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

Abstract

BackgroundMany 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.MethodsData 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.ResultsAt 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.ConclusionsIn 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.

Time trend of prevalence of self-reported cataract and its association with prolonged sitting in Taiwan from 2001 and 2013

“…Limited research has been conducted on prolonged sitting and the development of cataract. Some studies have found that a sedentary lifestyle is associated with reduced visual function in individuals with diabetes [ 18 , 19 ]. In addition, older persons with a sedentary lifestyle are more likely to have visual impairment [ 15 ] or age-related macular degeneration [ 17 ].…”

“…A small number of studies have found an association between a sedentary lifestyle and visual impairment in older persons [ 15 , 16 ] and age-related macular degeneration [ 17 ]. Sedentary behavior is also associated with visual function in people with diabetes [ 18 , 19 ]. Prolonged sitting and lack of physical activity are both distinct risk factors for cataract, and even those who frequently exercise can spend prolonged time sitting in front of a TV [ 20 – 22 ].…”

Visual impairment and mortality in patients with type 2 diabetes

“…For adequate analysis, this visual acuity was converted to logMAR: minus one times the logarithm of visual acuity of the best seeing eye21; increments of 1 logMAR unit from 0 to 3 are approximately equivalent to decimal visual acuity values of 1.00, 0.35, 0.15, and 0.05, respectively. The result of the funduscopy was recorded as one of six response categories1: no diabetic lesions, microaneurysms only, background retinopathy without or with maculopathy, and proliferative retinopathy without or with new vessels on the optic disc. Concurrently, information about other retinal pathologies such as eye operations, glaucoma, presence of cataract and reasons for impaired vision was obtained.…”

“…Visual impairment is a common consequence of type 2 diabetes, affecting about 4%–16% of patients 1–3. The global epidemic of type 2 diabetes has led to an increase in the number of microvascular and macrovascular conditions related to vision loss.…”

Systemic Erythropoietin Concentration and its Correlation with Stage of Diabetic Retinopathy

“…A common complication of diabetes mellitus is diabetic retinopathy which, in addition to cataract, glaucoma and senile macular degeneration, is one of the leading causes of visual impairment and blindness in the world (31,32). Although investigated in numerous studies for decades, pathophysiological mechanism of the development of diabetic retinopathy has not been completely clarified.…”