A Survey of the Management of Diabetic Macular Oedema in Sub-Saharan Africa

Abstract

Background: There is minimal information about the availability of treatment for Diabetic macular oedema (DMO) in sub-Saharan Africa  (SSA). The principal aim of this survey was to determine the ‘real world’ management of DMO amongst ophthalmologists working in SSA.

Methodology: Questionnaires were distributed to members of retinal and ophthalmological societies in SSA.

Results: Ninety-Three  ophthalmologists from 24 countries participated with the majority working in Nigeria (51, 55%). Most were retina specialists (50, 54%) and  consultants (67, 62%). Clinically significant macular oedema prompted treatment for 62 (67%) ophthalmologists, whilst visual acuity  (81, 87%) and OCT changes (76, 82%) were more common reasons to treat DMO. Treatment included intravitreal anti-VEGF (91, 98%),  laser (70, 75%), intravitreal steroid (57, 61%), topical drops (52, 56%), oral tablets (32, 34%) and surgery (20, 22%). The commonest  intravitreal anti-VEGF agents used were bevacizumab (89, 96%) and ranibizumab (71, 76%). Intravitreal triamcinolone was used by 69  (74%), topical NSAIDs by 51 (55%), and acetazolamide tablets by 22 (24%) ophthalmologists as a treatment for DMO.

Conclusion: Sub- Saharan African ophthalmologists commonly use intravitreal anti-VEGF, laser, intravitreal steroid, and topical NSAIDs to treat DMO.  Economic constraints and/or the inability to maintain the intensive regimen required for successful intravitreal anti-VEGF therapy  probably influence some treatment choices.