A, Farzadfar F, Larijani B. Predictive factors of diabetic complications: A possible link between family history of diabetes and diabetic retinopathy. J Diabetes Metab Disord 2014;13:55.  Back to cited text no. 4
Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010;376:124-36.  Back to cited text no. 5
Moss SE, Klein R, Klein BE. Ten-year incidence of visual loss in diabetic population. PubMed 1994;101(6):1061-70.  Back to cited text no. 6
Jingi AM, Nansseu JR, Noubiap JJ, Bilong Y, Ellong A, Mvogo CE. Diabetes and visual impairment in sub-Saharan Africa: Evidence from Cameroon. J Diabetes Metab Disord 2015;14:21.  Back to cited text no. 7
Conlin PR, Asefzadeh B, Pasquale LR, Selvin G, Lamkin R, Cavallerano AA. Accuracy of a technology-assisted eye exam in evaluation of referable diabetic retinopathy and concomitant ocular diseases. Br J Ophthalmol 2015;99:1622-7.  Back to cited text no. 8
Denniston KO, Murray I. Oxord handbook of ophthalmology. 1st ed., 2006. p. 419.  Back to cited text no. 9


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