Abstract
Purpose :
To document the spectrum of eye disorders in people with type 2 diabetes mellitus (T2 DM) reporting to the eye care facilities in India and determine the associations.
Methods :
In an observational cross sectional study the systemic, clinical and ocular parameters of people with known T2 DM presenting for the first time at the retina clinic were analyzed. Ocular disorders were diagnosed by clinical and slit lamp examination, ophthalmoscopy, fluorescein angiography, intra ocular pressure measurement and gonioscopy. International Clinical Diabetic Retinopathy (ICDR) classification scale was used to grade DR.
Results :
A total of 11 182 people with T2DM (male: 59.2%; mean age 58.2 years), were enrolled in 13 eye care facilities across India. 5416 (48.4%) were hypertensive. DR (n= 3360 right eye, 3335 left eye; 30.1% - 29.8%) and lens opacities (n= 5764 right eye, 5890 left eye; 51.6% - 52.7%) were the common ocular disorders. At presentation 502 (4.5%) were blind (visual acuity, VA <3/60 in better eye) and 1077 (9.63 %) had moderate to severe visual impairment (MSVI, VA <6/18- <3/60). Lens opacity and refractive error were common causes of blindness and MSVI respectively.
A. Diabetic retinopathy (DR): almost a third (32.3%) had any DR, and 19.1% had sight- threatening DR. Diabetic macular edema and proliferative DR were present in 9.06% and 12.55% people respectively. Statistically significant associations with DR were: male sex (Odds ratio [OR] 1.61, 95% Confidence Interval [CI] 1.48-1.75), poor glycemic control– glycated hemoglobin >10% (OR 2.35, 95% CI1.37-4.03); use of insulin (OR 3.83, 95% CI 3.31-4.43), history of hypertension (OR 1.34, 95% CI 1.23-1.45) and duration of T2DM >16 years (OR 5.96,95% CI 5.24-6.79).
B. Retinal Vein occlusion (RVO): 207 (1.85%) people had RVO. Hypertension (OR: 1.85; 95% CI: 1.45-2.37; p <0.001) and history of stroke (OR: 5.33; 95% CI: 2.22-12.77; p <0.001) had significant association.
C. Glaucoma: 547 (4.9%) people had glaucoma in at least one eye- primary open angle glaucoma in 50% eyes and secondary glaucoma in 8% eyes. Bilateral glaucoma was detected in 431 (76.4% of glaucoma) people. There was strong association with advancing age (p <0.001).
Conclusions :
People with T2DM presenting at eye clinics in India have high rates of vision loss. In addition to lens opacity and refractive error, 1 in 3 had retinopathy and 1 in 5 had sight- threatening retinopathy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.