China has 92 million people with diabetes, more than any other country in the world, and the burden continues to grow. Within the past 30 years, the diabetes prevalence rate has increased tenfold, to 9.7% in 2010 (Yang W et al, 2010). Many people remain undiagnosed or receive inadequate care resulting in serious long term complications. Diabetic retinopathy is one of them. Diabetic retinopathy (DR) is the third most common cause of blindness in the world and diabetes is a rapidly-growing cause of blindness in China (Wang FH et al, 2009). 64-76% of cases of diabetes in China remain undiagnosed (Wang FH et al, 2009), and less than 10% of patients needing DR care have received such care. Only one third of the people diagnosed with diabetes get annual eye examinations, while only one fifth of the people diagnosed with diabetes in rural areas get proper care (Wang D et al, 2010). This project aims to create a scalable model for enhancing capacity and delivering sight-saving diabetes care at ten county-level facilities in rural Southern China through capacity building and education.
This project will leverage The Comprehensive Rural Eye Service Training (CREST) initiative which is a collaboration between ORBIS International and Zhongshan Opthalmic Center (ZOC) Eye Hospital. It will strengthen both the supply-side and demand-side of DR care in rural China. The Comprehensive Rural Eye Service Training (CREST) network will train 70 rural doctors from 10 county hospitals to diagnose, treat, provide follow-up, and refer cases requiring laser treatment to ZOC, which will use the equipment purchased through this project, such as a van with portable lasers and cameras, for diagnosis and treatment. A telemedicine network will be established to link the county level hospitals to one another and to ZOC. A web-based medical record system will prompt doctors to carry out and record patient data and all elements of eye examinations, which will allow ZOC to assess the examinations carried out. This will help build capacity and enhance compliance to protocols of care. Videos explaining the importance of eye examinations and the consequences of DR will be shown to all known patients with diabetes at all the hospitals within the CREST network. The cost of examinations will initially be subsidised by ORBIS for patients 40 and above, and will be phased out with the expectation that hospitals will begin to offer the comprehensive examination package at a lower price. An SMS reminder network will be created to enhance long-term adherence to DR follow-up examinations, which addresses the key challenge with patients with diabetes in this region.
• 10 county hospitals strengthened to screen for DR• 75,740 people received education and eye exams at community level• 1,071 people diagnosed with DR and treated with laser or surgery• 609,229 people educated on DM and DR• SMS reminder network created and 7,625 patients enrolled