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Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study.

de Fine Olivarius N, Siersma V, Almind GJ, Nielsen NV - BMC Public Health (2011)

Bottom Line: The incidence (95% confidence interval) of blindness was 40.2 (25.3-63.8) per 10,000 patient-years.Baseline predictors of level of visual acuity (age, age-related macular degeneration (AMD), cataract, living alone, low self-rated health, and sedentary life-style) and speed of continued visual loss (age, AMD, diabetic retinopathy (DR), cataract, living alone, and high fasting triglycerides) were identified.Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. olivarius@sund.ku.dk

ABSTRACT

Background: Many diabetic patients fear visual loss as the worst consequence of diabetes. In most studies the main eye pathology is assigned as the cause of visual impairment. This study analysed a broad range of possible ocular and non-ocular predictors of visual impairment prospectively in patients newly diagnosed with clinical type 2 diabetes.

Methods: Data were from a population-based cohort of 1,241 persons newly diagnosed with clinical, often symptomatic type 2 diabetes aged ≥ 40 years. After 6 years, 807 patients were followed up. Standard eye examinations were done by practising ophthalmologists.

Results: At diabetes diagnosis median age was 65.5 years. Over 6 years, the prevalence of blindness (visual acuity of best seeing eye ≤ 0.1) rose from 0.9% (11/1,241) to 2.4% (19/807) and the prevalence of moderate visual impairment (> 0.1; < 0.5) rose from 5.4% (67/1,241) to 6.7% (54/807). The incidence (95% confidence interval) of blindness was 40.2 (25.3-63.8) per 10,000 patient-years. Baseline predictors of level of visual acuity (age, age-related macular degeneration (AMD), cataract, living alone, low self-rated health, and sedentary life-style) and speed of continued visual loss (age, AMD, diabetic retinopathy (DR), cataract, living alone, and high fasting triglycerides) were identified.

Conclusions: In a comprehensive assessment of predictors of visual impairment, even in a health care system allowing self-referral to free eye examinations, treatable eye pathologies such as DR and cataract emerge together with age as the most notable predictors of continued visual loss after diabetes diagnosis. Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

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Vision loss during the first 6 years after diabetes diagnosis according to all statistically significant predictors at diagnosis except fasting triglycerides and self-rated health. The curves are defined by medians of decimal acuity (interquartile ranges) at diagnosis and 6 years later. a Diabetic retinopathy: no retinopathy (green); microaneurysms only (blue); further retinopathy (red). b Age-related macular degeneration: no (green); yes (red). c Cataract: no (green); yes (red). d Age, years: 40- < 60 (green); 60- < 70 (blue); ≥ 70 (red). e Living alone: no (green); yes (red). f Physical activity: moderate/high (green); low (red).
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Figure 2: Vision loss during the first 6 years after diabetes diagnosis according to all statistically significant predictors at diagnosis except fasting triglycerides and self-rated health. The curves are defined by medians of decimal acuity (interquartile ranges) at diagnosis and 6 years later. a Diabetic retinopathy: no retinopathy (green); microaneurysms only (blue); further retinopathy (red). b Age-related macular degeneration: no (green); yes (red). c Cataract: no (green); yes (red). d Age, years: 40- < 60 (green); 60- < 70 (blue); ≥ 70 (red). e Living alone: no (green); yes (red). f Physical activity: moderate/high (green); low (red).

Mentions: During the 6 years of follow up, DR had appeared in 11.7% (90/770) of patients without DR at diagnosis (Table 4). At 6-year follow up, DR and AMD were also relatively more common among the visually impaired (Table 5). The influence of eye complications at diagnosis on change in visual acuity over 6 years was investigated in linear mixed models (Table 1). The 112 patients in Table 1 with "other retinopathy" presented with133 retinal pathologies other than DR and AMD: hypertensive retinopathy (n = 43), retinal vasosclerosis (41), drusen (18) and other retinopathy (31). DR (n = 52), AMD (154), and cataract (337) were associated with the level of visual acuity and/or its annual change also in age- and sex-adjusted analyses. These effects are illustrated with median decimal acuity values in Figure 2.


Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study.

de Fine Olivarius N, Siersma V, Almind GJ, Nielsen NV - BMC Public Health (2011)

Vision loss during the first 6 years after diabetes diagnosis according to all statistically significant predictors at diagnosis except fasting triglycerides and self-rated health. The curves are defined by medians of decimal acuity (interquartile ranges) at diagnosis and 6 years later. a Diabetic retinopathy: no retinopathy (green); microaneurysms only (blue); further retinopathy (red). b Age-related macular degeneration: no (green); yes (red). c Cataract: no (green); yes (red). d Age, years: 40- < 60 (green); 60- < 70 (blue); ≥ 70 (red). e Living alone: no (green); yes (red). f Physical activity: moderate/high (green); low (red).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045948&req=5

Figure 2: Vision loss during the first 6 years after diabetes diagnosis according to all statistically significant predictors at diagnosis except fasting triglycerides and self-rated health. The curves are defined by medians of decimal acuity (interquartile ranges) at diagnosis and 6 years later. a Diabetic retinopathy: no retinopathy (green); microaneurysms only (blue); further retinopathy (red). b Age-related macular degeneration: no (green); yes (red). c Cataract: no (green); yes (red). d Age, years: 40- < 60 (green); 60- < 70 (blue); ≥ 70 (red). e Living alone: no (green); yes (red). f Physical activity: moderate/high (green); low (red).
Mentions: During the 6 years of follow up, DR had appeared in 11.7% (90/770) of patients without DR at diagnosis (Table 4). At 6-year follow up, DR and AMD were also relatively more common among the visually impaired (Table 5). The influence of eye complications at diagnosis on change in visual acuity over 6 years was investigated in linear mixed models (Table 1). The 112 patients in Table 1 with "other retinopathy" presented with133 retinal pathologies other than DR and AMD: hypertensive retinopathy (n = 43), retinal vasosclerosis (41), drusen (18) and other retinopathy (31). DR (n = 52), AMD (154), and cataract (337) were associated with the level of visual acuity and/or its annual change also in age- and sex-adjusted analyses. These effects are illustrated with median decimal acuity values in Figure 2.

Bottom Line: The incidence (95% confidence interval) of blindness was 40.2 (25.3-63.8) per 10,000 patient-years.Baseline predictors of level of visual acuity (age, age-related macular degeneration (AMD), cataract, living alone, low self-rated health, and sedentary life-style) and speed of continued visual loss (age, AMD, diabetic retinopathy (DR), cataract, living alone, and high fasting triglycerides) were identified.Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. olivarius@sund.ku.dk

ABSTRACT

Background: Many diabetic patients fear visual loss as the worst consequence of diabetes. In most studies the main eye pathology is assigned as the cause of visual impairment. This study analysed a broad range of possible ocular and non-ocular predictors of visual impairment prospectively in patients newly diagnosed with clinical type 2 diabetes.

Methods: Data were from a population-based cohort of 1,241 persons newly diagnosed with clinical, often symptomatic type 2 diabetes aged ≥ 40 years. After 6 years, 807 patients were followed up. Standard eye examinations were done by practising ophthalmologists.

Results: At diabetes diagnosis median age was 65.5 years. Over 6 years, the prevalence of blindness (visual acuity of best seeing eye ≤ 0.1) rose from 0.9% (11/1,241) to 2.4% (19/807) and the prevalence of moderate visual impairment (> 0.1; < 0.5) rose from 5.4% (67/1,241) to 6.7% (54/807). The incidence (95% confidence interval) of blindness was 40.2 (25.3-63.8) per 10,000 patient-years. Baseline predictors of level of visual acuity (age, age-related macular degeneration (AMD), cataract, living alone, low self-rated health, and sedentary life-style) and speed of continued visual loss (age, AMD, diabetic retinopathy (DR), cataract, living alone, and high fasting triglycerides) were identified.

Conclusions: In a comprehensive assessment of predictors of visual impairment, even in a health care system allowing self-referral to free eye examinations, treatable eye pathologies such as DR and cataract emerge together with age as the most notable predictors of continued visual loss after diabetes diagnosis. Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

Show MeSH
Related in: MedlinePlus