Current Epidemiology of Diabetic Retinopathy and Diabetic Macular Edema

With increasing global prevalence of diabetes, diabetic retinopathy (DR) is set to be the principle cause of vision impairment in many countries. DR affects a third of people with diabetes and the prevalence increases with duration of diabetes, hyperglycemia, and hypertension—the major risk factors for the onset and progression of DR. There are now increasing data on the epidemiology of diabetic macular edema (DME), an advanced complication of DR, with studies suggesting DME may affect up to 7 % of people with diabetes. The risk factors for DME are largely similar to DR, but dyslipidemia appears to play a more significant role. Early detection of DR and DME through screening programs and appropriate referral for therapy is important to preserve vision in individuals with diabetes. Future research is necessary to better understand the potential role of other risk factors such as apolipoproteins and genetic predisposition to shape public health programs.

[1]  P. Toth Serum Apolipoprotein AI and B Are Stronger Biomarkers of Diabetic Retinopathy Than Traditional Lipids , 2011 .

[2]  Simon P. Harding,et al.  Safety and Efficacy of Ranibizumab in Diabetic Macular Edema (RESOLVE Study) , 2010, Diabetes Care.

[3]  Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. , 1998, Archives of ophthalmology.

[4]  H. Parving,et al.  Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial , 2008, The Lancet.

[5]  E. Mathiesen,et al.  Pregnancy‐induced sight‐threatening diabetic retinopathy in women with Type 1 diabetes , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[6]  Diederick Grobbee,et al.  Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. , 2008, The New England journal of medicine.

[7]  J. Shaw,et al.  Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies , 2008, The Lancet.

[8]  M. Palta,et al.  Lower-than-expected prevalence and severity of retinopathy in an incident cohort followed during the first 4-14 years of type 1 diabetes: the Wisconsin Diabetes Registry Study. , 2006, American journal of epidemiology.

[9]  J. Tamsma,et al.  Renal and retinal effects of enalapril and losartan in type 1 diabetes. , 2009, The New England journal of medicine.

[10]  N. Chaturvedi,et al.  Markers of inflammation are cross-sectionally associated with microvascular complications and cardiovascular disease in type 1 diabetes—the EURODIAB Prospective Complications Study , 2005, Diabetologia.

[11]  Tin Aung,et al.  Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. , 2008, Ophthalmology.

[12]  T. Wong,et al.  Obesity and eye diseases. , 2007, Survey of ophthalmology.

[13]  R. Simó,et al.  Advances in the Medical Treatment of Diabetic Retinopathy , 2009, Diabetes Care.

[14]  Ronald Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. , 2009, Ophthalmology.

[15]  T. Wong,et al.  Differential association of serum lipids with diabetic retinopathy and diabetic macular edema. , 2011, Investigative ophthalmology & visual science.

[16]  D L DeMets,et al.  The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. , 1984, Archives of ophthalmology.

[17]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[18]  M. Daly,et al.  Candidate gene association study for diabetic retinopathy in persons with type 2 diabetes: the Candidate gene Association Resource (CARe). , 2011, Investigative ophthalmology & visual science.

[19]  R. Elston,et al.  Heritability of the severity of diabetic retinopathy: the FIND-Eye study. , 2008, Investigative ophthalmology & visual science.

[20]  A. Hewitt,et al.  A Systematic Meta-Analysis of Genetic Association Studies for Diabetic Retinopathy , 2009, Diabetes.

[21]  P. Zimmet,et al.  The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives , 2012, Nature Reviews Endocrinology.

[22]  M. Davidson Apolipoprotein Measurements: Is More Widespread Use Clinically Indicated? , 2009, Clinical cardiology.

[23]  T. Wong,et al.  Fenofibrate and diabetic retinopathy , 2008, The Lancet.

[24]  J. P. O’Hare,et al.  Higher Prevalence of Retinopathy in Diabetic Patients of South Asian Ethnicity Compared With White Europeans in the Community , 2009, Diabetes Care.

[25]  Matthew D. Davis,et al.  Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. , 2000, The New England journal of medicine.

[26]  P. Mitchell,et al.  Temporal trends in the age-specific prevalence of diabetes and diabetic retinopathy in older persons: Population-based survey findings. , 2006, Diabetes research and clinical practice.

[27]  Simon P Harding,et al.  Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study , 2003, The Lancet.

[28]  A. Vitelli,et al.  [Epidemiology of diabetic retinopathy]. , 1988, Minerva endocrinologica.

[29]  Ann L. Albright,et al.  Prevalence of diabetic retinopathy in the United States, 2005-2008. , 2010, JAMA.

[30]  Thomas W. Gardner,et al.  The restore study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema , 2011 .

[31]  Lloyd Paul Aiello A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. , 2008, Ophthalmology.

[32]  R. Klein,et al.  Is the Risk of Diabetic Retinopathy Greater in Non-Hispanic Blacks and Mexican Americans Than in Non-Hispanic Whites With Type 2 Diabetes?: A U.S. population study , 1998, Diabetes Care.

[33]  P. Mitchell,et al.  Systemic management of diabetic retinopathy , 2009, BMJ : British Medical Journal.

[34]  B. Klein,et al.  Global Prevalence and Major Risk Factors of Diabetic Retinopathy , 2012, Diabetes Care.

[35]  Stephen J. Aldington,et al.  Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. , 2001, Diabetes care.

[36]  Diabetes Control Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. , 2000, Diabetes care.

[37]  R. Klein,et al.  Is Menarche Associated With Diabetic Retinopathy? , 1990, Diabetes Care.

[38]  P. McGuire,et al.  Diabetic Retinopathy and Inflammation: Novel Therapeutic Targets , 2012, Middle East African journal of ophthalmology.

[39]  Rury R Holman,et al.  Long-term follow-up after tight control of blood pressure in type 2 diabetes. , 2008, The New England journal of medicine.

[40]  T. Kern,et al.  Inflammation in diabetic retinopathy , 2011, Progress in Retinal and Eye Research.

[41]  M. Bachmann,et al.  Incidence and Progression of Diabetic Retinopathy During 17 Years of a Population-Based Screening Program in England , 2012, Diabetes Care.

[42]  D. Friedman,et al.  Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. , 2009, Ophthalmology.

[43]  Tien Yin Wong,et al.  Diabetic retinopathy , 2010, The Lancet.

[44]  Jennifer K. Sun,et al.  Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. , 2011, Ophthalmology.

[45]  R. Klein,et al.  Inflammatory, Hemostatic, and Other Novel Biomarkers for Diabetic Retinopathy , 2009, Diabetes Care.

[46]  M. Okano,et al.  Cohort Study , 2020, Definitions.

[47]  B. P. Sheth Does pregnancy accelerate the rate of progression of diabetic retinopathy?: An update , 2008, Current diabetes reports.

[48]  Lloyd Paul Aiello,et al.  Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema , 2010, Ophthalmology.

[49]  Quan Dong Nguyen,et al.  Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. , 2012, Ophthalmology.

[50]  Walter T Ambrosius,et al.  Effects of medical therapies on retinopathy progression in type 2 diabetes. , 2010, The New England journal of medicine.

[51]  P. Mitchell,et al.  Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial , 2007, The Lancet.

[52]  Kui Huang,et al.  Epidemiology, risk factors and management of paediatric diabetic retinopathy , 2012, British Journal of Ophthalmology.

[53]  Beverley Balkau,et al.  The prevalence of and factors associated with diabetic retinopathy in the Australian population. , 2003, Diabetes care.

[54]  V. Mohan,et al.  Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I. , 2005, Investigative ophthalmology & visual science.

[55]  R. Raman,et al.  Influence of serum lipids on clinically significant versus nonclinically significant macular edema: SN-DREAMS Report number 13. , 2010, Ophthalmology.

[56]  D L DeMets,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VI. Retinal photocoagulation. , 1987, Ophthalmology.

[57]  入江 潤一郎,et al.  Glucose control and vascular complications in veterans with type 2 diabetes , 2009 .

[58]  M. Craig,et al.  Do all prepubertal years of diabetes duration contribute equally to diabetes complications? , 2003, Diabetes care.

[59]  Judy E. Kim,et al.  A Randomized Trial Comparing Intravitreal Triamcinolone and Focal/Grid Photocoagulation for Diabetic Macular Edema: Baseline Features , 2008, Retina.

[60]  R. Crazzolara Novel Therapeutic Targets in ALL Therapy , 2011 .

[61]  P. Hougaard,et al.  The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes. , 2004, Journal of diabetes and its complications.

[62]  J. C. Huber,et al.  Familial aggregation of severity of diabetic retinopathy in Mexican Americans from Starr County, Texas. , 2005, Diabetes care.

[63]  R. Klein,et al.  The Role of Genetics in Susceptibility to Diabetic Retinopathy , 2009, International ophthalmology clinics.

[64]  M. Boulton,et al.  Intraretinal leakage and oxidation of LDL in diabetic retinopathy. , 2008, Investigative ophthalmology & visual science.

[65]  D. Lackland,et al.  Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort. , 2004, Investigative ophthalmology & visual science.

[66]  R. Klein,et al.  Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials , 2008, The Lancet.

[67]  R. Klein,et al.  Are Individuals With Diabetes Seeing Better? , 2010, Diabetes.

[68]  R. Larson,et al.  Intravitreal triamcinolone acetonide injection for treatment of refractory diabetic macular edema: a systematic review. , 2009, Ophthalmology.

[69]  T. Wong,et al.  Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project. , 2011, Investigative ophthalmology & visual science.

[70]  R V North,et al.  Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis , 2012, BMJ : British Medical Journal.

[71]  Judy E. Kim,et al.  Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. , 2009, Archives of ophthalmology.

[72]  D. Nicolae,et al.  Genome-wide meta-analysis for severe diabetic retinopathy. , 2011, Human molecular genetics.

[73]  J. Jonas,et al.  Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006 , 2008, Graefe's Archive for Clinical and Experimental Ophthalmology.

[74]  P. Damm,et al.  Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes , 2010, Diabetologia.

[75]  Clustering of Long-Term Complications in Families With Diabetes in the Diabetes Control and Complications Trial , 1997, Diabetes.

[76]  R. Beck To mask or not to mask. , 2009, Archives of ophthalmology.

[77]  T. Wong,et al.  DIRECT new treatments for diabetic retinopathy , 2008, The Lancet.

[78]  R. Simó,et al.  Elevation of apolipoprotein A-I and apolipoprotein H levels in the vitreous fluid and overexpression in the retina of diabetic patients. , 2008, Archives of ophthalmology.

[79]  P. Mitchell,et al.  C-reactive protein, body mass index, and diabetic retinopathy. , 2010, Investigative ophthalmology & visual science.

[80]  L. Holmes,et al.  The Diabetes in Early Pregnancy Study: beta-hydroxybutyrate levels in type 1 diabetic pregnancy compared with normal pregnancy. NICHD-Diabetes in Early Pregnancy Study Group (DIEP). National Institute of Child Health and Development. , 1998, Diabetes care.

[81]  A. Bhalla,et al.  Images in clinical medicine. Paget's disease of the mandible. , 2008, The New England journal of medicine.

[82]  R. Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. , 1995, Ophthalmology.

[83]  L. Nyström,et al.  The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS). , 2003, Diabetes care.

[84]  C. Forsblom,et al.  Heritability of Proliferative Diabetic Retinopathy , 2008, Diabetes.

[85]  Michael E. Miller,et al.  Effects of intensive glucose lowering in type 2 diabetes. , 2008, The New England journal of medicine.

[86]  Ronald Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. , 2008, Ophthalmology.

[87]  T. Wong,et al.  Management of diabetic retinopathy: a systematic review. , 2007, JAMA.

[88]  David M Nathan,et al.  Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. , 2008, Archives of ophthalmology.

[89]  R. Klein,et al.  Diabetic retinopathy in a multi-ethnic cohort in the United States. , 2006, American journal of ophthalmology.

[90]  R. Klein,et al.  Replication analysis for severe diabetic retinopathy. , 2012, Investigative ophthalmology & visual science.

[91]  Cristina Hernández,et al.  Apolipoprotein A1 is overexpressed in the retina of diabetic patients. , 2009, American journal of ophthalmology.

[92]  R. Klein,et al.  Is obesity related to microvascular and macrovascular complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy. , 1997, Archives of internal medicine.

[93]  V. Mohan,et al.  Association of serum lipids with diabetic retinopathy in urban South Indians—the Chennai Urban Rural Epidemiology Study (CURES) Eye Study—2 , 2006, Diabetic medicine : a journal of the British Diabetic Association.

[94]  E. Chew,et al.  Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study , 1995, Diabetes Care.