Patterns of referral and examination for retinopathy in pregnant women with diabetes by primary care physicians
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Abstract:
Family practice (FP), General Practice (GP) and obstetrics-gynecology (OB/GYN) physicians were surveyed to determine whether they routinely referred pregnant patients with diabetes to an ophthalmologist, looked into the patient's eyes to screen for retinopathy, and dilated the eyes for fundi examination.Hospitals providing obstetrical services were contacted to identify primary-care physicians. Physicians identified as having obstetrical privileges were surveyed by mail to determine if they were actively providing obstetrical care. Physicians who provided both obstetrical and diabetes care were mailed a survey.Of 668 physicians surveyed, 429 responded: 224 FPS, 184 OB/GYNS and 21 GPS. A relatively small percentage (27%) of physicians in both groups routinely refer all of their pregnant patients with pre-existing diabetes to an ophthalmologist. Family practice physicians were more likely to perform an eye exam to screen for retinopathy in patients with both pre-existing and gestational diabetes than OB/GYNS (p < .0005). Only 11% of FPS and no OB/GYNS reported that they dilated the eyes when performing a fundus examination (p = .04).The physicians surveyed under-utilize recommended strategies for eye care of pregnant women with pre-existing diabetes. Based upon these results, we call for a recommitment to partnership of primary-care physicians and ophthalmologists in the detection and treatment of diabetic retinopathy during pregnancy.Keywords:
Eye examination
Fundus (uterus)
Primary care physician
Knowledge, attitudes and practices of 40 randomly selected physicians was assessed in the North Sharqiya region of Oman in 2003. We evaluated non-ophthalmologist physicians' knowledge of techniques of eye examination of diabetic patients, attitudes towards fundus examination and practices of detailed eye examination. Knowledge about different parts of the eye was satisfactory in only 58% of physicians and knowledge about method of fundus examination for diabetic retinopathy was poor in 40%. Attitudes towards eye examination by non-ophthalmologists at primary level were positive. In practice 20 physicians had attempted to use an ophthalmoscope and only 9 could see details of the retina. Our general physicians would need detailed training if they are to be involved in early detection of diabetic retinopathy.
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Purpose: This study was performed to determine the time of initial fundus examination after the diagnosis of diabetes and the probability of diabetic retinopathy in the primary eye clinic. Methods: 158 diabetes who visited on primary eye clinic between September 2003 and February 2004 were enrolled. We perfomed fundus examination with stereoscopic photograph. and made some questions about the delyed fundus examination. Results: Among 158 patients (Mean age 59.569.66), diabetic retinopathy was demonstrated in 59 (37.3%). The average delayed time of initial fundus examination was 5.985.30years. The longer duration of the interval, the higer was the prevalence of diabetic retinopathy and the more severe retinopathy was found. The common reason of delayed fundus examination after diagnosis of diabetes was `having no symptom` (50.0%) and `not knowing of diabetic ocular complication` (15.0%). Conclusions: We concluded the prevalence of diabetic retinopathy in primary eye clinic was not remarkable different in tertiary hospital. In order to prevent vision threatening diabetic retinopathy, We should perfom the fundus examination before becoming too advanced. In primary eye clinic as well as tertiary hopital, education of diabetic patients and thorough understanding of diabetic retinopathy must be needed.
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the prevalence of overweight and obesity in women of childbearing age.Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus.If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes.This review provides an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.
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Gestational diabetes mellitus(GDM)is one of the common complications during pregnancy. It is associated with many adverse pregnancy outcomes, threatening maternal and child health seriously. The exact pathogenesis of GDM remains unclear. Long term exposure to persistent organic pollutants (POPs) is considered to be one of the risk factors for GDM. More and more studies are concerned about the relationship between them. Based on the literature published at home and abroad, this article summarizes the correlation and possibly related mechanism of POPs and GDM, and explores the correlation between pops and GDM, so as to provide a new idea for the prevention of gestational diabetes.妊娠期糖尿病（gestational diabetes mellitus，GDM）是妊娠期常见的并发症之一，它与多种不良妊娠结局密切相关，严重危害母子健康，但其确切的发病机制目前尚不明确。近期研究发现长期接触持久性有机污染物（persistent organic pollutants，POPs）是妊娠期糖尿病发病风险因素之一，两者之间的关系已经受到越来越多的关注和重视。本文以国内外发表的文献为基础对POPs与GDM的相关性及其可能相关作用机制进行阐述，分析POPs与GDM之间的关联，从而为妊娠期糖尿病的预防提供新思路。.
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In order to enhance cost-benefit value of the gestational diabetes mellitus screening (GDM) the concept of universal screening i.e., screening of all pregnant women for gestational diabetes, has mostly been abandoned in favor of the concept of selective screening. Selective screening implies that only women with risk factors are being screened for GDM. However, some recent studies have shown that with the application of the selective screening approach, some women with GDM may not receive proper and timely diagnosis. This review addresses the pros and cons of both concepts. It will also discuss screening methods and methods of preparation and performance of oral glucose tolerance test and the interpretation of its results.
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The hospital of Bruneck in South Tyrol has had an Eye Consultant from the University Eye Clinic in Innsbruck for more than two years. The examination carried out in the eye department of the Bruneck hospital includes routine ophthalmoscopy of the fundus periphery to detect early retinal degenerations and thus prevent retinal detachment. In almost 5,000 cases (both in- and outpatients) seen during 1981 changes in the fundus periphery were detected and treated in 5.5%. The importance of screening with routine examination by indirect ophthalmoscopy to detect retinal degeneration or early detachment is emphasized.
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Gestational diabetes mellitus (GDM) is a new epidemic among Australian women, especially those with Asian backgrounds. The 1998 Australia National Diabetes Strategy and Implementation Plan recognises GDM as an independent glucose metabolic disorder affecting sub-groups of Australians. Gestational diabetes mellitus is an Australian national diabetes priority area, along with insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). This paper reviews the many issues relating to GDM that continue to be debated by researchers and clinical service providers. These issues include the diagnosis of GDM, the effect of GDM on fetal outcomes, the long-term health effects on the offspring of GDM mothers, the effect of GDM on maternal outcomes and the long-term health effects on women with a history of GDM.
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There is very little data regarding the referral rates of primary care physicians for eye care. We studied the extent to which primary care physicians follow guidelines and standards that have been set by professional organizations within eye care.Forty-eight patients over age 40 years seen during one day in the Primary Care Department of a large, metropolitan hospital were reviewed.Only 12.5 percent of patients seen were referred for eye care. Only 8 percent of those who were diabetic and 13 percent of those with hypertension were referred for eye care, while of each group respectively, 25 percent and 34.8 percent had been seen for eye care in the previous year. Referrals tended to be for acute problems, not for routine monitoring of ocular signs associated with hypertension or diabetes. Only 33.3 percent of the patients had an ocular assessment in the physician's records within the year. In addition, most patients did not have ophthalmoscopy, glaucoma testing, or any other form of vision care during the year.In this study, referrals for eye care seemed to be driven by acute, symptomatic problems, and to a lesser extent by a known ocular condition. The importance of routine eye care was not reflected in the referral patterns observed in this study.
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Many patients with symptomatic eye conditions present initially to their primary care physician. Eye issues account for 2-3% of all primary care office visits. Knowing how to respond when these patients come is critical for the family physician, as is knowing when to refer them to an ophthalmologist for additional care. Family doctors should be able to spot eye disorders that can cause vision loss and necessitate an immediate referral to an ophthalmologist. A comprehensive history and physical examination are essential in reaching a diagnosis and determining the severity of the eye problem. Visual changes, length of symptoms, presence or absence of a foreign body, history of trauma or recent eye surgery, and concomitant symptoms such as a headache, nausea, or ocular discharge should all be addressed in the history. Almost 50% of all eye disorders presented to a family physician. Comprehensive treatment of such conditions can often be provided in the primary care setting. Patients with persistent or severe conditions, particularly those involving foreign bodies and corneal abrasions due to high-velocity injuries, should be referred for immediate care by an ophthalmologist. This review aims to review most prevalent eye complaints in primary health care centers in Saudi Arabia.
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