Unmet Needs and Obstacles to Addressing Diabetic Retinopathy in Developing Nations: Results of a West African Study

Diabetes-related blindness remains a global public health burden. Many key determinants have produced different proposed interventional strategies, with varying levels of theoretical and evidence-based support, especially among developing economies. Among these include the use of telemedicine, the training of nonmedical personnel in the delivery of diabetic eye care and the delivery of diabetic eye care by general ophthalmologists. The purpose of this study was to assess the attitudes, preferred practice patterns, preferences, and unmet needs of general ophthalmologists in one developing West African nation, Ghana. The findings appear to challenge currently held beliefs regarding the effectiveness of interventional strategies being developed.

Of surveyed Ghanaian ophthalmologists, only 4.4% of their collective 141,000 patients annually were identified as diabetic – a figure well below what would be expected from previously described population-based surveys. Roughly 20% of these diabetic patients were identified as having diabetic retinopathy. Most required referral to specialty clinics, primarily due to a lack of equipment and time (71% and 17%, respectively), as well as self-reported lack of competence and confidence in administering laser treatments (70%). If provided a laser, almost 90% of Ghanaian ophthalmologists said they would be willing to deliver laser surgery for their diabetic patients, but would be hindered by poor reimbursement, and the burden of patients in need of cataract surgery (34%, collectively). Strategies to address the lack of equipment and time had variable responses; while equipment provision received a high level of interest, the idea of training nonmedical care provider to help was met unfavorably.