Vision loss in diabetics caused by diabetic retinopathy has increased worldwide

Over the past two decades, researchers have found an increased prevalence of diabetic patients with visual impairment caused by diabetic retinopathy (DR) worldwide. DR now accounts for an increasing proportion of all blindness and moderate and severe vision impairments (MSVI), causing blindness in 1 out of 39 blind people, and causeing visual impairment in 1 out of 52 visually impaired persons, according to their results published in the August 23, 2016 issue of the journal Diabetes Care.

“With the alarming prevalence of vision loss due to diabetes rising more than two-thirds in the last 20 years, the precipitous global epidemic of diabetes must be addressed,” said Rupert RA Bourne, FRCOphth, MD, lead investigator of the report, ophthalmologist, professor, and associate director of the Vision and Eye Research Unit at Anglia Ruskin University, Cambridge, United Kingdom.

In this meta-analysis of published population studies conducted from 1990 to 2012, researchers sought to estimate both global and regional trends in the prevalence of individuals who live with visual impairment caused by DR. They included cases of moderate and severe vision impairment (MSVI) with a presenting visual acuity of < 6/18, ≥ 3/60, and blindness (presenting visual acuity of < 3/60.

Globally, the study included 191 million visually impaired and 32.4 million blind individuals. DR was the cause of blindness in 0.8 million individuals and visual impairment in 3.7 million, for increases of 27% and 64%, respectively, over the two decades encompassing 1990 to 2010.

In 2010, DR accounted for 2.6% of all blindness and 1.9% of all MSVI worldwide, an increase from 1990 rates of 2.1% and 1.3%, respectively. Regions with younger populations, including East and Southeast Asia and Oceania, had lower rates compared with high-income regions with relatively aging populations, including North America, Western Europe, and Australasia (< 2% vs > 4%, respectively).

“Unfortunately diabetic retinopathy usually does not have any symptoms in the early stages,” said study co-author Janet Leasher, OD, MPH, professor, Nova Southeastern University’s (NSU) College of Optometry in Fort Lauderdale/Davie, Florida. “People diagnosed with diabetes should have a dilated eye health exam at least every year and be advised by their eye care practitioner for their personal situation. Patients should work closely with their health care provider to determine the best methods to control their blood sugar levels.”

Based on their findings, these researchers recommended public policy planning in those regions most affected by DR, including:

• Strategies for preserving the vision of diabetic adults;
• Evidence-based, cost-effective strategies to screen for DR;
• Improved control of systemic risk factors such as glucose and blood pressure in people with diabetes;
• Increased health education and awareness of the risk of visual loss from DR;
• Intensified prevention and treatment of DR through the introduction of laser treatments, intra-vitreal injections of steroids, and anti-vascular endothelial growth factor drugs; and
• Reduction of differences between regions in the screening and management of diabetes and DR, socioeconomic factors, and medical infrastructure.

This research was partially funded by the Bill & Melinda Gates Foundation, Fight for Sight, Fred Hollows Foundation, and the Brien Holden Vision Institute.