Diabetic retinopathy contributes to global vision loss

Abstract

Purpose : The WHO initiative, VISION 2020: The Right to Sight showed that understanding global burden of eye diseases aids planning for appropriate care delivery. Here we report extensively updated estimates of the burden of vision loss due to diabetic retinopathy (DR) from 2000 to 2020, and distribution by sex and region.

Methods : A systematic review and meta-analysis of population-based surveys of eye diseases from January 1980 to October 2018 were carried out by the Vision Loss Expert Group of the Global Burden of Disease Study (GBD) and collated into the Global Vision Database. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 and/or less than 10° visual field around central fixation) caused by DR by age, region, and year for those aged 50 years and older.

Results : Worldwide in 2020, due to DR an estimated 861,000 (592,000-1235,000) people aged 50+ years were blind and 2.95 million (2.14-3.95M) had MSVI. Since 2000, age-standardised prevalence (ASP) of DR-blindness and MSVI increased by 7.0% and 1.6% respectively. Reflecting growth in number of people aged 50+ and diabetes prevalence, overall DR-blindness increased by 89.9% with an 80.5% increase in DR-MSVI. Between 2000-2020, for DR-blindness the ratio of females/males increased to 1.20:1.00 from 1.06:1.00; DR-MSVI to 1.13:1.00 from 1.08:1.00. ASP for DR-blindness in males was unchanged (-0.1%) with a 12.9% increase in females.
In 2020, among GBD super-regions, the ASP of DR-blindness was highest in Latin America/Caribbean (LAC) (0.15%, 0.10-0.21) followed by North Africa/Middle East (NA/MI) (0.06%, 0.04-0.09),. For MSVI, NA/MI had the highest prevalence (0.41%, 0.30-0.55), followed by LAC (0.30%, 0.22-0.40). The largest increase in ASP of DR blindness was in South Asia (+25.7%) followed by Southeast Asia, East Asia and Oceania (SA/EA/O) (+15.4%) and Sub-Saharan Africa (+2.5%), the 4 other super-regions showing a decrease. Only SA/EA/O showed an increase in ASP of DR-related MSVI of 2.3%.

Conclusions : There are regional differences in DR-related blindness and MSVI and females are increasingly disproportionately affected by DR-visual loss. Further targeted region-specific actions on reducing burden of diabetes and its complications and improving female care access are essential to reduce DR-related blindness/MSVI.

This is a 2021 ARVO Annual Meeting abstract.