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Max Schlesinger, Anurag Shrivastava, Kira Lin, David Rubaltelli, Richard Klein; Diabetic Retinopathy in the Bronx and Myanmar: A Matched Cohort Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1065. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the prevalence and severity of diabetic retinopathy (DR), in addition to systemic and ocular comorbidities, in the Bronx and Myanmar.
We retrospectively compared a database of diabetic patients who underwent telemedicine screening for DR at Montefiore clinics in the Bronx from June 2014- April 2017 (Telemedicine Group) and patients screened for DR in rural Myanmar in 2016 by Montefiore physicians (Myanmar Group). For further analysis, we then compared the Myanmar Group to an age- and gender-matched sub-group (Bronx sub-group) from within the Telemedicine Group.
There were 97 patients in the Myanmar Group and 3205 in the Telemedicine Group. The Bronx sub-group included 283 patients from the Telemedicine Group. Basic demographic data is in Figure 1. Rates of vision-threatening retinopathy were significantly higher in the Myanmar group compared to the Bronx sub-group (10% vs 2.8% for severe non-proliferative DR, p=0.02; 13.5% vs 0.35% for proliferative DR, p=0.00). In contrast, for less severe retinopathy, Myanmar had significantly lower rates than the Bronx sub-group (13.5% vs 21.9% for mild/moderate non-proliferative DR, p=0.02). There were also differences in medication use: 30% of patients in the Myanmar group used no diabetic medication, compared to 16% in the Bronx sub-group (p=0.01); 51% of Myanmar patients used 1 medication compared to 31% in the Bronx (p=0.00); 1% of Myanmar patients used insulin compared with 33% in the Bronx (p=0.00). Similar proportions used 2 or more medications. Other data regarding comorbidities is in Figure 2.
In our cohort, patients in Myanmar had a significantly higher prevalence of DR in its vision-threatening stages, relative to the Bronx. Differences in other systemic and ocular comorbidities were less striking. Disparities in the treatment of diabetes, most notably with regard to the use of insulin, may be contributory. Implementing robust diabetic screening and education programs in the developing world may ultimately prove useful in preventing vision threatening retinopathy on a global scale.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1: Demographic Data
Figure 2: Ocular and Systemic Comorbidities
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