Blindness Due to Diabetic Retinopathy Surges Worldwide

Miriam E Tucker

August 26, 2016

Visual impairment due to diabetic retinopathy (DR) is rising worldwide, and diabetic eye disease is now the fifth most common cause of blindness, new research shows.

The findings, from a meta-analysis of all available population-based studies performed worldwide from 1990 to 2012 for the Global Burden of Disease (GBD) Study 2010, were published in the September 2016 issue of Diabetes Care by Janet L Leasher, OD, of Nova Southeastern University College of Optometry, Fort Lauderdale/Davie, Florida, and colleagues.

The number of people with visual impairment due to DR represents an increasing proportion of all cases of blindness and moderate to severe visual impairment.

In all, the researchers found, DR was responsible in one of every 39 cases of blindness and one of every 52 cases of visual impairment in 2010.

"With the alarming prevalence of vision loss due to diabetes rising more than two-thirds in the past 20 years, the precipitous global epidemic of diabetes must be addressed," said coauthor Rupert RA Bourne, MD, professor and associate director of the Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom, in a press statement.

In the Global Burden of Disease Study, blindness was defined as presenting visual acuity below 3/60 and moderate to severe visual impairment as presenting visual acuity below 6/18 but 3/60 or greater. Data were collected from 14 countries in Australasia, Central and Western Europe, North America, the Caribbean, Latin America, Oceania, and South, East, and Southeast Asia.

In 2010 worldwide, approximately 32.4 million people were blind and 191 million people were visually impaired. Of those, DR was responsible for 833,690 cases of blindness and 3.7 million of visual impairment. From 1990 to 2010, the number of people with DR-induced blindness increased by approximately 27% and the number with DR-related visual impairment by 64%.

By percentage, DR caused 2.6% of all cases of blindness and 1.9% of all visual impairment in 2010, up from 2.1% and 1.3%, respectively, in 1990. The percentage of blindness caused by DR in 2010 ranged from less than 2% in Southeast Asia and Oceania to 5.5% or greater in southern Latin America.

In general, the percentage of blindness and visual impairment attributable to DR was lower in low-income regions with younger populations such as East and Southeast Asia and higher in high-income parts of the world, with older populations, including North America and Western Europe.

A possible reason is that low-income regions may have a higher percentage of untreated cataracts or refractive error–related visual impairment, thereby reducing the proportion attributable to DR, the authors suggest. Also, in regions with poor access to medical services, people with diabetes may not live long enough to experience DR, they point out.

And, "unfortunately, diabetic retinopathy usually does not have any symptoms in the early stages," noted Dr Leasher.

"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," she advised. "Patients should work closely with their healthcare provider to determine the best methods to control their blood sugar levels," she added.

Overall, "it is imperative to plan for a greater share of blindness and visual impairment due to DR and to develop strategies to prevent DR and subsequent vision loss," she and her colleagues write.

Such strategies include the following:

  • Develop evidence-based, cost-effective DR screening strategies.

  • Improve systemic risk-factor control (such as glucose and blood pressure).

  • Increase health education and awareness of the risk of DR-related visual loss.

  • Prevent and treat DR through expanded use of laser treatments, intravitreal steroid injections, and anti-VEGF drugs.

  • Reduce regional differences in screening and management of diabetes and DR, socioeconomic factors, and medical infrastructure.

This study was partially funded by the Bill & Melinda Gates Foundation, Fight for Sight, the Fred Hollows Foundation, and the Brien Holden Vision Institute. The authors have no relevant financial relationships.

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Diabetes Care. 2016; 39: 1643-1649. Abstract

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