Causes and Risk Factors of Visual Impairment in Type 2 Diabetes Mellitus at King Hussein Medical Center

Abstract

Objectives: To investigate the causes of severe visual impairment among Jordanians with type II diabetes mellitus and its associated systemic factors. . After getting the ethical approval and taking a consent form, all patients with type II diabetes mellitus who attended the medical retina clinic in the ophthalmology department and found to have best corrected visual acuity (BCVA) of less than 6/12 in the best eye were included in the study. The patients were subjected to detailed ophthalmic exam including best corrected visual acuity using Snellen chart, anterior segment exam using slit lamp bio-microscopy, intra-ocular pressure measurement using Golmann applanation tonometry and posterior segment exam using 78 and 90 diopter lens. The patients were divided into two groups; Group A where the best corrected vision in the good eye is 6/60 or worse and Group B where vision in the good eye is less than 6/12 and better than 6/60. The outcome of ocular exam in both groups was recorded and compared and the overall data were analyzed using the Excel.Results: Ninety-three patients aged between 43 and 80 years (mean 63.1± 12) were included in the study, 55% of them were males with a ratio of 1.2: 1. The duration of Diabetes Mellitus (DM) ranged between 5 and 30 years (mean 14.4± 5 years).The hemoglobin A1c (HbA1c) ranged between 6.2% and 12% (mean 8.7± 1.2). Sixty-five patient (70%) had BCVA less than 6/12 and better than 6/60 while 28 patients (30%) had BCVA of 6/60 or less. In Group A, 20 patients (70.4%) had proliferative diabetic retinopathy (PDR) while the remaining patients had non-proliferative diabetic retinopathy (NPDR). On the other hand PDR was found only in 11 patients (16.9%) in Group B, 46 patients (70.8%) in this group had NPDR and 8 patients (12.3%) had no DR. Macular edema was found in 86.2% of patients with severe visual impairment. Hypertension, hyperlipidemia, and renal failure were present in 46%, 19% and 13% of the patients, respectively, and showed statistically significant association with severe visual loss (P value <0.01). Age more than 63 years and duration of DM more than 10 years also showed significant association. Conclusion: legal blindness is frequently found among Jordanian diabetics at king Hussein Medical Centre. The most common ocular finding in patients with severe visual impairment (best corrected visual acuity is 6/60 or less) is macular edema. Hypertension, hyperlipidemia , renal failure, age more than 63 years and duration of DM more than 10 years showed statistically significant association.

Prevalence, Cause, and Associated Factors of Visual Impairment Among Diabetic Patients at the Debre Tabor General Hospital, Northwest Ethiopia

“…Diabetic patients with duration of 5 or more years were 3.7 times more likely to be visually impaired compared to diabetics with duration of below 5 years. This finding was similar to previous studies in Denmark (Siersma et al, 2019), Jordan (Khatatbeh et al, 2018), Pakistan (Shehzad et al, 2020), and Tunisia (Kahloun et al, 2014), which demonstrated that longer duration of diabetes had a significant association with the occurrence of visual impairment. With an increase in the span of diabetes, there is a high chance of developing ocular comorbidities such as advanced diabetic retinopathy and neovascular glaucoma, which, in turn, leads to severe visual impairment.…”

“…The most prevalent causes of visual impairment in diabetic patients are cataract, diabetic retinopathy, refractive error, glaucoma, and other ocular conditions (e.g., epiretinal membrane, corneal opacity, and age-related maculopathy) (Mabaso & Oduntan, 2014; Onakpoya et al, 2016; Seba et al, 2015; Shehzad et al, 2020, Wen et al, 2020). The possible risk factors for the occurrence of visual impairment among diabetic patients are older age, longer duration of diabetes, body mass index (BMI), hypertension, heart disease, peripheral neuropathy, and renal failure (Kahloun et al, 2014; Khatatbeh et al, 2018; Shehzad et al, 2020; Siersma et al, 2019; Zhang et al, 2008).…”