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Stuart Keel, Jing Xie, Joshua Ross Foreman, Peter Van Wijngaarden, Hugh Taylor, Mohamed Dirani; The prevalence of diabetic retinopathy in Australian adults with self-reported diabetes: the National Eye Health Survey. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2882.
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To determine the prevalence of and factors associated with diabetic retinopathy (DR) among non-Indigenous and Indigenous Australian adults with self-reported diabetes.
The National Eye Health Survey (NEHS) is a population-based cross-sectional study that examined 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. Diabetes was determined based on self-report of previous diagnosis of the disease. Non-mydriatic fundus photographs were taken of each eye and graded according to the modified Airlie House Classification system. The weighted prevalence of DR was calculated using generalised regression models taking into account the sampling weight.
Four hundred and thirty-one (13.9%) non-Indigenous Australians and 645 (37.1%) Indigenous Australians had self-reported diabetes, of which 93% (1004/1076) had retinal images that were gradable for DR. The weighted prevalence of any DR for Indigenous and non-Indigenous adults with self-reported diabetes was 39.4% and 28.5%, respectively (p = 0.03). Indigenous Australians with self-reported diabetes had a 2.1 times higher weighted prevalence of vision-threatening diabetic retinopathy (VTDR) (9.5%, 95% CI: 6.8, 13.1) when compared to non-Indigenous Australians (4.5%, 95% CI: 2.6, 7.9, p = 0.02). Longer diabetes duration was a significant risk factor for VTDR in the Indigenous (OR = 2.17 per 10 year increase from 40 years, p = 0.01) and non-Indigenous population (OR = 1.56 per 10 year increase from 50 years, p = 0.03). The treatment coverage of proliferative DR (PDR) and clinically significant macular edema (CSME) was 75% (56/75) in Indigenous and 79% (15/19) in non-Indigenous Australians. Vision loss (<6/12 in the better eye) was found in 7% of non-Indigenous and 15% of Indigenous participants with self-reported diabetes.
Three quarters of non-Indigenous and Indigenous adults with PDR or CSME have received laser treatment. Our data indicates a possible decline in the prevalence of VTDR in non-Indigenous and Indigenous Australian adults, however it remains that 1 in 10 Indigenous adults with self-reported diabetes suffer VTDR. This highlights that intensified prevention strategies may be required in order to delay or prevent avoidable vision loss from DR in Indigenous communities.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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