Prevalence of diabetic retinopathy and eye care in a rural area of Spain

OBJECTIVE To study the prevalence of diabetic retinopathy (DR) in a sample Of 3544 patients living in a rural area of the province of Valladolid, Spain; as well as to estimate the current eye care to the diabetic population. METHODS Participants received a comprehensive ocular examination in their local area where they resided and a grading of DR was made using standard protocols. Physicians then provided us with the systemic and demographic data. RESULTS The population studied included 175 younger-onset and 3344 older-onset patients, all of whom were under physicians' care, distributed in an 18-county-area far from the urban center. Mean duration of the disease was 7.89 +/- 7.7 years (range 0 to 59 years) . 73% of participants had not received ophthalmologic care the preceding year and 63.6% had not received a dilated eye examination either. The prevalence of DR was 20.9%; macular edema was found in 5.7% of the patients. Differences in participation were found among counties and these also correlated with differences in prevalence of DR. Prevalence of DR in the younger-onset group was 25.6% and 14-81% in insulin- and non-insulin-dependent patients, respectively. In the older-onset group, it was present in 48.6% and 14.7% of insulin- and non-insulin-dependent patients. Patients with retinopathy were older, with a longer duration of disease, were insulin dependent and had had less eye care. CONCLUSIONS Deficient screening of ophthalmic disease in diabetic patients should be improved, especially in isolated areas, in order to reduce DR in this group. Insulin-dependent older-onset patients with a longer duration of diabetes had a higher frequency of these complications.