Original Research

Screening for diabetic retinopathy at a health centre in South Africa: A cross-sectional study

Ntokozo Zulu, Patrick Ngassa Piotie, Elizabeth M. Webb, Wezi G. Maphenduka, Steve Cook, Paul Rheeder
Journal of Public Health in Africa | Vol 16, No 1 | a681 | DOI: https://doi.org/10.4102/jphia.v16i1.681 | © 2025 Ntokozo Zulu, Patrick Ngassa Piotie, Elizabeth M. Webb, Wezi G. Maphenduka, Steve Cook, Paul Rheeder | This work is licensed under CC Attribution 4.0
Submitted: 12 June 2024 | Published: 14 January 2025

About the author(s)

Ntokozo Zulu, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Patrick Ngassa Piotie, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria; and, University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Elizabeth M. Webb, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria; and, University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Wezi G. Maphenduka, Department of Ophthalmology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Steve Cook, The Eye Centre, East London; and, Department of Ophthalmology, Faculty of Medicine and Health Sciences, Walter Sisulu University, East London, South Africa
Paul Rheeder, University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria; and, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

Abstract

Background: In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss.

Aim: To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals.

Setting: Laudium Community Health Centre (CHC), a PHC facility in Tshwane.

Methods: We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected.

Results: A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management.

Conclusion: The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency.

Contribution: The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.


Keywords

diabetic retinopathy; screening; primary care; diabetes; non-mydriatic photography; AI; microvascular complications; fundus camera.

Sustainable Development Goal

Goal 3: Good health and well-being

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