Consequences of diabetes
Diabetic retinopathy affects the retina, the light sensetive tissue at the back of the eye that transmits visual messages via the optic nerve to the brain.When this delicate tissue is damaged by diabetic retinopathy, the result may be visual impairment or blindness in many cases.

In general, the progression of retinopathy is orderly, advancing step by step. Diabetic retinopathy --

*Affects all system of the body (and leads the patients towards death and disability)

*Retinopathy (defect in vision linked to diabetes) -- a common complication of diabetes with high potential for vision loss

*Approximately two-thirds with diabetic retinopathy losses vision after after 35 years of diabetes

*Current treatment modalities are effective in preventing 98 per cent of the vision loss

*Patients' lack of awareness seems to be the main reason behind underutilisation

A prospective study
To assess the current health behavior of the diabetic population to reduce diabetic retinopathy a survey was performed among the diabetic patients of Jamalpur, Sherpur, Tangail districts and Dhaka City. The title of the study was “A study on knowledge, attitude and practice (KAP) of diabetic patients for reducing the risk of developing diabetic retinopathy”.

The objectives of the study were to asses the knowledge and attitude of the diabetic patients to delay the onset of diabetic retinopathy as well as to evaluate and care of the disease.

In view of this a total 750 respondents were selected for the study using simple random sampling technique. Out of 750 respondents, 686 were feasible to be interviewed.

Result of the study
The respondents were of different age group, sex; from different areas like urban and rural and different professions. Their levels of education, knowledge and socio-economic condition were also different.

Among sociodemographic variables, age and sex were not found associated with combined knowledge score. However residence, income, occupation and education were found significantly associated with the same variable.

Of the total respondents, 631 (92%) knew that diabetes causes eye-diseases, even 429 (62.5%) of them had never had their eyes examined by an ophthalmologist after diabetes being detected. The mean time of having their eyes checked after diabetes being detected was around 26 2.4 months.

Those who had never had their eyes examined were motivated to do the same immediately. 97% of them showed a positive attitude, although, in practice, only 5% of them were known to visit an ophthalmologist within a month after motivation. Those who visited, more than half (52.39%) of them had some pathology.

Association between knowledge and existing practice showed that 40% diabetics with knowledge of diabetes induced eye-diseases had ever had their eyes checked, while only 7.3% of diabetics without knowledge had done the same indicating that knowledge tends to improved practice.

Conclusion
The importance of diabetic retinopathy as a cause of blindness has increased because of longevity and decline in the other preventable causes of blindness in developing countries like ours. A diabetic patient can have a serious eye disease and even do not know it until irreversible vision loss occurs. Diabetic retinopathy has a defined preventive measure to delay the onset and progression of the disease and consequent visual loss.

Faced with this situation there are only two ways left to prevent blindness from diabetic retinopathy --

1. Maintaining a strict glycaemic control; and

2. Regular ophthalmic examinations of those identified as diabetic to detect early retinopathy.

National policy-guidelines will have to be formulated for developing awareness of the community aiming at preventing or delaying the onset of diabetic retinopathy so that diabetic retinopathy does not become a major cause for visual impairment or blindness in the future.

Recommendation
*Awareness be developed first in diabetic community. 99 per cent respondent told that they did not have any idea about the exact name and consequence of diabetes on eye. If respondent knew that diabetes might cause irreversible visual impairment, many of them would not have shown such reluctant behavior.

*General practitioners, Medicine and Endocrine specialist are usually the first to detect diabetes. They should advice patients to have their eyes checked by an opthalmologist, who will guide the patients for further management.

The study was performed by Dr Md Ashraf ul Karim Khan, Senior Assistant Professor of Department of Opthalmology of Gono Bishawbiddaloy SV Medical College, Savar, Dhaka ([email protected]).