Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes

ObjectiveTo evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.Research design and methodsThis is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality.ResultsVisual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years’ incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity.ConclusionsVisual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.

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Changes in Detection of Retinopathy in Type 2 Diabetes in the First 4 Years of a Population-Based Diabetic Eye Screening Program

Diabetes Care ◽

10.2337/dc13-0130 ◽

2013 ◽

Vol 36 (9) ◽

pp. 2663-2669 ◽

Cited By ~ 16

Author(s):

Alice S. Forster ◽

Angus Forbes ◽

Hiten Dodhia ◽

Clare Connor ◽

Alain Du Chemin ◽

...

Keyword(s):

Type 2 Diabetes ◽

Screening Program ◽

Population Based ◽

Eye Screening ◽

Diabetic Eye Screening

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Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study

World Journal of Cardiology ◽

10.4330/wjc.v13.i8.372 ◽

2021 ◽

Vol 13 (8) ◽

pp. 372-380

Author(s):

Wisit Kaewput ◽

Charat Thongprayoon ◽

Ram Rangsin ◽

Tarun Bathini ◽

Michael A Mao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Visual Impairment ◽

Nationwide Study ◽

Onset Atrial Fibrillation ◽

New Onset

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The Prevalence and Causes of Visual Impairment in Type 2 Diabetes Mellitus in Northeast China

Journal of Ophthalmology ◽

10.1155/2020/5969816 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Liang Wen ◽

Yu Wang ◽

Zhong Lin ◽

Feng Hua Wang ◽

Xiao Xia Ding ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Visual Acuity ◽

Visual Impairment ◽

Refractive Error ◽

Northeast China ◽

Low Vision ◽

Uncorrected Refractive Error ◽

Myopic Maculopathy

Purpose. To evaluate the prevalence and causes of visual impairment in a group of community people with type 2 diabetes mellitus (T2DM) in Northeast China. Methods. Population-based cross-sectional survey. Patients diagnosed with T2DM residing in 15 communities in Fushun, Northeast China, were enrolled between July 2012 and May 2013. All participants underwent an extensive and standardized eye examination (visual acuity testing, slit-lamp, and fundus examination). Low vision was defined as presenting VA of better-seeing eye <20/60 and ≥20/400, and blindness was defined as VA <20/400, according to the World Health Organization (WHO) definitions. The primary causes of blindness and low vision were assessed by senior ophthalmologists. Results. Visual acuity measurements were available for 1998 (89.8%) of 2224 subjects in the study. The prevalence of bilateral blindness and low vision defined was 0.90% and 10.81%. Uncorrected refractive error was the first leading cause of low vision (75.0%) and blindness (38.9%). After correcting the refractive error, the first leading cause of low vision was cataract (44.4%), followed by diabetic retinopathy (29.6%) and myopic maculopathy (18.5%), while the first leading cause of blindness was proliferative DR (45.4%), followed by cataract (36.4%) and myopic maculopathy (18.2%). Conclusions. This study suggested a high prevalence of low vision and blindness in this study cohort. Uncorrected refractive error and cataract remain the leading cause of visual impairment, but the major challenge is the early diagnosis and intervention of diabetic retinopathy to reduce diabetes-related blindness.

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Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study

BMC Public Health ◽

10.1186/1471-2458-11-80 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 13

Author(s):

Niels de Fine Olivarius ◽

Volkert Siersma ◽

Gitte Juul Almind ◽

Niels Vesti Nielsen

Keyword(s):

Type 2 Diabetes ◽

Visual Impairment ◽

Newly Diagnosed ◽

Follow Up Study ◽

Clinical Type

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PPARG Polymorphisms Are Associated with Unexplained Mild Vision Loss in Patients with Type 2 Diabetes Mellitus

Journal of Ophthalmology ◽

10.1155/2019/5284867 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Tao Li ◽

Xian Xu ◽

Yi Xu ◽

Peiyao Jin ◽

Jianhua Chen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Visual Acuity ◽

Type 2 Diabetes Mellitus ◽

Visual Impairment ◽

Vision Loss ◽

Corrected Visual Acuity ◽

Pparg Gene ◽

Best Corrected Visual Acuity

Objectives. To investigate whether the presence of peroxisome proliferator-activated receptor gamma (PPARG) gene polymorphisms is associated with unexplained mild visual impairment (UMVI) in patients with type 2 diabetes mellitus (T2DM). Methods. A total of 135 T2DM residents with UMVI and 133 with normal vision (NV; best-corrected visual acuity ≥ 20/25 in both eyes) were enrolled. UMVI was defined as best-corrected visual acuity (BCVA) < 20/25 and ≥ 20/63 in both eyes, with no visual impairment-causing diseases found. Four PPARG gene single-nucleotide polymorphisms (SNPs) (rs3856806, rs1801282, rs709158, and rs10865710) were assessed with the HAPLOVIEW 4.0 software to examine the statistical association of PPARG polymorphisms and UMVI in patients with T2DM. Results. Four SNPs qualified the Hardy–Weinberg equilibrium (p>0.05). The frequency of genotype GC at SNP rs10865710 was significantly higher in the UMVI group than in the NV group (p<0.001; GG + GC versus CC) (OR = 8.94, 95% CI: 4.90–16.31), whereas genotype CC decreased the risk (OR = 0.07, 95% CI: 0.03–0.14). Genotype TT at SNP rs3856806 was strongly associated with UMVI (p<0.0001, TT + TC versus CC) (OR = 4.74, 95% CI: 2.68–8.54), whereas genotype CC appeared to be protective for UMVI (OR = 0.55, 95% CI: 0.37–0.82). Conclusions. Susceptibilities of PPARG variants may lead to differences in PPARG transcription, result in early function loss of retinal photoreceptor cells, and eventually cause UMVI.

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