Effectiveness of remote screening for diabetic retinopathy among patients referred to Mozambican Diabetes Association (AMODIA): a retrospective observational study

Abstract

Aims Diabetes represents a growing public health problem in sub-Saharan Africa, where diabetic retinopathy (DR) is a major cause of permanent visual loss. We reported the results of a remote screening of DR among urbanized Mozambican people with diabetes. Methods We retrospectively collected retinal images and clinical characteristics from 536 patients screened for DR in Maputo (Mozambique), over a period of 2 years (2018–2019). Retinal photographs were captured, digitally stored, and scored locally and by an expert ophthalmologist in Italy remotely. Results The overall prevalence of DR was 29% with sight-threatening forms accounting for 8.1% of that number. Inter-reader agreement between the local and the Italian ophthalmologists was poor (k < 0.2). Patients with DR were older, had a longer duration of disease, worse glycaemic control, and a higher prevalence of comorbidities. In the multivariate logistic regression analysis, HbA1c, diabetes duration, and coronary heart disease (CHD) were associated with DR. Conclusion Prevalence of DR among urbanized Mozambican patients was similar to that observed in Western countries. Telediagnosis might partially overcome the paucity of local ophthalmologists with experience in DR.