[01] Hanan Ali Mubarak Obaid, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [02] Waad Mohamed Obaid Aal Ali, Health Centre Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [03] Ayesha Sultan Alolama, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [04] Mai Haider Mohammad Zain, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [05] Abdulla Abdul Salam Abdulla Ali Naqi, Ophthalmology Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates. [06] Hend Mohd Sultan Hannawi Ajtabi, Health Centre Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [07] Amani Mahmood Mohd Saeed AlJassmi, Ophthalmology Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates. [08] Patricio M. Aduriz-Lorenzo, Information Technology Department, Dubai Health Authority, Dubai, United Arab Emirates. [09] Amel Ibrahim Buharoun, Health Centre Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [10] Nahed AbdulKhaleq Monsef, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [11] Manal Mohammad Omran Taryam, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [12] Salah Ahmed Mohamed Elbadawi, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates. [13] Moulham Saleh Ashtar, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, United Arab Emirates.

Diabetic Retinopathy (DR) is the leading cause of blindness among adults. It represents 4.8% of the total cases of blindness globally. One in 3 people with diabetes mellitus (DM) have Diabetic Retinopathy. One in 10 develop Vision Threatening Diabetic Retinopathy (VTDR). The prevalence of Diabetic Retinopathy in UAE around 19%. The objectives of this study are to assess the effectiveness of the diabetic retinopathy-screening program in reducing the waiting time for referral to ophthalmologist, reducing unnecessary referral to ophthalmology clinic, increasing the number of screened patients, in addition to the early detection and management of retinal abnormalities on timely basis. A retrospective review of Data of 5270 diabetic patients attended the screening program in health centers of Dubai health authority was performed. The data was stored in electronic medical records. Patients included in the study are those who attended Diabetes clinics in 12 health centers in primary health care in the period of the study from April 2015 until December 2017, a total number of 12626. The number of screened diabetic patients in 2015 was 1135, in 2016 was 2205 and in 2017 was 1930 patients. About 41.74% of patients had Non Mydriatic Retinal Camera screening, 30% in 2015, 46.91% in 2016 and 45.97% in 2017.Percentage of referral to ophthalmology clinic diminished from 80% before screening implementation to 10% after screening implementation. Waiting time to get an appointment for funduscopic examination reduced from 52 days in 2013 to Zero days in 2017. Percentage of DM patients with DR was 22.12%, 7.83% with mild Non Proliferative Diabetic Retinopathy (NPDR), 8.76% with moderate NPDR, 0.46% with severe and 5.07 with Proliferative Diabetic Retinopathy (PDR).In conclusion, DR screening in PHC reduced waiting time for retinal screening of diabetic patients. It reduced unnecessary ophthalmology referral and expedited ophthalmologist engagement for management when it is required. Due to obvious success of retinopathy-screening program, it is recommended to increase the service to reach more diabetic patients in order to prevent eye complication of diabetes. This expansion of services could be followed by another study to assess its effect on blindness.

Diabetic Retinopathy (DR), Vision-Threatening Diabetic Retinopathy (VTDR), Diabetes Mellitus (DM), Primary Health Care (PHC), Dubai Health Authority (DHA), Non-Mydriatic Retinal Camera (NMRC)

[01] Dowler J. Diabetic Retinopathy. Last updated Dec 18, 2017, BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/532. [02] Prevention of blindness from diabetes mellitus, report from WHO, Geneva, Switzerland November 2005. http://www.who.int/blindness/Prevention%20of%20Blindness%20from%20Diabetes%20Mellitus-with-cover-small.pdf. [03] MacEwen C, O'Colmain U, Ho Ho O. W, Based on a text by Henriksen J. E, Nielsen O. H, Nielsen H. B. Diabetic retinopathy (eye disease), Last updated 24.11.2014. https://www.netdoctor.co.uk/conditions/diabetes/a833/diabetic-retinopathy-eye-disease/. [04] Kertes PJ, Johnson TM, eds. (2007). Evidence Based Eye Care. Philadelphia, PA: Lippincott Williams & Wilkins. ISBN 0-7817-6964-7. https://books.google.ae/books?hl=en&lr=&id=Egc_2ZrbV8YC&oi=fnd&pg=PA6&dq=J+Kertes,+TM+Johnson+Eds.+Evidence-Based+Eye+Care+(c)+2007&ots=VEmRcFGmI3&sig=SGaumtF1_OqvKo-lEoBka4CvOKQ&redir_esc=y#v=onepage&q&f=false. http://thevillageseyeinstitute.com/81/What-is-Diabetic-Retinopathy. [05] Tapp R, Shaw J, Harper C, P de Courten M, et al. (June 2003). "The prevalence of and factors associated with DR in the Australian population", American Diabetic Association, Diabetes Care, 26 (6): Diabetes Care 2003 Jun; 26(6): 1731-1737. [06] http://care.diabetesjournals.org/content/26/6/1731. http://www.silverbook.org/fact/it-is-estimated-that-proper-treatment-and-monitoring-of-the-eyes-of-diabetics-could-reduce-new-cases-of-diabetic-retinop/. [07] Engelgau, Michael, Linda Geiss, Jinan Saaddine, Jame Boyle, Stephanie Benjamin, Edward Gregg, Edward Tierney, Nilka Rios-Burrows, Ali Mokdad, Earl Ford, Giuseppina Imperatore, K. M. Venkat Narayan. "The Evolving Diabetes Burden in the United States." Annals of Internal Medicine, 1 June 2004. Web. 22 Apr. 2014. http://annals.org/aim/fullarticle/717516/evolving-diabetes-burden-united-states. [08] Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27:1047-1053. Full text Abstract. http://www.who.int/diabetes/facts/en/diabcare0504.pdf. [09] Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian Journal of ophthalmology. 2012 Sep-Oct; 60(5): 428–431. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491270/. [10] Yau JW1, Rogers SL, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar; 35(3):556-64. Doi: 10.2337/dc11-1909. Epub 2012 Feb 1. https://www.ncbi.nlm.nih.gov/pubmed/22301125. [11] Saaddine JB1, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP, Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050, https://www.ncbi.nlm.nih.gov/pubmed/19064858. [12] Al-Maskari F, El-Sadig M, Prevalence of diabetic retinopathy in the United Arab Emirates: a cross-sectional survey, BMC Ophthalmology 2007, 7:11. https://bmcophthalmol.biomedcentral.com/articles/10.1186/1471-2415-7-11. [13] Scotland G, McKeigue P, Philip S, Leese GP, Olson JA, Looker HC, Colhoun HM, Javanbakht M, Modelling the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland, Diabetic Medicine, 2016 Jul;33(7):886-95, doi: 0.1111/dme.13129, Epub 2016 May 11.https://www.ncbi.nlm.nih.gov/pubmed/27040994. [14] Kim S. W , Kang G. W. Cost-Utility Analysis of Screening Strategies for Diabetic Retinopathy in Korea, J Korean Med Sci. 2015 Dec; 30(12): 1723–1732.Published online 2015 Nov 30. doi: 10.3346/jkms.2015.30.12.1723. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689815/. [15] Scarpa G, Urban F, Vujosevic S, Tessarin M, Gallo G, Visentin A, Foglia E, Ferrario L, Midena E . The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application, Journal of Ophthalmology, Volume 2016, Article ID 4625096, 7 pages. https://www.hindawi.com/journals/joph/2016/4625096/. [16] National Institute for Clinical Excellence, Management of type 2 diabetes, Retinopathy screening and early management, page 3. Marsh 2005. http://www.wales.nhs.uk/sites3/documents/334/diabetesretinopathyguideline.pdf. [17] Malaysian guideline on screening of diabetic retinopathy June 2011 pages 7-8. http://www.moh.gov.my/penerbitan/CPG2017/6601.pdf. [18] Vashist P, Singh S, Gupta N, Saxena R. Role of Early Screening for Diabetic Retinopathy in Patients with Diabetes Mellitus: An Overview, Indian J Community Med. 2011 Oct-Dec; 36(4): 247–252. doi: 10.4103/0970-0218.91324. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263142/. [19] International clinical diabetic retinopathy disease severity scale, American Academy of Ophthalmology, The Eye MD Association, http://www.icoph.org/downloads/Diabetic-Retinopathy-Detail.pdf. [20] How to improve your diabetic eye exam screening score, The Physician Alliance, Saint Clair Shores, Michigan USA; 2016. http://thephysicianalliance.org/images/FilesDocuments/2016_dm_eyeexam_FINAL_20161207.pdf. [21] Van Eijk K. N. D, Blom J. W, Gussekloo J, Polak B. C. P, Groeneveld Y. Diabetic retinopathy screening in patients with diabetes mellitus in primary care: Incentives and barriers to screening attendance, Science direct, Diabetes Research and Clinical Practice, Volume 96, Issue 1, April 2012, Pages 10-16. https://www.sciencedirect.com/science/article/pii/S0168822711006267#! [22] Ting D. S. W, Cheung C. Y. L, Lim G; et al. Development and Validation of a Deep Learning System for Diabetic Retinopathy and Related Eye Diseases Using Retinal Images From Multiethnic Populations With Diabetes. JAMA. 2017. [23] https://jamanetwork.com/journals/jama/fullarticle/2665775. [24] Tien Yin Wong, MD, PhD; Neil M. Bressler, MD. Artificial Intelligence With Deep Learning Technology Looks Into Diabetic Retinopathy Screening. JAMA. 2016. https://jamanetwork.com/journals/jama/article-abstract/2588762. [25] FDA permits marketing of artificial intelligence-based device to detect certain diabetes-related eye problems. April 2018.US Food and Drug Administration. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm604357.htm. [26] Spurling K. P. G, Askew A. D, Hayman N. E, Hansar N, Cooney A. M, Jackson C. L. Retinal photography for diabetic retinopathy screening in Indigenous primary health care: the Inala experience. Australian and Zealand Journal of Public Health, July 2010. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-6405.2010.00549.x. [27] Harrison R. J, Wild J. M, Hobley A. J. Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease. BMJ 1988 ;297:1162. https://www.bmj.com/content/297/6657/1162. [28] Shotliff K, Duncan G. One way to reduce ophthalmology clinic waiting times for patients with diabetes, 2004 John Wiley & Sons, Ltd. https://onlinelibrary.wiley.com/doi/full/10.1002/pdi.638. [29] Shelley Walters S, Moynihan V. Diabetic retinopathy screening for Indigenous Australians in the Kimberley.2015. http://www.ruralhealth.org.au/13nrhc/images/paper_Walters%2C%20Shelley.pdf. [30] Khan A. R, Wiseberg J. A, Abdul Lateef Z. A, Khan S. A. Prevalence and determinants of diabetic retinopathy in Al Hasa region of Saudi Arabia: primary health care centre based cross-sectional survey, 2007-2009. http://www.meajo.org/article.asp?issn=0974-9233;year=2010;volume=17;issue=3;spage=257;epage=263;aulast=Khan. [31] Wanjiku M, Andrew B, Tunde P, Irene L, David Y, Allen F, Hannah K. Prevalence and Correlates of Diabetic Retinopathy in a Population-based Survey of Older People in Nakuru, Kenya. Ophthalmic epidemiology Journal. Volume 21, 2014 - Issue 3. 23 Apr 2014. https://www.tandfonline.com/doi/full/10.3109/09286586.2014.903982. [32] Burgess P. I, MacCormick I. J. C, Harding S. P, Bastawrous A, Beare N. A. V, Garner P. Epidemiology of diabetic retinopathy and maculopathy in Africa: a systemic review. Diabetic Medicine. 2012. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-5491.2012.03756.x.