Prevalence of Diabetic Retinopathy

In Diabetic patients cared for at the Family Care Center at RCRMC

Kam Chan, DO

[ role of BP & glycemic control ]

Background Estimated 18.2 million Americans and one in 20

world-wide lives with diabetes Type II Diabetes account for 90% of total cases in

the US Diabetic Retinopathy is the most frequent cause

of new cases of blindness in diabetic patients aged 20-74 years in the US

Diabetic Retinopathy Background Retinopathy -

microaneurysm formation, capillary leakage causing dot blot hemorrhage & hard exudates

Pre-proliferative retinopathy - cotton-wool spots due to infarction of retinal nerve fiber layers and venous beading

Proliferative retinopathy { PDR } growth of new blood vessels from the optic nerve head OR posterior surface of vitreous

Diabetic Retinopathy

NON PROLIFERATIVE RETINOPATHY

PROLIFERATIVE RETINOPATHY

ASSOCIATED RISK FACTORS

Duration / Onset age Glycemic control Renal disease

Systemic HTN Hyperlipidemia Pregnancy

RETINOPATHY vs DURATION

TYPE I diabetes < 5 years - 17% 

5 - 10 years - 74%  > 15 years - 98%

TYPE II diabetes 0 - 10%

0 - 5 years - 29%> 15 years - 78%

Data TOTAL # of SUBJECTS = 133

Approx. 70% of patients were Hispanic Age range - 31-85 years Mean age = 57 +/- 8 years 68% females

50% patients had some type of eye disorder 26% with diabetic retinopathy 9% with PDR 17% with NPDR  9% cases – cataract alone 2% glaucoma alone 2% both 4 cases NPDR + cataract

PREVALENCE OF DIABETIC RETINOPATHY IN DIABETIC PATIENTS [ FCC-RCRMC ]

74%

17%

9%

No Retinopathy

NPDR

PDR

OTHER EYE DISORDERS

Cataract

Both

Glaucoma

No Eye disorder

NPDR

PDR

Impact of uncontrolled HTNPDR NPDR CATARACT GLAUCOMA

12 23 15 69% 17% 11% 5%

HTN HTN HTN HTN7 13 5 2

No of patients

Percent of Total

N = 133 subjects

Association of Hypertension with Diabetic Retinopathy

0

20

40

60

80

100

120

better BP control

Poor BP control

PDR NPDR No Retinopathy

No of patients

Glycemic Control - Role in Diabetic Retinopathy

0

2

4

6

8

10

PDR NPDR No Retinopathy

A1c

N=12 N=23 N= 98

 <140 159 15.1

 140–160 28 14.3

 >160 9 33.3

Diabetes and Diabetic Retinopathy in a Mexican-American Population Proyecto VER

Sheila K. West, PHD1, Ronald Klein, MD2, Jorge Rodriguez, MD, MPH3, Beatriz Muñoz, MS1, Aimee T. Broman, MS1, Rosario Sanchez, MD, MPH1 and Robert Snyder, MD, PHD

3

Prevalence of retinopathy in patients with different presenting BP

CONCLUSION The prevalence of diabetic patients with

retinopathy in our clinic is 26% Tighter control of BP will have immense impact

on the progression of retinopathy More effort should be placed in making sure all

diabetics obtain eye exams This study will help provide a reference point for

implementing changes toward improved therapy

Bibliography1. Fong, DS et. al. Diabetic retinopathy. Diabetes Care. 2003 Jan; 26(1): 226-9. Review2. Tooke, JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes.J Diabetes Complications. 2000 Jul-Aug; 14(4): 197-200. Review3. Klein R, et al: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526, 19844. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:708–713, 19985. Estacio RO et al: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 23 (Suppl. 2):B54–B64, 2000Sheila K. West, et al. Diabetes and Diabetic Retinopathy in a Mexican-American Population: Proyecto VER Diabetes Care 2001 24: 1204-12099. Harris MI, 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. Diabetes Care 21:1230–1235, 1998