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Correspondence:

Inger Christine Munch

Department of Ophthalmology

Glostrup Hospital

Nordre Ringvej 59

DK-2600 Glostrup

Denmark

Tel: + 45 38634811

Fax + 45 38634669

Email: icm@dadlnet.dk

Awareness of diabetic

retinopathy among

diabetic patients in Nepal

Raba Thapa,1 Govinda Paudyal,1

Nhukesh Maharjan1 andPaul S. Bernstein2

1Tilganga Institute of Ophthalmology,Kathmandu, Nepal2Moran Eye Center, University of

Utah, Salt Lake City, Utah, USA

doi: 10.1111/j.1755-3768.2011.02163.x

Dear Editor,

D iabetes mellitus is a chronic dis-ease with increasing prevalence

worldwide. Among the total diabeticpatients expected in 2030, half will bein Asian countries (Wild et al. 2004).This increase has been attributed tothe rapid economic, demographic, andnutritional transition in the developingcountries (Wild et al. 2004). Almostone-fourth of people 20 years andolder and one-third 40 years and olderin urban areas of Nepal exhibited dia-betic tendencies in one population-based study from Nepal (Singh &Bhattarai 2003), and now diabetes isconsidered as an epidemic healthproblem there. Urbanization, chang-ing dietary patterns from a roughfiber diet to a more refined one with

abundant fatty foods, and an increas-ingly sedentary life style are likely tocontribute to additional cases in thefuture. Likewise, the tradition ofexcessive feeding of fatty and sweetfoods following delivery appears tohave increased obesity and diabeticpredisposition in women in Nepalesesociety (Singh & Bhattarai 2003).

Diabetic retinopathy (DR) is one ofthe common complications of diabetesmellitus. As in developed countries,DR could soon become one of themost common causes for blindness indeveloping nations like Nepal. Nepal’ssituation is compounded by a low lit-eracy rate and presumed lack ofawareness of diabetic ocular complica-tions. Since early detection and timelyocular treatment may prevent manyof the blinding ocular complication ofdiabetes, enhanced awareness of thesecomplications among diabetic patientsand the general public could be aneffective public health measure. Previ-ous population-based and secondaryhealth care level studies from Nepalhave shown that only 50% of the dia-betic patients were aware of potentialdiabetic ocular complications (Shres-tha et al. 2007; Paudyal et al. 2008).When we surveyed new diabeticpatients who presented to a tertiaryeye care center in Nepal for ophthal-mic evaluation, we found that 37% ofpatients were unaware of diabetic ocu-lar complications even though amajority of the patients had beenreferred for further evaluation andmanagement. Our unawareness ratewas substantially higher than ratesreported in studies from neighboringcountries (Saikumar et al. 2007).

In our series, almost half of thepatients were illiterates who must relyon non-print sources for informationon DR. Only half of those who wereaware of diabetic ocular problemsreceived their information from pri-mary care physicians or from thereferring ophthalmologist. This mayreflect the small amount of timephysicians and ophthalmologists candevote to discussion of diabeticcomplications with patients in adeveloping country with a low doctor-to-patient ratio. The other majorsource of awareness was from familymembers, especially since one-third ofcases had a positive family history inat least one-first-degree relative, pre-

sumably due to genetic predispositionand common environmental factorssuch as food habits and lifestyle.Media (magazines and radio) playeda less important role in disseminatinginformation in our patient group, incontrast to the study by Saikumaret al. (2007) in which media was themain source for awareness. This find-ing emphasizes the need for bettermedia coverage to spread the aware-ness in our country.

Although 51% of the total diabeticpatients had a history of diabetes ofmore than 10 years duration, almosthalf of the subjects had never evenhad a fundus evaluation prior to theirinitial visit to the Tilganga Institute ofOphthalmology. Improved awarenesscampaigns and increased collabora-tion with primary-care physicians andcomprehensive ophthalmologists toensure timely and regular referrals ofat-risk patients are imperative toreduce DR related blindness in coun-tries such as Nepal.

ReferencesPaudyal G, Shrestha MK, Meyer JJ, Thapa

R, Gurung R & Ruit S (2008): Prevalence

of diabetic retinopathy following a commu-

nity screening for diabetes. Nepal Med Coll

J 10: 160–163.

Saikumar SJ, Giridhar A, Mahesh G, Elias A

& Bhat S (2007): Awareness about eye dis-

eases among diabetic patients: a survey in

South India. Community Eye Health 20:

16–17.

Shrestha S, Malla OK, Karki DB & Byanju

RN (2007): Retinopathy in a diabetic pop-

ulation. Kathmandu Univ Med J 5: 204–

209.

Singh DL & Bhattarai MD (2003): High

prevalence of diabetes and impaired fasting

glycemia in urban Nepal. Diabet Med 20:

170–171.

Wild S, Roglic G, Green A, Sicree R &

King H (2004): Global prevalence of dia-

betes: estimates for the year 2000 and

projections for 2030. Diabetes Care 27:

1047–1052.

Correspondence:

Dr. Raba Thapa

Tilganga Institute of Ophthalmology

Kathmandu

Nepal

Tel: + 977-1-4493775

Fax: + 977-1-4474937

Email: raba_thapa@hotmail.com

Acta Ophthalmologica 2012

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