Four-year incidence and progression of visual impairment in a South Indian population with diabetes

Abstract

Purpose:The aim of this study is to investigate the 4-year incidence and progression of visual impairment (VI) and the associated risk factors for incident VI in a South Indian population with type 2 diabetes.Methods:A total of 634 participants with type 2 diabetes were found eligible after 4 years. Visual acuity (VA) was estimated using the modified Early Treatment Diabetic Retinopathy Study protocol. VA in the better eye was considered for the assessment of VI based on the World Health Organization criteria. Mild VI was defined as VA <20/40 but up to 20/60, moderate VI as VA <20/60 but up to 20/200, severe VI as VA <20/200 but up to 10/200, and blindness as VA worse than 10/200.Results:The 4-year incidence of any VI, mild VI, moderate VI, severe VI, and blindness was 21.7%, 18.3%, 3.4%, 0.0%, and 0.0%, respectively; of the 13 participants with VI at baseline, 12 (92%) showed worsening/progression of VI on follow-up. Multiple logistic regression showed that nuclear cataract of grades >4.0 (odds ratio [OR]: 2.612 [1.148–5.942], P = 0.022) and lower socioeconomic score (OR: 0.965 [95% confidence interval, (0.933-0.998)], P = 0.040) were associated with the risk of future incident VI. Refractive error (47%) and cataract (30%) were identified as the leading causes of incident VI at follow-up.Conclusions:VI seems to be a significant problem among diabetic participants in the South Indian population. Refractive error and cataract are the leading but treatable causes of incident VI in this population and would benefit from intervention.

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual

“…As doenças oculares (RD, glaucoma e catarata) foram à causa da DV relatadas pela maioria das pessoas (62,75%), com associação estatisticamente significante entre a causa e os tipos da DV (p= 0,000) (Tabela 1). Esses dados vão ao encontro ao estudo realizado no estado da Bahia 15 , no qual 53,90% das pessoas idosas com diabetes possuíam a complicação visual; e pesquisa realizada no Sul da Índia, que acompanhou as pessoas com diabetes durante quatro anos, e identificou a incidência de DV (21,70%), sendo que leve (18,30%) e moderado (3,40%) 16 . No presente estudo, o glaucoma não predominou em nenhum dos tipos de DM, sendo que 52,17% das pessoas com diabetes tipo 1 e 53,57% do tipo 2 não tinham a doença; como também não prevaleceu na maioria da amostra estudada (52,94%).…”

Diabetic Retinopathy and Blindness: An Epidemiological Overview

“…Thus, intravitreal anti-VEGF drugs serve as an effective temporizing treatment but are not a replacement for close monitoring and definitive treatment of neovascular glaucoma [106,107]. Impairment of vision in diabetic patients is not limited to retinopathy-the leading causes of deteriorated vision and progression of vision loss in a cohort from South India were cataracts and uncorrected refractive errors [108]. The introduction of phacoemulsification significantly reduced the surgical trauma and leads to a growing tendency toward earlier cataract surgery in diabetic patients [109].…”