Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760 Nepal J Ophthalmol 2014; 6 (2): 24-30

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The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100601 ◽

2014 ◽

Vol 21 (6) ◽

pp. 339-345 ◽

Cited By ~ 1

Author(s):

N Othman ◽

Ck Chan ◽

Fl Lau

Keyword(s):

Risk Factors ◽

Hong Kong ◽

Emergency Departments ◽

Multiple Logistic Regression Analysis ◽

Case Series ◽

Female Ratio ◽

Intentional Ingestion ◽

Accident And Emergency ◽

Case Series Study ◽

Clinically Significant

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

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Evaluation of HbA1c Level and Other Risk Factors in Diabetic Retinopathy: A Study of Type 2 Diabetic Patients Attending in a Tertiary Level Hospital

KYAMC Journal ◽

10.3329/kyamcj.v6i2.33738 ◽

2017 ◽

Vol 6 (2) ◽

pp. 614-619 ◽

Cited By ~ 1

Author(s):

Sayama Hoque ◽

MA Muttalib ◽

Md Imtiajul Islam ◽

Parvin Akter Khanam ◽

Subhagata Choudhury

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Diabetic Retinopathy ◽

Blood Glucose ◽

Advanced Age ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Duration Of Diabetes ◽

Type 2 Diabetic

Background: Retinopathy is the leading cause of blindness in persons with diabetes. Strict monitoring and maintenance of normal blood glucose specially HbA1c and prevention of different risk factors can prevent and delay the diabetic retinopathy. The purpose of the study was to explore the factors influencing or related to the development of the diabetic retinopathy with spcial concern to the HbA1c levels.Materials and Methods: We studied 400 type 2 diabetic patients in this cross-sectional study which was conducted in the out-patient department of BIRDEM hospital, Bangladesh. The randomly selected patients were evaluated for the presence of retinopathy through the review of their registered diabetic guide book. We included sociodemographic information, blood pressure, anthropometry (height, weight, BMI) and lipid profile of the patients. Glycaemic status was assessed by HbA1c (HbA1c was categorized into 3 groups) and plasma glucose levels. We used Student's t-test, Chi-square test and logistic regression analysis to determine and quantify the association of diabetic retinopathy with various risk factors specially HbA1c.Results: 400 type 2 diabetic patients (male 166 and female 234) were studied. The prevalence of retinopathy was 12.3%; male 12.7%, female 12.0%. Increasing HbA1c categories above 7.0% were significantly associated with increased prevalence of retinopathy (4.2 vs 12.3 vs 18.1%;c2 = 12.529, p < .01). Logistic regression models of univariate analysis showed that the risk of retinopathy at HbA1c categories >7.0% was (OR = 3.22; 95% CI: 1.12-9.25) and the risk was strongly increased at the HbA1c categories 8% (OR = 5.07; 95% CI: 1.90-13.50). Advanced age (OR = 2.92; 95% CI: 1.44-5.91), longer duration of diabetes (OR = 3.08; 95% CI: 1.49-6.37), presence of hypertension (OR = 2.42; 95% CI: 1.14-5.16), FBG (OR = 1.139; 95% CI: 1.036-1.251), blood glucose 2 hours ABF (OR = 1.124; 95% CI: 1.046-1.207) and SBP (OR = 1.033; 95% CI: 1.011-1.056) had significant association with retinopathy.Conclusions: HbA1c categories >7.0% is an important risk factor for the development of retinopathy. Poor glycaemic control, advanced age, longer duration of diabetes, hypertension are other significant risk factors of diabetic retinopathy.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 614-619

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Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v7i1.13163 ◽

2015 ◽

Vol 7 (1) ◽

pp. 26-32

Author(s):

R Thapa ◽

S Bajimaya ◽

S Sharma ◽

B B Rai ◽

G Paudyal

Keyword(s):

Diabetic Retinopathy ◽

Glycemic Control ◽

Blood Sugar ◽

Proliferative Diabetic Retinopathy ◽

Poor Glycemic Control ◽

Diabetic Patients ◽

Newly Diagnosed ◽

Duration Of Diabetes ◽

Case Series Study

Introduction: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among the diabetics. Objective: to study the systemic association of proliferative diabetic retinopathy. Materials and methods: A prospective, case-series study was conducted among the newly diagnosed proliferative diabetic retinopathy cases presenting at the Tilganga Institute of Ophthalmology (TIO) from January 2012 to January 2013. Diabetic retinopathy was classi¿ed using the Early Treatment Diabetic Retinopathy Study criteria. Blood pressure, fasting and postprandial blood sugar, glycosylated hemoglobin, lipid pro¿le, urine for microalbumin, urea, and creatinine were evaluated at the time of diagnosis.Results: A total of 104 type 2 diabetic patients with newly diagnosed PDR presented during the study period. Concurrent macular edema was present in 93 cases (89.42 %). The mean age was 56.96 ± 9.394 (range 32 - 78) years. Males and females comprised of 75.7 % and 24.3 % respectively. The majority (37.5 %) were involved in business, followed by government service (17.30 %), and housewives (16.34 %). Mean duration of diabetes was 11.42 ± 5.356 years (range 1 month - 26 years). Concurrent hypertension was found in 55.76 %, uncontrolled fasting and or postprandial blood sugar in 72.54 %, poor glycemic control (HbA1C > 7 %) in 73.97 %, abnormal lipid profile in 52.56 %, microalbuminuria in 67.85 %, and positive urine albumin in 50 % of the cases.Conclusion: Despite the short duration of diabetes, the concurrent hypertension, poor glycemic control, proteinuria and dyslipidemia were the main systemic associations for PDR at our clinical set-up. Awareness, identification and management of these systemic problems could reduce the rapid progression to PDR.

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Prevalence and associated risk factors for diabetic retinopathy at first ophthalmological contact

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.36430 ◽

2021 ◽

Vol 12 (8) ◽

pp. 118-124

Author(s):

Bhavkaran Singh ◽

Prempal Kaur ◽

Jaspreet Singh ◽

Parveen Grang

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Observational Study ◽

Health Concern ◽

Accurate Estimation ◽

Diabetic Patients ◽

Cross Sectional ◽

Screening Programs ◽

Duration Of Diabetes ◽

Associated Risk Factors

Background: Type 2 diabetes mellitus (DM) is now considered as a growing global public health concern due to cost associated with diabetic micro and macrovascular complications. Diabetic retinopathy (DR) is one of the leading causes of vision loss. Accurate estimation of prevalence of DR among diabetic patients and associated risk factors are of crucial importance to plan and execute preventive strategies in the community. Aims and Objectives: The present cross sectional hospital based observational study was undertaken to determine the prevalence of DR in diabetic patients at their first ophthalmological contact and toevaluate associated risk factors. Materials and Methods: In this cross sectional hospital based observational study, all diabetic patients visiting ophthalmology clinic for the first time after being diagnosed as diabetic were enrolled. After recording demographic data and biochemical findings, each patient was investigated for DR and correlated with associated risk factors. Results: Of 1699 patients, majority (68.9%) of them had come to ophthalmology clinic with complaint of decreased vision. Only 16.12 % (274) patients had been referred for retinal exam by treating physician. DR was prevalent in 242(16.98%) non-referred and 31(11.31%) referred patients. Mean age and mean duration of diabetes was significantly higher in non-referred patients. Vision threatening DR was also significantly higher in nonreferred patients. Prevalence of DR was significantly correlated with age at presentation, duration of diabetes, rural background, uncontrolled diabetes, systolic blood pressure and high BMI. Conclusion: Low referral by treating physician and lack of awareness among patient accounts for late presentation of diabetic patients to ophthalmologist. Beyond just developing strategies to promote screening programs for early detection and management of DR, education of the patients,comprehensive planning and coordination between ophthalmologist and physician can go a long way to decrease the economic and social burden of preventable blindness due to diabetic retinopathy.

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Prevalence and Associated Risk Factors for Diabetic Retinopathy among in-patients Diagnosed with Diabetes Mellitus: A Retrospective Study Conducted in Nobel Medical College and Teaching Hospital, Biratnagar

Journal of Nobel Medical College ◽

10.3126/jonmc.v7i1.20848 ◽

2018 ◽

Vol 7 (1) ◽

pp. 50-55

Author(s):

Bishwa Nath Adhikari ◽

Pramod Sharma Gautam ◽

Binod Bekoju ◽

Sadhana Basnet ◽

Himlal Bhandari

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Retinopathy ◽

Retrospective Study ◽

Modern World ◽

P Value ◽

Significant Relation ◽

Duration Of Diabetes ◽

Medical College ◽

Associated Risk Factors

Background: Diabetes mellitus (DM) being disease of modern world occurrence of Diabetic retinopathy (DR) has become more frequent. Knowledge on the prevalence and associated risk factors of diabetic retinopathy helps to detect the disease in its early course. The objective of the study was to establish the prevalence and to analyze the associated risk factors and help to screen the disease as early as possible so as to prevent and /or to delay the onset as well as progression of DR. Materials and Methods: A hospital based retrospective study conducted among 213 in-patients of Nobel Medical College, Biratnagar diagnosed with DM. Result: The prevalence of diabetic retinopathy was 32.39% and prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR, proliferative diabetic retinopathy and clinically significant macular edema was 12.7%, 8.9%, 6.1%, 5%, 1.9% & 2.3% respectively. There was statistically significant relation of diabetic retinopathy with duration of diabetes (p value 0.004) and the mean duration was 8.704 years. Conclusions: The prevalence of diabetic retinopathy among in-patients was 32.39%. Though there was no significant relation with occurrence of DR with type of diabetes, age, sex, alcoholism, smoking and drug intake history, the duration of diabetes and hyperlipidemia, poor hyperglycemic control were highly significantly associated with DR while high BP showed marginally insignificant relation with the same. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 50-55

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The Evaluation of Cardiac Disorders and Systemic Hypertension in JAK2 V617F Positive Patients at a Multicenter Institution

Blood ◽

10.1182/blood.v124.21.5560.5560 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5560-5560

Author(s):

Abuzar Moradi Tuchayi ◽

Sid Hemant Sheth ◽

Roy E. Smith

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Myeloproliferative Neoplasms ◽

Case Series ◽

Jak2 V617f ◽

Jak2 V617f Mutation ◽

Systemic Hypertension ◽

P Value ◽

Cardiac Disorders ◽

V617f Mutation

Abstract INTRODUCTION: Myeloproliferative neoplasms (MPN) represent a significant risk for arterial and venous thrombosis. The JAK2 V617F mutation is an acquired mutation common in patients with polycythemia vera and essential thrombocythemia. Studies have shown that both cardiovascular disorders and JAK2 V617F mutation are independent risk factors for thrombosis in MPN. Additionally in JAK2 V617F transgenic mice, there is reported association of cardiac hypertrophy and myeloproliferative neoplasms. However, there is limited clinical data regarding which cardiovascular risk factors are associated with JAK2 V617F mutations. Our study evaluated cardiac disorders in patients with and without JAK2 V617F mutation, and compared arterial and venous thrombosis rates between the two groups. METHODS: We performed a retrospective case series study at our multiinstitutional center. Demographic information was collected of patients who were evaluated for JAK2 V617F mutation from 2005 to 2014. 34 patients were female and 35 patients were male. Mean age was 64 .Cardiac disorders were characterized as coronary artery disease (CAD), atrial fibrillation (Afib), left heart failure (LHF), myocardial infarction (MI), and dysrhythmia (DYS) other than Afib. In total, thirty-four patients were JAK2 V617F positive while thirty-five patients were JAK2 V617F negative. Data was analyzed by SPSS software version 11.5 . We used pearson chi square test to compare the incidence of cardiac disorders and systemic hypertension (HTN) between two groups. Two tailed p-value <0.05 was considered statistically significant. RESULTS: 34 patients were female and 35 patients were male. Mean age was 64 .Baseline characteristics including mean age and gender were not significantly different between two groups. In JAK2 V617F positive patients, there was a statistically significant higher incidence of systemic hypertension and atrial fibrillation. The remaining characteristics were not significant. Additionally, we found no difference in rates of arterial and venous thrombotic events between two groups. We did not find any association between JAK2 V617F mutation and deep vein thrombosis (p= 0.154), stroke (p=0.289), pulmonary embolisms (p=0.538), and peripheral arterial disease (p=0. 572). Table P- VALUE JAK2 V617F MUTATION CAD MI LHF AFIB HTN DYS 0.216 0.538 0.289 *0.018* *0.012* 0.289 CONCLUSION: We identified systemic hypertension (p=0.012) and atrial fibrillation (p=0.018) to be strongly associated with JAK2 V617F mutation. This association has not been reported so far. Due to the retrospective nature of this case series, we are unable to determine whether there is a causal relationship between the presence of JAK2 V617F mutation and systemic hypertension and/or Afib. Further investigation is necessary to determine whether there is a causal relationship between the presence of JAK2 V617F mutation and systemic hypertension and/or Afib. Disclosures No relevant conflicts of interest to declare.

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Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy

10.21203/rs.3.rs-21982/v1 ◽

2020 ◽

Author(s):

YUHUA DING ◽

BANGTAO YAO ◽

HUI HANG ◽

HUI YE

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Case Series ◽

Tertiary Hospital ◽

Vitreous Haemorrhage ◽

Fluid Exchange ◽

Duration Of Diabetes ◽

Multiple Factors ◽

Sugar Levels ◽

Sutureless Vitrectomy

Abstract Background We aimed to analyse multiple factors in the prediction of risk of postoperative recurrent vitreous haemorrhage (RVH) for non-clearing vitreous haemorrhage in patients with diabetic retinopathy (DR) who underwent sutureless vitrectomy with 23- (23G) or 25-gauge (25G) narrow-gauge systems. Methods A retrospective consecutive case series design was used. DR patients who underwent sutureless vitrectomy for non-clearing vitreous haemorrhage between June 2017 and October 2019 were enrolled. All operations were performed at a tertiary hospital. Patient demographics and risk factors, including age, gender, duration of diabetes, preoperative fasting blood sugar levels (FBSL), systolic blood pressure (SBP), serum creatinine (Cr), urea, triamcinolone acetonide (TA), electrical coagulation, air-fluid exchange, pan‑retinal photocoagulation status (PRP), anti-vascular endothelial growth factor drug (anti-VEGF), and other factors, were recorded. Patients were divided into two groups based on the timing of their postoperative RVH: immediate postoperative RVH (within 2 weeks after operation) and delayed postoperative RVH (beyond 2–4 weeks after operation). Results Overall, 167 eyes (167patients) were enrolled. Seventy eyes were underwent 23G and 25G sutureless vitrectomy performed in 97 eyes, respectively. Postoperative RVH developed in 18 eyes (25.7%) in Group 23G and in 20 eyes (21.6%) in Group 25G (P = 0.540). Of these, 3 eyes (4.3%) had severed RVH in Group 23G compared with 5 eyes (5.2%) in Group 25G (P = 0.584). Delayed postoperative RVH occurred in 6 eyes (8.6%) in Group 23G and 8 eyes (8.2%) in Group 25G (P = 0.789). A binomial logistic regression analysis revealed that age, duration of diabetes, and Cr level were significantly associated with RVH in both Group 23G (P < 0.05) and Group 25G (P < 0.05). Conclusions The incidence and severity of RVH were 25.7% and 4.3%, respectively, in Group 23G and 21.6% and 5.15%, respectively, in Group 25G. Thus, the 23G sutureless vitrectomy approach was as safe as the 25G sutureless vitrectomy approach for treating vitreous haemorrhage in patients with DR. A younger age, shorter duration of diabetes, and higher Cr levels were risk factors for postoperative RVH in sutureless vitrectomy.

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Evaluation of Corneal Endothelium after Myopic Laser-Assisted In Situ Keratomileusis (LASIK) with Accelerated Cross-Linking (CXL) in Diabetic Patients

The Open Ophthalmology Journal ◽

10.2174/1874364102115010329 ◽

2021 ◽

Vol 15 (1) ◽

pp. 329-337

Author(s):

Mohamed Salah El-Din Mahmoud ◽

Ebtesam E. Hassan ◽

Ahmed S. Abdelhalim

Keyword(s):

Corneal Endothelium ◽

Case Series ◽

P Value ◽

Diabetic Patients ◽

Case Series Study ◽

Group A ◽

Significant Change ◽

Group B

Purpose: To study the effect of LASIK with accelerated CXL on corneal endothelium in myopic diabetic patients. Methods: A prospective comparative interventional case series study on 120 eyes of 60 myopic patients treated with LASIK with accelerated CXL. They were divided into two groups; group A included 60 eyes of diabetic patients, group B included 60 eyes of non-diabetic patients. Corneal endothelium was evaluated by specular microscope preoperatively and after 3 and 6 months postoperatively. Results: The endothelial cells density (ECD) showed statistically significant changes after 3 and 6 months postoperatively (p-value <0.001) in group A while group B showed statistically significant changes after 3 months without significant change after 6 months (p-value= 0.103), both groups had improved to near preoperative levels, with no significant differences between them at the end of 6 months follow-up (p-value = 0.219). Regarding pleomorphism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B (p-value= 0.884), and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Regarding polymegathism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B after 3 (p-value= 0.178) and 6 (p-value= 0.866) months follow-up, and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Conclusion: LASIK with accelerated CXL is safe on corneal endothelium in diabetic myopic patients but needs to follow up for a long period.

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Characteristics and outcomes of vitrectomy for proliferative diabetic retinopathy in young versus senior patients

BMC Ophthalmology ◽

10.1186/s12886-020-01688-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mengyu Liao ◽

Xiaohong Wang ◽

Jinguo Yu ◽

Xiangda Meng ◽

Yuanyuan Liu ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Retinal Detachment ◽

Patient Group ◽

Proliferative Diabetic Retinopathy ◽

Young Patients ◽

Case Series ◽

Vitreous Hemorrhage ◽

Diabetic Patients ◽

Case Series Study ◽

Senior Patients

Abstract Background Proliferative diabetic retinopathy (PDR) is one of the most common cause of vision loss in diabetic patients, and the incidence age of PDR patients gradually gets younger. This study aims to compare the characteristics of PDR and outcomes following vitrectomy in young and senior patients. Methods This is a retrospective case series study. Data of 116 eyes of 92 patients who underwent vitrectomy for PDR from February 2012 to February 2017 were reviewed, which were divided into young and senior patient groups. All patients were followed up for 24 months at least. Results There were 62.1% of eyes with tractional retinal detachment secondary to PDR in the young patient group, while only 12.1% of eyes in the senior patient group with this surgery indication. (P < 0.001) The best corrected visual acuity increased in 41 eyes (70.7%), stable in 9 eyes (15.5%), and decreased in 8 eyes (13.8%) in young patients at the final follow-up. And it increased in 47 eyes (81.0%), stable in 2 eyes (3.4%), and decreased in 9 eyes (15.5%) in senior patients.(P = 0.085) Postoperative complications mainly included recurrent vitreous hemorrhage (24.1%), retinal detachment (3.4%), neovascular glaucoma (NVG) (27.6%) and nuclear sclerosis (53.4%) in young patients, and it was 19.0, 0.0, 1.7 and 3.4% in senior patients respectively. Conclusion PDR of young patients is more severe than that of senior patients, and vitrectomy is an effective and safe method for PDR treatment. NVG is a main and severe complication besides nuclear sclerosis in young patients, and the incidence of NVG is higher compared to that in senior patients.

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Determining Risk Factors That Affect Progression in Patients with Nonproliferative Diabetic Retinopathy

Journal of Ophthalmology ◽

10.1155/2021/6064525 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Dalbert J. Chen ◽

Jacky C. Kuo ◽

Alex J. Wright ◽

Alice Z. Chuang ◽

Wenyaw Chan ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Diabetic Patients ◽

Progression Rate ◽

Factors Affecting ◽

Duration Of Diabetes ◽

Nonproliferative Diabetic Retinopathy ◽

Sojourn Times ◽

Endothelial Growth Factor

Purpose. To determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR. Patients and Methods. Charts of diabetic patients who received an initial eye exam between 2010 and 2017 at our county hospital were included. Patients with proliferative diabetic retinopathy (PDR), fewer than 2 years of follow-up, or fewer than 3 clinic visits were excluded. Demographics and baseline systemic and ocular characteristics were recorded. Follow-up mean annual HbA1c and blood pressure, best-corrected visual acuity, and the number of antivascular endothelial growth factor treatments were recorded. Stage and date of progression were recorded. A 5-state nonhomogeneous continuous-time Markov chain with a backward elimination model was used to identify risk factors and estimate their effects on progression. Results. Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1–9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99, P = 0.047 ), duration of diabetes (HR = 1.02, P = 0.018 ), and Hispanic ethnicity (HR = 1.31, P = 0.068 ). Mean sojourn times at mean age, duration of diabetes, and annual HbA1c for a non-Hispanic patient were estimated to be 3.03 (±0.97), 4.63 (±1.21), 6.18 (±1.45), and 4.85 (±1.25) years for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Each 1% increase in HbA1c annually diminished sojourn times by 15%, 10%, 7%, and 10% for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Conclusion. HbA1c level is a significant modifiable risk factor in controlling the progression of DR. The proposed model could be used to predict the time and rate of progression based on an individual’s risk factors. A prospective multicenter study should be conducted to further validate our model.

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