PONE-D-22-24140Prevalence and Associated Factors of Visual Impairment Among Adult Diabetic Patients Visiting Adare General Hospital, Hawassa, South Ethiopia, 2022PLOS ONE

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Additional Editor Comments:

The reviewers raised several issues about discussion section and study limitations.

Please, address all issues raised by the reviewers and submit a revised manuscript.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I read with great interest the paper “Prevalence and Associated Factors of Visual Impairment Among Adult Diabetic Patients Visiting Adare General Hospital, Hawassa, South Ethiopia, 2022" by Mikias Mered Tilahun et al.

The article is well written. Paper design is fine. The article is logically divided into sections and subsections. The analysis is well performed

Comments:

1. Limitation of the study is also represented by the lack of data about 2 major risk factors that have been associated to diabetic retinopathy, that are albuminuric chronic kidney disease and high HDL levels, which should be added to the appropriate section.

2. Discussion should be treated more in depth. For example, the role played by physical activity in ameliorating insulin resistance. In fact, a wrong lifestyle may produce an excessively positive caloric balance, thus causing insulin resistance by enhancing visceral adipose tissue and consequently releasing a much higher level of free fatty acids, TNF-α, adipokines and hyperglycaemia which will lead to increased inflammation, endothelial disfunction and, as a consequence to increased prevalence of diabetes complications and in particular retinopathy (doi: 10.3390/antiox10020270).

Reviewer #2: Dear Editor

I’ve read with great interest the manuscript draft “Prevalence and Associated Factors of Visual Impairment Among Adult Diabetic Patients Visiting Adare General Hospital, Hawassa, South Ethiopia, 2022” by Henok Biruk Alemayehu et al. However, some issues need to be raised.

Abstract:

- There are some typing errors.

Introduction:

- “Diabetes is a complex…” seems too generic, I would suggest to specify which type of diabetes.

- Please insert the entire words when an acronym is used for the first time throughout the text.

Methods:

- The authors write “systemic co-morbidities were collected from each patient's medical chart”. I would suggest to briefly specify how co-morbidities diagnosis has been done, particularly for what concerns the statistically associated peripheral neuropathy.

Discussion:

- The authors write “Studying the prevalence in this setup would increase the magnitude of visual impairment.” Recently, some authors have demonstrated that telemedicine could allow to implement the screening programs also during a pandemic period (Galiero R, Pafundi PC, Nevola R, et al. The Importance of Telemedicine during COVID-19 Pandemic: A Focus on Diabetic Retinopathy. J Diabetes Res. 2020;2020:9036847. Published 2020 Oct 14. doi:10.1155/2020/9036847; Sasso FC, Pafundi PC, Gelso A, et al. Telemedicine for screening diabetic retinopathy: The NO BLIND Italian multicenter study. Diabetes Metab Res Rev. 2019;35(3):e3113. doi:10.1002/dmrr.3113). I would suggest to briefly discuss this point.

Limitations:

- This is a single-center study, thus it seems difficult to fully generalize the results. I would suggest to add this issue to limitations section.

- To evaluate glycemic control, the study lacks glycated hemoglobin, I would suggest to discuss this issue or to move in to limitation section.

Conclusion:

- The authors write “Diabetic patients should engage in regular physical activity for at least 150 minutes per week, control their glucose levels with proper use of medication, and have regular eye

exams.”, however no references have been associated with this sentence. I would suggest to at least a reference linked to this point.

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Reviewer #1: No

Reviewer #2: No

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Prevalence and Associated Factors of Visual Impairment Among Adult Diabetic Patients Visiting Adare General Hospital, Hawassa, South Ethiopia, 2022

PONE-D-22-24140R1

Dear Dr. Tilahun,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ferdinando Carlo Sasso, PhD, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors addressed all issues raised by reviewers.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors answered appropriately to all my quarries. The paper can now be further processed for publication

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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