Creating access to eye care in Uzbekistan

Before the establishment of the eye care facilities, there were no trained ophthalmologists at regional level who could treat diabetic retinopathy. Now patients can have their vision controlled regularly and receive necessary treatment for diabetic retinopathy

In 2004, the World Diabetes Foundation supported the Association of Endocrinologists in Uzbekistan in a countrywide project to establish regional diabetes information centres in existing endocrinological dispensaries. The successful establishment of diabetes information centres in each of Uzbekistan’s 14 regions laid the foundation for further improving the level of diabetes care. Forty-two doctors and nurses underwent training in improved diabetes care, and more than 3,000 patients have received in-depth information about the condition.

As a follow-up to the 14 diabetes information centres, UMID (Charity Public Union of persons and people with diabetes mellitus) applied for support to a project to prevent blindness among people with diabetes in Uzbekistan. Since October 2007, the World Diabetes Foundation has supported this project which includes the establishment of diabetes eye care facilities in each of the 14 regional endocrinological dispensaries. The project also includes the training of one ophthalmologist in Moscow for two months who in turn will train 50 ophthalmologists at regional level.  

No exact data on diabetic retinopathy

The prevalence of diabetes in Uzbekistan follows the increasing global trend. According to local studies, between 1998 and 2008 the number of people registered with diabetes increased from 75,544 to 103,902 (83% with type 2 diabetes).

Dr. Nargiza Normatova, leading specialist in diabetic retinopathy, explains about the alarming trend related to diabetic retinopathy:  “There are no exact statistical data on the prevalence of diabetic retinopathy in Uzbekistan. With this in mind the project includes screening of people with diabetes to identify stages of diabetic retinopathy,” she says. The results of the screenings in three pilot regions (Bukhara region, Ferghana region and the Republic of Karakalpakstan) will be presented at the forthcoming conference in Tashkent in February 2009. Statistical processing of the data obtained is presently underway and will be submitted to medical journals.

The establishment of 14 diabetes information centres followed up by 14 eye care facilities has improved the quality of diabetes care in Uzbekistan.

The eye care facilities

Each of the 14 eye care facility is equipped with a desk, a bookcase, six chairs and a direct ophthalmoscope, a tool for measuring eye pressure, a "Rota" apparatus with a table, and visual materials for training including the booklet for patients, "What is diabetic retinopathy?”

Project Coordinator, Dr. Nilufar Ibragimova explains the positive change the eye care facilities have created: “Before the diabetic eye care facilities were launched, patients had to walk from one ophthalmologic clinic to another asking for help. Now all individuals with diabetes can receive qualified advisory and medical care from the ophthalmologist located at the eye care facilities within the endocrinological dispensaries,” she says. All endocrinological dispensaries are staffed with an ophthalmologist and a nurse, and meet the initial requirements and ophthalmologic standards. All patients examined at the diabetic eye care facilities are registered in a computer database for further analysis of the prevalence of diabetic retinopathy in Uzbekistan.

In Uzbekistan 80% of people with diabetes reside in rural areas where access to proper treatment of diabetes is lacking. Modern laser coagulation can preserve vision for most people with early stages of diabetic retinopathy, but this treatment is not available to the majority of people with diabetes in the country. In addition, general practitioners at rural medical facilities lack the adequate knowledge of diabetes and its complications, and qualified ophthalmologists and diabetic eye care facilities are virtually non-existent.

Too late to be treated

Mr. Murat Kurbanazarov from the Uzbek Republic of Karakalpakstan is a living example of the consequences of poor training in self-care and uncontrolled diabetes. Born in 1952, he has been suffering from type 2 diabetes for twelve years and lost vision in one eye completely. During a screening in the diabetic eye care facility, to her regret Dr. Nargiza Normatova found the patient to have diabetic retinopathy at stage 2 worsening to stage 3. Earlier when Mr. Kurbanazarov visited the local ophthalmologists in his home town, he did not receive any concrete medical care and was merely given a general explanation that all what happened to him was due to his diabetes. He neither received examination by an eye doctor nor had access to laser photo coagulation so the condition worsened leading to blindness in one eye.

According to Dr. Nargiza Normatova, the majority of regional ophthalmologists do not have adequate knowledge on how to treat their patients with diabetic complications. The purpose of the seminars for regional general practitioners and ophthalmologists within the framework of the project are intended to increase their knowledge of diabetes and diabetic retinopathy and in addition enable them to better detect and treat people with diabetes in the region. “As an ophthalmologist I think this project has helped ophthalmologists develop an algorithm of diagnosis and treatment of patients with diabetic retinopathy,” explains Dr. Nargiza Normatova. 

Dr. Nadira Yuldasheva was selected as the ophthalmologist to undergo training at the National Medical and Surgery Centre of the N.I.Pirogov Institute in Moscow. Here, she learned about modern diagnostic and treatment methods of diabetic retinopathy and upon return to Uzbekistan she presented her report for fellow ophthalmologists at a two-day seminar. “The knowledge and experience gained on current methods of treatment of diabetic retinopathy and cataract will allow us to improve the standards and the quality of medical care provided locally. This will help preserve vision for many people with diabetes,” she says.

Important for Uzbekistan

“The establishment of the 14 diabetes information centres in each region followed by the eye care facilities has played an important role in the improvement and quality of the diabetes services in the country,” says Dr. Nilufar Ibragimova. “Eighty-five percent of the 2,087 patients attending pilot screenings in three regions of the country had never been eye examined by an ophthalmologist in their life. Before the establishment of the eye care facilities, there were no trained ophthalmologists at regional level who could treat diabetic retinopathy. Due to this project, patients can now have their vision controlled regularly and receive necessary treatment for diabetic retinopathy,” she elaborates.

Programme Coordinator at the World Diabetes Foundation, Ms. Hanne Strandgaard praises the excellent local support and sees this as crucial for the long term sustainability of the project: “Diabetes care is being revolutionised in Uzbekistan and it is clear that a huge movement towards improving and supporting diabetes care is taking place. More importantly, the Uzbek parliament is supportive of diabetes care and thus the Ministry of Public Health seems to have prioritised diabetes on the health agenda. I am impressed with the extensive collaborations among health institutions and agencies and the level of dedication and motivation of the people working within diabetes care,” she concludes.

Read more about the project to prevent blindness in Uzbekistan