LETTERS TO THE EDITOR
Cultural Barriers to the Uptake of Diabetic Retinopathy Treatment To the Editor: s a leading cause of preventable blindness, diabetic retinopathy is a major public health problem for many developed countries worldwide. Less is known about its adverse impact in low-income, developing countries. In this issue of the Journal, Chakrabarti and Chatterjee1 have highlighted the important issues of care delivery for diabetic retinopathy in developing Southeast Asian countries, such as Vietnam. The authors have proposed several solutions with achievable goals, but there are many challenges ahead. Perhaps, the authors may want to extend the discussion on one of less recognized challengesV cultural barriers to care. The need to consider cultural factors in the care of people with diabetes has been identified for several decades. However, this issue is often not effectively addressed in clinical practice because patients’ culture is frequently perceived as a problem of patients. This attitude needs to be changed. The delivery of culturally appropriate diabetes care may help reduce the burden of diabetic retinopathy. This requires practitioner competencies in cultural knowledge, selecting among levels of intensity of cultural interventions, adapting patient education, and developing community partnerships.
A
Ning Cheung, MBBS, FRANZCO Department of Ophthalmology and Visual Sciences Chinese University of Hong Kong Hong Kong, China
barriers when planning interventions for managing diabetic retinopathy in lowresource settings. The necessity of policy developers to be sensitive to cultural barriers was highlighted in this Journal by Orsmby et al,1 who identified low levels of awareness and knowledge of the management of common eye problems at the community level in Cambodia. In addition, Yan et al2 highlighted in rural China that priorities to improve compliance with eye care from a patient perspective included improved training of physicians, greater patient education, provision of reminders about appointments and medications (through messages/calls), and facilitating a patient transportation service run by the hospital using focus group methods of clinicians. We agree that it is imperative for management of diabetic retinopathy that culturally appropriate education and awareness of diabetes is entrenched at the community level. Through empowering the community through education, it is hoped that the importance of attending regular eye checks (even if the last examination was normal) and emphasis of primary prevention can be conveyed. In addition, it is imperative that local stakeholders (for example, respected community leaders and district hospital staff) are involved in the planning and implementation of programs, including the development of guidelines. This will undoubtedly imbue a sense of community ownership and provide a strong foundation upon which change can be made.
Rahul Chakrabarti, MBBS(Hons) BMedSc(Hons) Center for Eye Research Australia The University of Melbourne Royal Victorian Eye and Ear Hospital Victoria Australia
Letter to the Editor in Response to ‘‘An Update on the Diagnosis and Management of Central Serous Chorioretinopathy’’ Dear Editor: r Liu et al have made a comprehensive update on diagnosis and management of central serous chorioretinopathy (CSCR). In the article, the relatively aggressive behavior of CSCR has been touched upon, in particular the formation of subretinal or sub-retinal pigmented epithelium fibrin. In fact, this rarer form of CSCR would perhaps be most important because they are potentially visual threatening. Misdiagnosis or delayed treatment could lead to irreversible visual loss.1,2 Surgical treatment has been reported to treat such subretinal fibrosis,3 which is not mentioned as one of the treatment in the update. Multifocal CSCR is another severe form of CSCR. It is sometimes difficult to differentiate between multifocal CSCR and Vogt-Koyanagi-Harada disease especially in the early phase of the disease. Use of systemic steroid with a view to treat VogtKoyanagi-Harada could make the CSCR worsen. Moreover, safety-enhanced photodynamic therapy with reduced verteporfin dosage may not be feasible for some cases of multifocal CSCR as limited by the spot size of photodynamic therapy. The author did not include the factor of multifocal CSCR in the suggested management algorithm. In the interest of readers, it would be most grateful if the author would clarify whether multifocal CSCR should be a determinative factor in the management algorithm.
D
Vincent Y. W. Lee, FRCS, MBChB Dennis Lam & Partners Eye Center
Tanushree Chatterjee, MBBS(Hons) REFERENCE 1. Chakrabarti R, Chatterjee T. Tip of the iceberg: the need for diabetic retinopathy screening in developing countries. Lessons from Vietnam. Asia-Pac J Ophthalmol. 2013;2:76Y78.
The Need for Diabetic Retinopathy Screening in Low-Resource Settings Dear Editor:
W 206
e thank Dr Cheung for raising the critical point of sensitivity to cultural
Department of Internal Medicine Southern Medical University, Guangzhou Guangdong, People’s Republic of China
REFERENCES
REFERENCES 1. Schatz H, McDonald HR, Johnson RN, et al Subretinal fibrosis in central serous chorioretinopathy. Ophthalmology. 1995;102:1077Y1088.
1. Ormsby G, Arnold A, Busija L, et al. The impact of knowledge and attitudes on access to eye-care services in cambodia. Asia-Pac J Opthalmol. 2012;1:331Y335.
2. Hooymans JM. Fibrotic scar formation in central serous chorioretinopathy developed during systemic treatment with corticosteroids. Graefes Arch Clin Exp Ophthalmol. 1998;236:876Y879.
2. Yan X, Liu T, Gruber L, et al. Attitudes of physicians, patients, and village health workers toward glaucoma and diabetic retinopathy in rural china: a focus group study. Arch Ophthalmol. 2012;130:761Y770.
3. Kang JE, Kim HJ, Boo HD, et al Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy. Korean J Ophthalmol. 2006;20:131Y138.
Asia-Pacific Journal of Ophthalmology
&
Volume 2, Number 3, May/June 2013
Copyright © 2013 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
Cultural Barriers to the Uptake of Diabetic Retinopathy Treatment To the Editor: s a leading cause of preventable blindness, diabetic retinopathy is a major public health problem for many developed countries worldwide. Less is known about its adverse impact in low-income, developing countries. In this issue of the Journal, Chakrabarti and Chatterjee1 have highlighted the important issues of care delivery for diabetic retinopathy in developing Southeast Asian countries, such as Vietnam. The authors have proposed several solutions with achievable goals, but there are many challenges ahead. Perhaps, the authors may want to extend the discussion on one of less recognized challengesV cultural barriers to care. The need to consider cultural factors in the care of people with diabetes has been identified for several decades. However, this issue is often not effectively addressed in clinical practice because patients’ culture is frequently perceived as a problem of patients. This attitude needs to be changed. The delivery of culturally appropriate diabetes care may help reduce the burden of diabetic retinopathy. This requires practitioner competencies in cultural knowledge, selecting among levels of intensity of cultural interventions, adapting patient education, and developing community partnerships.
A
Ning Cheung, MBBS, FRANZCO Department of Ophthalmology and Visual Sciences Chinese University of Hong Kong Hong Kong, China
barriers when planning interventions for managing diabetic retinopathy in lowresource settings. The necessity of policy developers to be sensitive to cultural barriers was highlighted in this Journal by Orsmby et al,1 who identified low levels of awareness and knowledge of the management of common eye problems at the community level in Cambodia. In addition, Yan et al2 highlighted in rural China that priorities to improve compliance with eye care from a patient perspective included improved training of physicians, greater patient education, provision of reminders about appointments and medications (through messages/calls), and facilitating a patient transportation service run by the hospital using focus group methods of clinicians. We agree that it is imperative for management of diabetic retinopathy that culturally appropriate education and awareness of diabetes is entrenched at the community level. Through empowering the community through education, it is hoped that the importance of attending regular eye checks (even if the last examination was normal) and emphasis of primary prevention can be conveyed. In addition, it is imperative that local stakeholders (for example, respected community leaders and district hospital staff) are involved in the planning and implementation of programs, including the development of guidelines. This will undoubtedly imbue a sense of community ownership and provide a strong foundation upon which change can be made.
Rahul Chakrabarti, MBBS(Hons) BMedSc(Hons) Center for Eye Research Australia The University of Melbourne Royal Victorian Eye and Ear Hospital Victoria Australia
Letter to the Editor in Response to ‘‘An Update on the Diagnosis and Management of Central Serous Chorioretinopathy’’ Dear Editor: r Liu et al have made a comprehensive update on diagnosis and management of central serous chorioretinopathy (CSCR). In the article, the relatively aggressive behavior of CSCR has been touched upon, in particular the formation of subretinal or sub-retinal pigmented epithelium fibrin. In fact, this rarer form of CSCR would perhaps be most important because they are potentially visual threatening. Misdiagnosis or delayed treatment could lead to irreversible visual loss.1,2 Surgical treatment has been reported to treat such subretinal fibrosis,3 which is not mentioned as one of the treatment in the update. Multifocal CSCR is another severe form of CSCR. It is sometimes difficult to differentiate between multifocal CSCR and Vogt-Koyanagi-Harada disease especially in the early phase of the disease. Use of systemic steroid with a view to treat VogtKoyanagi-Harada could make the CSCR worsen. Moreover, safety-enhanced photodynamic therapy with reduced verteporfin dosage may not be feasible for some cases of multifocal CSCR as limited by the spot size of photodynamic therapy. The author did not include the factor of multifocal CSCR in the suggested management algorithm. In the interest of readers, it would be most grateful if the author would clarify whether multifocal CSCR should be a determinative factor in the management algorithm.
D
Vincent Y. W. Lee, FRCS, MBChB Dennis Lam & Partners Eye Center
Tanushree Chatterjee, MBBS(Hons) REFERENCE 1. Chakrabarti R, Chatterjee T. Tip of the iceberg: the need for diabetic retinopathy screening in developing countries. Lessons from Vietnam. Asia-Pac J Ophthalmol. 2013;2:76Y78.
The Need for Diabetic Retinopathy Screening in Low-Resource Settings Dear Editor:
W 206
e thank Dr Cheung for raising the critical point of sensitivity to cultural
Department of Internal Medicine Southern Medical University, Guangzhou Guangdong, People’s Republic of China
REFERENCES
REFERENCES 1. Schatz H, McDonald HR, Johnson RN, et al Subretinal fibrosis in central serous chorioretinopathy. Ophthalmology. 1995;102:1077Y1088.
1. Ormsby G, Arnold A, Busija L, et al. The impact of knowledge and attitudes on access to eye-care services in cambodia. Asia-Pac J Opthalmol. 2012;1:331Y335.
2. Hooymans JM. Fibrotic scar formation in central serous chorioretinopathy developed during systemic treatment with corticosteroids. Graefes Arch Clin Exp Ophthalmol. 1998;236:876Y879.
2. Yan X, Liu T, Gruber L, et al. Attitudes of physicians, patients, and village health workers toward glaucoma and diabetic retinopathy in rural china: a focus group study. Arch Ophthalmol. 2012;130:761Y770.
3. Kang JE, Kim HJ, Boo HD, et al Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy. Korean J Ophthalmol. 2006;20:131Y138.
Asia-Pacific Journal of Ophthalmology
&
Volume 2, Number 3, May/June 2013
Copyright © 2013 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
