Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

Abstract

Purpose To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.Methods Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. ResultsA total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI (P < 0.001), density of specialists (P = 0.004), subspecialists (P < 0.001), and sampling site (P = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.

Downregulation of Circular RNA PSEN1 ameliorates ferroptosis of the high glucose treated retinal pigment epithelial cells via miR-200b-3p/cofilin-2 axis

“…Previous studies demonstrated that circ-PSEN1 is upregulated in DR [ 30–32 ]. On the basis of this finding, we intended to further investigate whether circ-PSEN1 functioned in the DR-induced ferroptosis.…”

Single-Field Fundus Photography for Screening of Diabetic Retinopathy: The Prevalence and Associated Factors in a Population-Based Study

“…In a systematic review by Maroufizadeh et al [7], the prevalence of diabetic retinopathy in Iran (including general population, diabetic and eye clinics) was reported as 41.9% (95% CI 35.6-48.2). In another systematic review, the pooled prevalence of DR in population-based studies in Iran was 29.6% (95% CI 22.6-36.5) [8]. They showed that the rate was 31.8% (95% CI 24.5-39.2) in diabetic clinics and 57.8% (95% CI 50.2-65.3) in eye clinics.…”

“…In addition, 17.52% had new onset diagnosis of diabetes. Other causes of these differences in DR prevalence are difference in methodology (including the screening tool; the prevalence may be [16,40,41], setting and risk of selection bias (the prevalence is the lowest in general population, primary healthcare facilities, diabetic or eye clinics, and hospitals) [7,8], diagnostic method (diagnosis of diabetes based on patient self-report, without laboratory testing, may overestimate the prevalence of DR due to the exclusion of undiagnosed diabetes from the sample) [8], sample size, ethnicity (ethnic variations may be due to related social and economic differences and access to diabetes care) [42], nutrition, demographic, and lifestyle [4].…”

“…The prevalence of DR in patients with diabetes varies among different populations [2][3][4][5][6][7]. In Iran, the prevalence of DR in population-based studies is estimated at 29.6% [8].…”

Pharmacological Effects of Saffron and its Constituents in Ocular Disorders from in vitro Studies to Clinical Trials: A Systematic Review

“…Intravitreal ranibizumab and bevacizumab are administrated for the treatment of CSME [ 10 ]. Diabetic retinopathy occurs in 1 out of 3 people with diabetes, with reported rates of DME reaching 7% in this group of patients [ 11 , 12 ].…”