Global prevalence and major risk factors of diabetic retinopathy.
OBJECTIVE
To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.


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 A(1c), 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, 21 million with diabetic macular edema, and 28 million 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.
Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
Joanne W Y
JW
Yau
Sophie L
SL
Rogers
Ryo
R
Kawasaki
Ecosse L
EL
Lamoureux
Jonathan W
JW
Kowalski
Toke
T
Bek
Shih-Jen
SJ
Chen
Jacqueline M
JM
Dekker
Astrid
A
Fletcher
Jakob
J
Grauslund
Steven
S
Haffner
Richard F
RF
Hamman
M Kamran
MK
Ikram
Takamasa
T
Kayama
Barbara E K
BE
Klein
Ronald
R
Klein
Sannapaneni
S
Krishnaiah
Korapat
K
Mayurasakorn
Joseph P
JP
O'Hare
Trevor J
TJ
Orchard
Massimo
M
Porta
Mohan
M
Rema
Monique S
MS
Roy
Tarun
T
Sharma
Jonathan
J
Shaw
Hugh
H
Taylor
James M
JM
Tielsch
Rohit
R
Varma
Jie Jin
JJ
Wang
Ningli
N
Wang
Sheila
S
West
Liang
L
Xu
Miho
M
Yasuda
Xinzhi
X
Zhang
Paul
P
Mitchell
Tien Y
TY
Wong
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
D001786:Blood Glucose