Causes of visual impairment in Thai diabetic patients in the visual rehabilitation clinic.
BACKGROUND
Visual disability from diabetic retinopathy is one of many public health problems. Knowing the causes of blindness and low vision in diabetic patients will help in policy planning in order to reduce diabetic complications and prevent blindness.


OBJECTIVE
To study the causes of visual impairment, blindness and related factors in diabetic patients who registered at the visual rehabilitation clinic, Siriraj Hospital, Mahidol University, Bangkok.


METHODS
A retrospective study of 133 diabetic patients who registered at the visual rehabilitation clinic between January 2007 and December 2010 was conducted. The patients were divided into 2 groups: a low vision group (VA in the better eye < 6/18-3/60) and a blindness group (VA in the better eye < 3/60--No light perception). The history of diabetic mellitus, associated systemic diseases, laboratory investigations, ocular changes and treatment were recorded. The causes of visual impairment and blindness were collected and analyzed.


RESULTS
Of a total of 133 diabetic patients, 93 cases (69.9%) were in a low vision group and 40 cases (30.1%) were in a blindness group. The causes of visual impairment were proliferative diabetic retinopathy (84.6%), retinal detachment (37.2%), macular edema and scar (25.9%), optic atrophy (143%), neovascular glaucoma (11.7%) and vitreous hemorrhage (4.9%). Tractional retinal detachment (p-value < 0.001) and optic atrophy (p-value = 0.021) were the associated factors causing blindness in visual disability patients with statistical significance. Optic atrophy (38 eyes) occurred post vitrectomy in 19 eyes.


CONCLUSIONS
Visual disability in diabetic patients is caused by the complications of diabetic retinopathy and its management. The prevention of disease progression, especially macular edema and proliferative diabetic retinopathy, will decrease the rate of visual impairment and blindness.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. siasn@mahidol.ac.th
Apichart
A
Singalavanija
Kanin
K
Luangsawang
Suksri
S
Chotikavanich
Jutalai
J
Tanterdtham
Patthanee
P
Samsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001766:Blindness / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation; D003930:Diabetic Retinopathy / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013785:Thailand; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation