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