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Yau J.W.Y.,University of Melbourne | Rogers S.L.,University of Melbourne | Kawasaki R.,University of Melbourne | Lamoureux E.L.,University of Melbourne | And 32 more authors.
Diabetes Care

OBJECTIVE - To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS - A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. RESULTS - A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS - There are approximately 93 million people with DR, 17 million with proliferative DR, 21million with diabeticmacular edema, and 28million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics. © 2012 by the American Diabetes Association. Source

Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Pal S.S.,Shri Bhagwan Mahavir Vitreoretinal Services | Adams J.S.K.,Shri Bhagwan Mahavir Vitreoretinal Services | Rani P.K.,Shri Bhagwan Mahavir Vitreoretinal Services | And 2 more authors.
Investigative Ophthalmology and Visual Science

PURPOSE. To report the prevalence of cataract and its subtypes in patients with type 2 diabetes mellitus and the risk factors associated with these cataracts. METHODS. One thousand two hundred eighty-three eligible subjects with type 2 diabetes mellitus, enrolled from a crosssectional study, underwent examination at the base hospital. Lens opacity was graded by a trained ophthalmologist according to the Lens Opacity Classification System (LOCS) III system. RESULTS. The age- and sex-adjusted prevalence of cataract in the study was 65.7% (95% confidence interval [CI], 65.6-65.8). Mixed cataracts were more common than monotype ones (41.6% vs. 19.4%). The prevalence of cataract was higher in women, subjects with known diabetes and those with longer duration of diabetes (51.4%, 50.3%, and 64.5%, respectively). The risk factors for any type of cataract were increasing age (odds ratio [OR], 1.14; 95% CI, 1.11-1.16), macroalbuminuria (OR, 4.61; 95% CI, 1.56 -13.59) and increasing glycosylated hemoglobin (OR, 1.92; 95% CI, 1.22-3.00); higher hemoglobin (OR, 0.38; 95% CI, 0.22- 0.64) was the protective factor. The risk factors for nuclear cataract included increasing age (OR, 1.15) and high serum triglycerides (OR, 6.83). For cortical cataract, increasing age (OR, 1.14) and poor glycemic control (OR, 2.43) were the risk factors; increasing hemoglobin (OR, 0.41) was the protective factor. For posterior subcapsular cataract, the risk factors included increasing age (OR, 1.11), being of the female sex (OR, 9.12), employment (OR, 9.80), and duration of diabetes (OR, 21.37). CONCLUSIONS. Nearly two thirds of the diabetic population showed evidence of cataract; mixed cataracts were more common than the monotypes ones. © Association for Research in Vision and Ophthalmology. Source

Rani P.K.,Shri Bhagwan Mahavir Vitreoretinal Services | Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Rachapalli S.R.,Sankara Nethralaya | Kulothungan V.,Sankara Nethralaya | And 2 more authors.

Purpose: To report the prevalence of refractive errors and the associated risk factors in subjects with type 2 diabetes mellitus from an urban Indian population. Design: Population-based, cross-sectional study. Participants: One thousand eighty participants selected from a pool of 1414 subjects with diabetes. Methods: A population-based sample of 1414 persons (age >40 years) with diabetes (identified as per the World Health Organization criteria) underwent a comprehensive eye examination, including objective and subjective refractions. Main Outcome Measures: One thousand eighty subjects who were phakic in the right eye with best corrected visual acuity of ≥20/40 were included in the analysis for prevalence of refractive errors. Univariate and multivariate analyses were done to find out the independent risk factors associated with the refractive errors. Results: The mean refraction was +0.20±1.72, and the Median, +0.25 diopters. The prevalence of emmetropia (spherical equivalent [SE], -0.50 to +0.50 diopter sphere [DS]) was 39.26%. The prevalence of myopia (SE <-0.50 DS), high myopia (SE <-5.00 DS), hyperopia (SE >+0.50 DS), and astigmatism (SE <-0.50 cyl) was 19.4%, 1.6%, 39.7%, and 47.4%, respectively. The advancing age was an important risk factor for the three refractive errors: for myopia, odds ratio (OR; 95% confidence interval [CI] 4.06 [1.74-9.50]; for hyperopia, OR [95% CI] 5.85 [2.56-13.39]; and for astigmatism, OR [95% CI] 2.51 [1.34-4.71]). Poor glycemic control was associated with myopia (OR [95% CI] 4.15 [1.44-11.92]) and astigmatism (OR [95% CI] 2.01 [1.04-3.88]). Female gender was associated with hyperopia alone) OR [95% CI] 2.00 [1.42-2.82]. Conclusions: The present population-based study from urban India noted a high prevalence of refractive errors (60%) among diabetic subjects >40 years old; the prevalence of astigmatism (47%) was higher than hyperopia (40%) or myopia (20%). Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2010 American Academy of Ophthalmology. Source

Ramon R.,Shri Bhagwan Mahavir Vitreoretinal Services | Bhojwani D.N.,Shri Bhagwan Mahavir Vitreoretinal Services | Sharma T.,Shri Bhagwan Mahavir Vitreoretinal Services
Rural and Remote Health

Context: Diabetes mellitus is a healthcare burden in India. Seventy-four percent of India's population lives in rural areas with limited access to healthcare resources. Telemedicine can play a big role in screening people with diabetes at grassroots level. In the telescreening model, single field 45-degree photographs are used for detecting diabetic retinopathy. The American Academy of Ophthalmology does not recommends single-field fundus photography as an adequate substitute for a comprehensive ophthalmic examination because it may lead to a higher rate of underdiagnosis. We conducted a telescreening project using single-field fundus photography to determine its accuracy compared to the traditional camp-based screenings. Issues: In this project we compared the prevalence of diabetic retinopathy between an ophthalmologist-based and an ophthalmologist-led model on two different samples of people self-reporting with diabetes in rural South India. Between 2004 and 2005 in rural South India, 3522 people with diabetes mellitus underwent ophthalmologist-based diabetic retinopathy screening and 4456 people with diabetes underwent ophthalmologist-led (telescreening) diabetic retinopathy screening. The two population groups were randomly separated. In the ophthalmologist-based program, a trained retina specialist travels along with the camp team and screens patients at the camp site for diabetic retinopathy. In the ophthalmologist-led program (telescreening), fundus photographs are transmitted to the base hospital for further evaluation and grading. A total of 519 people (14.7%) were diagnosed to have diabetic retinopathy in the ophthalmologist-based model, and 853 people (19.1%) in the ophthalmologist-led model (p<0.0001). More sight-threatening retinopathies were found in the ophthalmologist-led model than in the ophthalmologist-based model (6.3% vs 5%). Lessons learned: The ophthalmologist-led (telescreening) model did not underestimate the prevalence of diabetic retinopathy. Therefore, because it obviates the need for travel by an ophthalmologist, it is a good method for diabetic retinopathy screening in rural areas of India. © R Ramon, DN Bhojwani, T Sharma, 2014. Source

Rishi P.,Shri Bhagwan Mahavir Vitreoretinal Services | Reddy S.,Shri Bhagwan Mahavir Vitreoretinal Services | Rishi E.,Shri Bhagwan Mahavir Vitreoretinal Services
Oman Journal of Ophthalmology

A 45-year-old man presented with diminution of vision in the left eye following a firecracker injury. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/125 in the left eye. Fundus examination revealed vitreous hemorrhage, a macular hole, and submacular hemorrhage in the left eye. The patient underwent vitrectomy, tissue plasminogen activator (tPA)-assisted evacuation of the submacular hemorrhage, internal limiting membrane (ILM) peeling, and 14% C3F8 gas insufflation. After two months, the BCVA remained 20/125 and optical coherence tomography (OCT) showed type 2 macular hole closure. On a follow-up, seven months after surgery, BCVA improved to 20/80, N6, with type 1 closure of the macular hole. The clinical findings were confirmed on OCT. Delayed and spontaneous conversion of the traumatic macular hole could occur several months after the primary surgery and may be associated with improved visual outcome. Larger studies are required to better understand the factors implicated in such a phenomenon. Copyright: © 2012 Sadagopan KA, et al. Source

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