To date, visual health has been largely ignored, which has resulted in significant numbers of Aboriginal Canadians suffering from serious ocular and visual health problems. Only a few ocular health programs have evolved targeting Aboriginal communities (Venne, 2011). As such, the purpose of this study was to investigate the risk factors for type 2 diabetes and the possibility of using a portable fundus camera (Optovue) as a novel approach for convenient, earlier, and more accessible vision screening and referral for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This mobile state-of-the-art technology allows for quick vision screening and can be used by registered nurses to screen for visual changes related to diabetes. The data can be saved and any images of concern can be securely emailed to the off-site ophthalmologist for further investigation.
Methods:
Study Design: This two stage quantitative pilot study screened participants for identification of risk factors of type 2 diabetes with anthropometrical measurements, blood pressure, and a A1C point of care blood glucose test (Stage 1), followed by vision exams to screen for signs of retinopathy in participants diagnosed with type 2 diabetes using fundus photography (Stage 2).
Population: A purposeful sample of adults living in northern and remote Canadian communities were invited to participate in this pilot study. Participants were recruited from an ophthalmology clinic (n=33) and criteria for the study included a diagnosis of type 2 diabetes.
Stage 1 - Risk Measurements: As recommended by the Canadian Diabetic Association (CDA), weight, height, Body Mass Index (BMI), blood pressure, and an A1C were measured to screen for risk of type 2 diabetes. Descriptive statistics were computed using the Statistical Package for Social Sciences (SPSS v.22.0). Stage 2 - Vision Exams: The first vision exam involved the nurse screening for retinopathy using a portable fundus camera. The second eye exam involved fundus photography completed by the ophthalmologist. The nurse led vision exam results were compared to those of the ophthalmologist to determine sensitivity of the portable fundal camera as a screening tool for detection of diabetic retinopathy. A Cohen's Kappa was used to evaluate the inter-rater agreement between the nurses and ophthalmologist.
Results: Stage 1-BMI: The participant’s BMI measurements ranged 18.75 and 48.63 with a mean of 32.22 (SD = 6.88). The percentage of obesity (>=30) = 54.5%. A1C: The A1C levels ranged from 5.50 to 13.00 with a mean of 8.30 (SD = 1.64). The percentage of elevated BMI (7.1 or higher) = 78.8%. Blood Pressure: The percentage of prehypertension (systolic = 120-130 OR diastolic = 80-89) and hypertension (systolic = 140-159 OR diastolic = 90-99) = 69.6%. Stage 2-Interrater reliability was calculated using Cohen’s Kappa with results demonstrating a moderate agreement between the health professionals’ judgments (k = .67).
Conclusion: Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lower the costs to families by reducing travel expenses, and prevent loss of vision for Aboriginal peoples. This research is being used as a foundation to advocate for expanded primary health services to improve the health outcomes for Aboriginal people living with type 2 diabetes in northern and remote Canadian communities. Future research with a larger sample is indicated to validate these results.