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Diabetes Retinopathy in Sub-Saharan Africa

Patient details
Mrs. A, a 52-year-old woman from a rural village in northern Ghana.
Patient case fields
History

Mrs. A has a 10-year history of type 2 diabetes mellitus, poorly controlled due to limited access to healthcare and medication. She was diagnosed late, and despite intermittent treatment, her blood sugar levels have frequently been elevated. Over the past year, she has noticed a gradual decline in her vision, especially at night, and occasional dark spots in her field of view.

 

Presentation:

Mrs. A presented to a local health clinic after experiencing significant difficulty with her vision, making it hard for her to perform daily tasks. She reported that her vision was blurry and that she could no longer recognise faces from a distance. Her symptoms have worsened over the last six months.

 

Examination

On examination, her visual acuity was markedly reduced in both eyes. Fundoscopic examination revealed signs of advanced diabetic retinopathy, including microaneurysms, dot and blot haemorrhages, and neovascularisation. There was also evidence of macular oedema, contributing to her vision loss.

 

Diagnosis

Mrs. A was diagnosed with proliferative diabetic retinopathy, a complication of her poorly managed diabetes.

 

 

Management

Given the limited resources at the clinic, Mrs. A was referred to a regional hospital with an ophthalmology unit. She was counselled on the importance of strict blood glucose control and started on insulin therapy. The ophthalmologist recommended laser photocoagulation to reduce the risk of further vision loss, although her prognosis was guarded due to the advanced stage of the disease.

 

Follow-up:

Mrs. A was scheduled for regular follow-up visits to monitor her condition and adjust her diabetes management. She was also advised to attend diabetic education sessions to improve her understanding of the disease and its complications.

 

Outcome

Despite the intervention, Mrs. A's vision remained compromised, highlighting the need for earlier detection and better management of diabetes in rural sub-Saharan Africa. Her case underscores the importance of access to healthcare and education in preventing severe complications like diabetic retinopathy.

Discussion
No data was found
Questions
1. What is the most likely cause of Mrs. A's vision loss?

a). Cataracts

b). Glaucoma

c). Diabetic retinopathy

d). Age-related macular degeneration

2. Which of the following was a major contributing factor to the progression of Mrs. A's condition?

a). Regular blood sugar monitoring

b). Early diagnosis and treatment

c). Poorly controlled diabetes

d). High physical activity levels

3. What specific finding on the fundoscopic examination indicated advanced diabetic retinopathy in Mrs. A?

a). Optic disc swelling

b). Neovascularisation

c). Retinal detachment

d). Dry macula

4. What was the recommended treatment to reduce the risk of further vision loss in Mrs. A?

a). Cataract surgery

b). Vitrectomy

c). Laser photocoagulation

d). Intravitreal steroid injection

Reveal answers

Answers

  1.  c). Diabetic retinopathy
  2. c). Poorly controlled diabetes
  3. b). Neovascularisation
  4. c). Laser photocoagulation