# Diabetic Retinopathy Prevalence and Incidence in Zimbabwe: The Feasibility of Digital Fundoscopy Screening

## TL;DR

This study evaluates digital fundoscopy for diabetic retinopathy screening in Zimbabwe, finding high DR rates and showing the method is feasible for early diagnosis.

## Contribution

The study demonstrates the feasibility of digital fundoscopy for DR screening in an underserved region and reports DR prevalence and incidence in Zimbabwe.

## Key findings

- 41.6% of participants had diabetic retinopathy at baseline.
- Annual incidence of DR was 6.8% among those without DR at baseline.
- Higher HbA1c levels were associated with increased odds of DR.

## Abstract

Diabetic retinopathy (DR) is the leading cause of blindness in the working‐age population, yet many underserved communities lack access to screening programmes that would facilitate earlier diagnosis and access to treatment. This study is aimed at evaluating the feasibility of embedding digital fundoscopy (DF) for routine screening of patients with diabetes mellitus (DM) in Masvingo, Zimbabwe; assessing the prevalence and progression of DR among this previously unstudied population; and determining the baseline variables associated with DR and its progression. An observational study was conducted at Masvingo Provincial Hospital. Eligible participants were aged ≥ 18 and routinely attended the clinic. Participants (N = 202) were assessed for the presence and severity of DR using DF at baseline and again at 1 year. Images were sent to a remote ophthalmologist for diagnosis. Logistic regression was used to investigate the association of the participants′ demographics and medical history with DR. At baseline, 84 (41.6%) participants were diagnosed with DR. Among participants without DR at baseline, eight had DR at Year 1, translating to an annual incidence of 6.8%. Higher levels of haemoglobin A1c (HbA1c) were associated with increased odds of DR at baseline (p = 0.03) compared with normal HbA1c. The mean turnaround between image capture and clinical report availability at baseline (36.16 days) and at Year 1 (18.89 days) was aligned with global guidelines. High DR rates in Masvingo provide compelling evidence of the need for increased healthcare resources for DR screening in underserved settings; our study demonstrates the feasibility of embedding DF into standard practice for this purpose. Patients with poorly managed DM, as indicated by elevated HbA1c, should be prioritised for DF screening programmes and monitoring to facilitate early diagnosis and prevent avoidable blindness. Further investigation is needed into factors associated with DR progression.