April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Progression to Proliferative Diabetic Retinopathy and Severe Visual Impairment: A Systematic Review and Meta-Analysis
Author Affiliations & Notes
  • H. W. Flynn, Jr.
    Bascom Palmer Eye Inst, University of Miami, Miami, Florida
  • T. Wong
    Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
  • M. Mwamburi
    UBC, Lexington, Massachusetts
  • R. Klein
    School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
  • M. Larsen
    Glostrup Hospital, University of Copenhagen, Copenhagen, The Netherlands
  • M. Hernandez-Medina
    UBC, Lexington, Massachusetts
  • G. Ranganathan
    UBC, Lexington, Massachusetts
  • B. Wirostko
    Pfizer Inc, New York, New York
  • A. Pleil
    Pfizer Inc, New York, New York
  • P. Mitchell
    Westmead Millennium Inst, University of Sydney, Sydney, Australia
  • Footnotes
    Commercial Relationships  H.W. Flynn, Jr., Pfizer Inc, C; T. Wong, Pfizer Inc, C; M. Mwamburi, Pfizer Inc, C; R. Klein, Pfizer Inc, C; M. Larsen, Pfizer Inc, C; M. Hernandez-Medina, Pfizer Inc, C; G. Ranganathan, Pfizer Inc, C; B. Wirostko, Pfizer Inc, E; A. Pleil, Pfizer Inc, E; P. Mitchell, Pfizer Inc, C.
  • Footnotes
    Support  Pfizer Inc
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 4420. doi:
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      H. W. Flynn, Jr., T. Wong, M. Mwamburi, R. Klein, M. Larsen, M. Hernandez-Medina, G. Ranganathan, B. Wirostko, A. Pleil, P. Mitchell; Progression to Proliferative Diabetic Retinopathy and Severe Visual Impairment: A Systematic Review and Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4420.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To examine trends in the incidence of proliferative diabetic retinopathy (PDR) and/or severe visual impairment (SVI).

Methods: : A systematic literature review and meta-analysis of studies from 1975 to 2008. All published interventional and prospective observational studies reporting disease progression outcomes for patients with DM whose DR was not treated. Baseline characteristics and outcome measures were summarized using weighted averages of counts and means. Main outcomes were incidence of PDR and/or severe SVI, (LogMAR <0.1). Baseline characteristics and outcomes were compared between two periods: 1975-1985 and 1986-2008.

Results: : 57 studies with 36,449 untreated DR patients were included. For those followed for 4 years, participants at baseline in the 1986-2008 period had lower proportions of PDR (3% vs 13%), non-proliferative DR (21% vs 47%) and diabetic macular edema (10% vs 30%), and had lower mean glycosylated hemoglobin (8.4% vs 11.7%) than participants in the 1975-1985 period. Blood pressure and duration of DM appeared comparable between periods. After 4 years, the meta-analyzed incidence of PDR and SVI was 11.0% and 7.2%, respectively - these rates were lower among participants in 1986-2008 than in 1975-1985 (2.6% vs. 19.5% for PDR and 3.2% vs. 9.7% for SVL, respectively). After 10 years, similar outcome patterns were observed.

Conclusions: : Lower rates of progression to PDR and SVI were observed after 1985. These findings may reflect improved DM management, and earlier identification and initiation of care, but could also reflect temporal differences in the distribution of baseline DR severity between the periods. While the visual prognosis in DM individuals may have improved, the burden of DM -related visual loss is impacted by the continuing global increase in DM prevalence.

Keywords: diabetic retinopathy 

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