Diabetic retinopathy visual impairment -
Trends in diabetes diagnoses and treatment for DR. A : Annual prevalence of patients with treated diabetes in the total population during — B : Annual incidence of people diagnosed with diabetes and related eye complications in the total population during — C : Annual incidence of operated-on people with diagnosed diabetes among patients with treated diabetes during — smoothed using a 3-year central moving average.
D : Annual incidence of operated-on people with diagnosed diabetes in total population during — smoothed using a 3 year central moving average.
Here we have shown that both the incidence and prevalence of VI due to DR have significantly decreased since the peak years in the s despite the increased prevalence of diagnosed and treated diabetes. Even though DR has been previously associated with the working age population, a noticeable shift to older age has occurred during the 40 years.
The severity of reported VI decreased during the same time period. Differences between sexes equalized in the s and s. This study extended the previous report by Laatikainen et al.
These improvements mostly occurred in the s. Our study shows that both the incidence and prevalence of VI due to DR increased gradually in the s and s.
This is likely explained by the increased prevalence of diabetes in Finland since the s 14 , 25 , Furthermore, the Social Insurance Institution of Finland register data show a threefold increase in the prevalence of patients with treated diabetes during the 40 years. However, the incidence and prevalence of VI due to DR started to decrease in the late s.
The positive trends in the VI since the late s are likely attributable to many factors. The treatment of diabetes was intensified in the late s In addition, Saramies et al. Furthermore, based on a population-based study of Finnish adults, the increase in the prevalence of hyperglycemia in previous decades had stagnated in the s The screening and treatment of DR have also improved since the s, as indicated by the increased incidence of DR-related treatments among patients with treated diabetes in our data.
The national screening program was intensified by the use of regular and standardized photographic methods.
Intravitreal injections of steroids and, later in the s, anti-vascular endothelial growth factor improved the prognosis of patients with diabetes 29 , These, as well as timely laser therapy for DR and vitrectomy surgery for advanced DR, all contribute to the improved prevention of vision loss due to DR 2.
The changes in the incidence and prevalence of VI due to DR have considerably varied in previous studies, which have usually been limited to small study populations, short follow-up periods, or specific region of study.
In Sweden, Bäcklund et al. In Denmark, Hovind et al. In the U. in Wisconsin, Klein et al. In Ireland, on the basis of a year follow-up, the incidence of VI due to DR among diagnosed patients with diabetes registered in the National Council for the Blind of Ireland almost doubled between and , whereas the incidence of blindness halved during the same period In a systematic review of medical literature based on collected data from different countries between and , Bourne et al.
In a meta-analysis of global scale, DR showed an increase in an estimated age-standardized prevalence between and worldwide, even though other vision-threatening eye diseases, such as age-related macular degeneration, decreased 8. Therefore, even though DR shows positive trends in Finland and other high-income countries, it continues to be a significant cause of VI worldwide.
The incidence of VI due to DR showed a shift to older age during the 40 years. This is further supported by the increased age at the onset of VI. This age shift is at least partly explained by the increasing prevalence of type 2 diabetes, which is more common among older people than type 1 diabetes in Finland, and the prevalence is likely to keep increasing due to the aging of the population and an increase of overweight and obesity in the population As the treatment of diabetes and DR has improved and the life expectancy of patients with diabetes increases, VI is more likely to occur at later age among other age-associated vision-threatening diseases.
We reported that both the incidence and prevalence of VI due to DR were higher in women in the s and s, but these differences equalized in the s and s. This could be explained by the declining share of women among patients with diabetes that was observed during — in Finland In global scale, the estimated prevalence of VI and blindness due to DR in was still higher in women 8.
The decline in the severity of VI due to DR during the past decades, as shown in this study, is likely associated with the declined rate of VI among patients with diabetes reported in previous studies.
In Iceland, the proportion of legally blind patients with diabetes decreased from 2. in Wisconsin, the estimated annual rate of any VI among patients with early-onset type 1 diabetes decreased from 1. They suggested that better glycemic and blood pressure control, as well as avoidance of smoking, likely contributed to these trends.
Even though the age at death has increased among DR patients during the 40 years, our data show that in the s, the life expectancy among people with VI due to NPDR was still 7 years shorter and due to PDR 10 years shorter than in the general population.
Similarly, Laatikainen et al. These adverse trends are likely attributable to the shorter life expectancy associated with diabetes, as patients with diabetes have an increased risk of life-threatening systemic vascular complications, such as stroke and heart failure 2 , All in all, these trends reflect the improvement and efficiency of the screening and treatment of DR during the past 40 years.
Nevertheless, patients with DR are still at risk of VI and blindness. VA may not always improve above the mild vision loss level, and some patients with long-standing DR may end up becoming blind due to neuroretinal and pigment epithelial atrophy Furthermore, the prognosis of treatment worsens the later the treatment begins during the course of DR de Fine Olivarius et al.
Patients with diabetes also have an increased risk of other vision-threatening diseases, such as cataract and glaucoma Hence, there is still a significant need to maintain and improve public awareness of vision-threatening complications of diabetes as well as systematic screening, early diagnosis, and prompt treatment of DR to reduce the magnitude of VI and blindness in patients with diabetes.
The strengths of our study include the large data set based on routinely collected health registers, thus ensuring that our results are generalizable to the population-level and comparable with those from studies in the other Western countries.
The use of different registers made it possible to provide a comprehensive overview of changes in both DR and diabetes. In fact, the prevalence of diabetes in Finland is considered similar regardless of the data source We had a unique opportunity to evaluate changes during a long, year follow-up.
The classification of VI is based on the Finnish national definitions and recommendations modified from the definitions by the World Health Organization that cover both decreased VA and VF constriction.
These criteria remained the same during the entire year period to ensure compatibility between decades, and the quality of the register data has been carefully followed.
Therefore, the changes in the prevalence and incidence of VI caused by DR are likely to not reflect the changes in the notification methods.
Our study also has limitations. The reimbursement data for diabetes medicine do not cover patients with diabetes with diet treatment or people diagnosed while institutionalized. Hence, the prevalence of treated people with diabetes is not equivalent to the prevalence of diabetes, although we tried to improve the coverage of diabetes by providing diagnosis data from the Care Registers for Social Welfare and Health Care.
Furthermore, in most cases, diabetes with diet treatment or without related medication is relatively mild and usually does not cause retinal complications unpublished results from the Savitaipale study [ 14 ]. Nevertheless, in most cases, the hidden diabetes form is also relatively mild and is not causing DR complications at the time of diagnosis.
We could not cover the patients treated with laser treatments for DR as outpatients due to the development of the Care Registers for Social Welfare and Health Care during the first decades of the study. Also, the Current Care Recommendations in the Finnish Health care changed the practices of the doctors during the study period.
As register data in general, the VI register data can have potential sources of biases, although not as remarkable as those in diabetes detection. These include difficulties in the estimation of the exact time point at which a person has become VI and when the disease itself has emerged, as well as the potential impact of other vision-threatening diseases.
However, to minimize this bias, we analyzed only those patients whose main diagnosis causing VI was DR. The register may also lack information on specific populations, such as institutionalized people with dementia.
Our data included predominantly people with a Finnish background; therefore, the results may not be directly applicable to other countries and ethnicities. In conclusion, the incidence and prevalence of VI due to DR showed a gradual increase during the s and s but have since dramatically decreased despite the ever-increasing prevalence of diabetes.
The severity of VI due to DR has decreased during the 40 years, and differences between sexes have equalized. Furthermore, the age at the onset of VI and age at death have increased in DR patients during the same period. These positive and encouraging trends underline the importance of efficient screening and timely treatment of diabetes and DR.
In the future, more population-based studies with long follow-up periods in other countries could explore the situation in different regions of the world.
This article is featured in a podcast available at diabetesjournals. This study was supported by Tampereen seudun Näkövammaisten tukisäätiö s. r, Tampere, Finland, and the Elsemay Björn Fund, Helsinki, Finland. The funding sources did not influence the study design, data collection, analysis, interpretation, or writing of the publication.
The decision of publishing the results was completely made by the authors. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions.
conducted the statistical analysis. investigated the data. and H. U wrote the manuscript. and M. reviewed the manuscript and contributed to discussion. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation.
Volume 45, Issue 9. Previous Article Next Article. Research Design and Methods. Article Information. Article Navigation. Changes in Visual Impairment due to Diabetic Retinopathy During — Based on Nationwide Register Data Petri K. Purola Corresponding author: Petri K.
Purola, petri. purola tuni. This Site. Google Scholar. Matti U. Ojamo ; Matti U. Mika Gissler ; Mika Gissler. Hannu M. Uusitalo Hannu M. Diabetes Care ;45 9 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest.
Figure 1. View large Download slide. Figure 2. Figure 3. Figure 4. Search ADS. Improving visual prognosis of the diabetic patients during the past 30 years based on the data of the Finnish Register of Visual Impairment. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for and Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis.
Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: GBD Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study.
Causes of blindness and vision impairment in and trends over 30 years, and prevalence of avoidable blindness in relation to VISION the Right to Sight: an analysis for the Global Burden of Disease Study. The impact of diabetic retinopathy: perspectives from patient focus groups.
Fear of visual loss in patients with diabetes: results of the prevalence of diabetic eye disease in Tayside, Scotland P-DETS study. Careful management of your diabetes is the best way to prevent vision loss.
If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Developing diabetes when pregnant gestational diabetes or having diabetes before becoming pregnant can increase your risk of diabetic retinopathy. If you're pregnant, your eye doctor might recommend additional eye exams throughout your pregnancy.
Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy. Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels.
But these new blood vessels don't develop properly and can leak easily. Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy NPDR — new blood vessels aren't growing proliferating. When you have nonproliferative diabetic retinopathy NPDR , the walls of the blood vessels in your retina weaken.
Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well.
NPDR can progress from mild to severe as more blood vessels become blocked. Sometimes retinal blood vessel damage leads to a buildup of fluid edema in the center portion macula of the retina. If macular edema decreases vision, treatment is required to prevent permanent vision loss.
Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy.
In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye vitreous.
Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain optic nerve , resulting in glaucoma.
In the early stages of diabetic retinopathy, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina.
Tissues in the retina may swell, producing white spots in the retina. As diabetic retinopathy progresses, new blood vessels may grow and threaten your vision.
Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye condition can increase as a result of:.
Diabetic retinopathy involves the growth of abnormal blood vessels in the retina. Complications can lead to serious vision problems:. Vitreous hemorrhage. The new blood vessels may bleed into the clear, jellylike substance that fills the center of your eye.
If the amount of bleeding is small, you might see only a few dark spots floaters. In more-severe cases, blood can fill the vitreous cavity and completely block your vision.
Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision will likely return to its previous clarity. You can't always prevent diabetic retinopathy.
However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss. Remember, diabetes doesn't necessarily lead to vision loss. Taking an active role in diabetes management can go a long way toward preventing complications.
On this page. Risk factors. A Book: Mayo Clinic Guide to Better Vision. A Book: The Essential Diabetes Book. As the condition progresses, you might develop: Spots or dark strings floating in your vision floaters Blurred vision Fluctuating vision Dark or empty areas in your vision Vision loss.
When to see an eye doctor Careful management of your diabetes is the best way to prevent vision loss. More Information. Screening for diabetic macular edema: How often? Spotting symptoms of diabetic macular edema. Request an appointment.
There are two types of diabetic retinopathy: Early diabetic retinopathy. Diabetic retinopathy. Reducing your risks of diabetic macular edema.
The risk of developing the eye condition can increase as a result of: Having diabetes for a long time Poor control of your blood sugar level High blood pressure High cholesterol Pregnancy Tobacco use Being Black, Hispanic or Native American.
Complications can lead to serious vision problems: Vitreous hemorrhage. Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or severe vision loss.
New blood vessels can grow in the front part of your eye iris and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure can damage the nerve that carries images from your eye to your brain optic nerve.
Diabetic retinopathy, macular edema, glaucoma or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed. If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following: Manage your diabetes.
Make healthy eating and physical activity part of your daily routine. Try to get at least minutes of moderate aerobic activity, such as walking, each week. Take oral diabetes medications or insulin as directed. Monitor your blood sugar level. You might need to check and record your blood sugar level several times a day — or more frequently if you're ill or under stress.
Ask your doctor how often you need to test your blood sugar. Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test.
Impairmrnt people living with diabetes have some form of eye Diabetic retinopathy visual impairment or retknopathy retinopathy". Diabetic retinopathy can lead to vision changes or Diabefic. With kmpairment glucose sugar control, regular eye exams and early treatment, the risk or worsening of eye damage can be reduced. Having too much sugar in your blood can damage the blood vessels in the part of the eye called the retina. The retina is the tissue lining the back of the eye.
0 thoughts on “Diabetic retinopathy visual impairment”