Year : 2016 | Volume : 4 | Issue : 2 | Page : 85 - 88  

Original Articles
To evaluate the awareness of diabetic retinopathy in self reported diabetic patients attending tertiary care centre in rural Telangana

Raghu V1, Shruthi T2, Saidivya R3, Rohini M4

1 Professor & HOD, Department of Ophthalmology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar

2, 3 & 4 P. G. Residents, Department of Ophthalmology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar

Corresponding Author:

Dr. Raghu V




Background &Objective: To evaluate awareness of diabetic retinopathy in self reported diabetic patients attending tertiary care centre in rural Telangana.

Methods: This was a prospective study conducted on 215 diabetic patients attending department of ophthalmology (Chalmeda Anand Rao Institute of Medical Sciences) which included questionnaire and analysis of patients based on age, duration of diabetes mellitus (DM), education level and presence of diabetes.

Results: Out of 215 patients (63% men, 37% female) participated in the study. Through analysis, results showed were 83% were aware of diabetic eye disease (DED), 60% knew the relationship between diabetic eye disease (DED) and diabetes. 50% go to eye checkups regularly and 53% had their vision affected.

Conclusions: Patients with longer diabetes mellitus duration and more educated had marginally better awareness.

Keywords: Diabetic retinopathy, awareness, self reported diabetic patients, diabetic eye disease.



The World Health Organization estimates that 45 million people are blind worldwide, yet an estimated 80 per cent of the blind suffer needlessly. Millions could be cured because their blindness is caused by conditions that are easily treatable or preventable (Kenneth, 2009).(1) With worldwide estimated 2.5 million blind people diabetic retinopathy emerges as the 4th leading cause of avoidable blindness accounting for approximately 5% of blindness.

Studies have shown that maintaining near-normal blood sugar can decrease your chance of developing retinopathy and can help keep existing retinopathy from getting worse (John, 2010).(2)

Routine screening offers the best hope for early detection of diabetic retinopathy. People with type 1 diabetes should have a complete eye exam within five years of diagnosis; those with type 2 should have an eye exam at the time their diabetes is diagnosed. After these initial exams, all people with diabetes should have an eye exam at least once a year. (WebMD, 2010). (3)

Blindness from diabetic retinopathy is a preventable complication of diabetes if the retinopathy is detected early. Among other approaches, strong awareness of retinopathy by diabetic patients could help in the early detection, management and prevention of this complication (Mohammed, 2009).(4) Without awareness of the disease it is impossible for any individual to aid the cause of preventing blindness from Diabetic Retinopathy, either in him or herself or in the community as a whole (Kaliyaperumal, 2004).(5) According to a research done in India, the results showed that 49.9% had knowledge of diabetes mellitus and 37.1% had knowledge of diabetic retinopathy. Knowledge about diabetes mellitus was more in women. Regarding practice patterns only 36.5% of individual with knowledge about diabetic retinopathy, believed that if they controlled their blood sugar, they could avoid a visit to an ophthalmologist, compared with 55.5% with no knowledge (Rani et al, 2008).(6)

For eye care programmes to be effective, they require that persons with diabetes are aware of the sight-threatening potential of diabetes and the need for regular eye examinations. Appropriate eye health education may encourage people at risk to seek timely and appropriate care. This will require developing educational materials that are regionally and culturally appropriate, and an understanding of current knowledge, attitudes and practices in the community (Dandona et al., 2001).(7) It is important to create awareness of diabetic retinopathy in self reported diabetic patients attending tertiary eye care centre.



Study Design

This was a prospective study of diabetic patients performed at tertiary care centre between august 2014 to july 2015.


This study was done in department of ophthalmology in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar with ethical approval from the ethical committe.

Patient Selection

All diabetic patients coming to ophthalmology department were taken for study with their informed consent.

Patients were interviewed under structural questionnaire. Eyes were examined under slit-lamp and retina examination was done for diabetic fundus .

Complete analysis was done based on age, DM duration, education level, presence of DR .

Inclusion Criteria

Both sexes

Age > 10

Educational backgrounds – illiterates to graduate

DM duration - < 1 yr to > 35 yrs

Exclusion Criteria

Age - < 10 yrs




A total of 215 patients ( 117 men, 98 women) participated in the study (Table 1). In terms of occupation, 17% were farmers, 20% were business men and women, 20% had different professions e.g. teachers, 30% were stay at home parents while 13% did not respond to that question. Most of the respondents (40%) were diagnosed with diabetes between ages 41 and 50 years, 20 % between ages 51 and 60 years and 17% between ages 31 and 40 years old.





Table 1: Characteristics of participants




























Business persons



Professional (eg. teacher)



Stay at home parents



                                                   Age diagnosed with                           diabetes























In regards to knowledge and awareness, 83% of the respondents had heard of diabetic eye disease (DED), while 17% had never heard of it. Sixty percent (60%) of those who had heard of DED, knew the relationship between DED and diabetes. Only 50% of all the respondents went for eye checkups while 47% did not go for eye checkups. Of the 50% who go for eye checkups, 27% of them went once a year, 10% went twice a year while 17% of them went for monthly check ups. Out of the 30 participants, 53% of them had had their vision affected in one way or another.

Table 2: Questionnaire regarding knowledge and awareness

  1. No

Knowledge and awareness



Have you ever heard about diabetic disease?

Yes                  83%

No                    17%


If yes, do you know the relationship between diabetic eye disease and diabetes?

Yes                   60%

No                    40%


Do you go for eye checkups?

Yes                   50%

No                   40%


If yes, how often?

Once a year      27%

Twice a year    10%

Monthly             17%


How was your vision been affected?

Yes                   53%

No                   45%

In terms of gender and knowledge/awareness, out of 83% of those who heard of diabetic eye disease 60% were female while 23% were male. 53% of the respondents had their eye sight affected one way or the other.



A number of health awareness studies have been performed in developing countries (James et al, 2008)(8), however Very limited literature exists on the knowledge and awareness of diabetic retinopathy amongst people with diabetes in India. The results of our study suggest that not only knowledge but also best disease practice were less than satisfactory.

A study conducted in Myanmar revealed that only 49% of general practitioners examined their diabetic patients’ eyes. Possible reasons for this were postulated to be a lack of ophthalmoscopy equipment, a lack of familiarity with ophthalmoscopic fundal examination techniques, a lack of familiarity with the ophthalmic signs of diabetes and the time constraints of a busy urban practice.(9)

The study in Myanmar found that 34% of patients only decided to go for an exam once they had developed problems with their eyesight.(9,10) Cultural beliefs also played a role(10), as did poor physician-patient communication(10) and poor literacy.(10) Other reasons included the belief that laser treatment was uncomfortable.(11) Overall, a general lack of awareness was the main barrier to people having eye exMethods to increase diabetics’ awareness of DR, the risk factors that play a role in the development of DR and the importance of annual eye examinations to detect retinopathy are postulated in the literature.

There is a need for awareness campaigns about DED that involve social workers, voluntary organisations and local community leaders.(12) Screening examination reminders could be communicated to patients by telephone, SMS, post, e-mail and visits by social workers.(12,11) Educational programmes, such as group teaching sessions, leaflets, brochures, and greater publicity in the media are also recommended.(12,13) Information should not only be provided about the ocular complications of diabetes, but also about the risk factors for developing DR, the importance of control of systemic risk factors, what treatment is available for DR, and what that treatment entails. Screening retinal examinations of hospitalised diabetic patients were also found to be effective in creating a greater awareness of DR.(14)

In terms of concerns about employment, the early involvement of social workers could mitigate against the fear of job loss due to absenteeism.(15) Making screening available at a primary care level increases attendance, in part due to the fact that it is more convenient for patients.(11) Improving physician-patient communication is important, and any such engagements should be tailored according to patients’ levels of education.(10)

They should actively provide information to patients especially in regard to preventive measures and screening for retinopathy. This was demonstrated in Australia (15) where information given by diabetes nurse educators during patient home visits positively predicted the possibility of having an eye screening examination by the patients. The effect was that 77% of 11,247 diabetics underwent eye screening within two years.

Awareness creation is a vitally important step in the creation of a successful program to battle against any disease in the community. This is especially true of the growing problem of Diabetic Retinopathy. Studies previously completed have revealed that Diabetic Retinopathy, despite its status as one of the greatest causes of blindness in both developed and developing countries, is virtually unknown to a large majority of the population. Without awareness of the disease it is impossible for any individual to aid the cause of preventing blindness from Diabetic Retinopathy, either in him or herself or in the community as a whole. Awareness creation is therefore necessary as one of the first steps in any program aimed at reducing Diabetic Retinopathy (Vision2020 e-resource, 2004).(16)

People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition. This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change (IDF, 2010).(17)

The issue of low screening rates amongst known diabetics seems to be a common finding even in other studies (18,19), where screening rates ranged from 5% to 47%. In this regard, primary diabetic caregivers, should be trained and encouraged to provide at least first line screening to patients preferably in a well planned retinopathy screening programme.



There is general awareness of diabetic retinopathy amongst a majority of patients (83%), there is however little or no knowledge of its risk factors and prevention. There is therefore a need for increasing awareness and also the provision of access to retinopathy screening services to the patient (Mohamed, 2009)(4). Aggressive and comprehensive awareness is needed to educate diabetic patients on diabetic retinopathy (Rani et al, 2008)(6).



  1. Kenneth O. Eye flying hospital lands in Nairobi, Daily Nation. Available from: Wednesday, June 3 2009.
  2. Seibel JA. Diabetes and eye problems. Accessed on August 2010
  3. WebMD, (2010). Diabetes and Eye Problems,, 18-08-2010.
  4. Mohammed, Waziri AM. Awareness of diabetic retinopathy amongst diabetic patients at the Murtala Mohammed Hospital, Kano, Nigeria. Nigeria J 2009;50(2):38-41.
  5. Kaliyaperumal K (2004). Diabetic Retinopathy Knowledge, Attitude and Practice Study Vol. 1 No.11 November. Kaushik, L. R. (2004). IDF and WHO initiatives to put diabetes on the health agenda in Africa. Diabetes Voice. 49:32–4.
  6. Rani P. K, Raman R, Subramanis, Perumala G, Kamaramanickavel G, Sharma T. (2008). Knowledge of diabetes and diabetic retinopathy among rural populations in India and the influence in India and the influence of knowledge of diabetic retinopathy on attitude and practice. Jul-Sep;8(3):838. Epub. 8:1-6.
  7. Dandona R, Dandona L, John RK, McCarty CA, Rao GN (2001). Awareness of eye diseases in an urban population in southern India. Bulletin of the World Health Organisation; 79(2): 96-102.
  8. James S. M. et al., (2008). Awareness of diabetic eye disease among general practitioners and diabetic patients in Yangon, Myanmar, Clinical and Experimental Ophthalmology. 36: 265–273.
  9. Schoenfeld ER, Greene JM, Wu SY, Leske MC. Patterns of adherence to diabetes vision care guidelines: baseline findings from the Diabetic Retinopathy Awareness Program. Ophthalmology 2001 Mar;108(3):563-571.
  10. Huang OS, Zheng Y, Tay WT, Chiang PP, Lamoureux EL, Wong TY. Lack of awareness of common eye conditions in the community. Ophthalmic Epidemiol 2013;20(1):52-60.
  11. Lewis K, Patel D, Yorston D, Charteris D. A qualitative study in the United Kingdom of factors influencing attendance by patients with diabetes at ophthalmic outpatient clinics. Ophthalmic Epidemiol 2007 Nov-Dec;14(6):375-380.
  12. Agarwal S, Mahajan S, Rani PK, Raman R, Paul PG, Kumaramanickavel G, et al. How high is the non-response rate of patients referred for eye examination from diabetic screening camps? Ophthalmic Epidemiol 2005 Dec;12(6):393-394.
  13. Trento M, Bajardi M, Borgo E, Passera P, Maurino M, Gibbins R, et al. Perceptions of diabetic retinopathy and screening procedures among diabetic people. Diabet Med 2002 Oct;19(10):810-813.
  14. Sadeh AD, Rosenblatt I, Rosenberger Y, Lazar M, Loewenstein A. Frequency and patients reported awareness of diabetic retinopathy among type 2 diabetic patients admitted to internal medicine wards. Diabetes Care 2000 Sep;23(9):1436-1437.
  15. Tapp RJ, Grad D, Zimmet PZ, Harper CA, PdeCourten M, Balkau P et al. Diabetes care in an Australian population­ Frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care 2004; 27: 688-693.
  16. Vision 2020 e-resource (2004). Diabetic Retinopathy Awareness Strategies. Vol. 1 No.11 November.
  17. IDF (2010), Diabetes Education, accessed on 18th August 2010.
  18. Amir AH, Islam Z, Jadoon MZ, Zeb S, Ali SS. Awareness of diabetic retinopathy amongst known diabetics. J Postgrad Med Inst 2007; 21(1):10-15.
  19. Verma L, Elankumaran P, Prakash G, Venkatesh P, Tewari HK. Awareness of diabetic retinopathy among diabetics. Indian J Ophthalmol 2002; 50:


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