因糖尿病视网膜病变致盲的全球现况急升


  新研究显示,因糖尿病视网膜病变(DR)导致的视力缺损情况正在全球增加,糖尿病引起的眼科疾病目前已是常见致盲原因的第5位。
  
  这些研究结果来自于针对1990-2012年间、全球为了「Global Burden of Disease (GBD) Study 2010」进行之人口基础研究的统合分析,由佛罗里达Nova Southeastern大学眼科视光学院Janet L Leasher医师等人发表于2016年9月的糖尿病照护期刊。
  
  因糖尿病视网膜病变导致视力不佳的人数,于所有致盲案例与中度到严重视力不佳案例中的比率持续上升。
  
  总之,研究人员发现,2010年时,糖尿病视网膜病变影响约39分之一的致盲案例与52分之一的视力不佳案例。
  
  共同作者、英国剑桥Anglia Ruskin大学视力与眼科研究小组副主任/教授Rupert RA Bourne医师表示,糖尿病引起的视力损失比过去20年增加了三分之二以上,急剧恶化的全球流行糖尿病是必须解决的问题。 
  
  在「Global Burden of Disease Study」这项研究中,眼盲定义为:呈现视敏度低于3/60,中到重度视力不佳定义为:呈现视敏度低于6/18但是大于等于3/60。收集的资料来自澳洲、中欧和西欧、北美、加勒比海、拉丁美洲、大洋洲、南亚、东亚和东南亚的14国。 
  
  2010年时,全球约有3,240万人眼盲、1亿9,100万人视力不佳,其中,糖尿病视网膜病变影响833,690例的眼盲与370万例的视力不佳。从1990-2010年,糖尿病视网膜病变引起眼盲的人数增加达将近27%、糖尿病视网膜病变相关的视力不佳人数增加达64%。
  
  按百分比而言,2010年时,所有眼盲案例的2.6%是糖尿病视网膜病变引起,引起1.9%的视力不佳,分别比1990年的2.1%与1.3%增加。2010年时,糖尿病视网膜病变引起的眼盲百分比范围,从东南亚与大洋洲的小于2%到南拉丁美洲的5.5%以上。
  
  一般来说,归因于糖尿病视网膜病变的眼盲与视力不佳之百分比,在低收入地区与年轻人口比较低,例如东南亚,在高收入地区与年长人口比较高,包括北美与西欧。
  
  作者们认为,一个可能原因是,低收入地区有较高比率之未治疗的白内障或屈光异常相关的视觉障碍,因此减少了归因于糖尿病视网膜病变的百分比,此外,因为贫穷区域的医疗服务资源有限,糖尿病患可能无法活到发生糖尿病视网膜病变时。
  
  Leasher 医师指出,而且不幸的是,糖尿病视网膜病变在初期时通常没有症状。
  
  她建议,诊断有糖尿病的患者应至少每年进行散瞳健康检查,并由他们的眼科医师根据个别状况提供建议。患者应与其照护者密切合作,以确认控制其血糖值的最佳方法。
  
  整体而言,他们写道,当务之急是要对归因于糖尿病视网膜病变的眼盲与视力不佳进行规划、发展预防糖尿病视网膜病变与后续视力损失的策略。
  这类策略包括:
  * 发展实证基础、具有成本效益的糖尿病视网膜病变筛检策略。
  * 改善全身性风险因素控制(例如血糖与血压)。
  * 增加对于糖尿病相关视网膜病变视力损失之风险的警觉与卫教。
  * 透过雷射治疗、玻璃体内类固醇注射、抗VEGF药物,预防与治疗糖尿病相关视网膜病变。
  * 减少糖尿病与糖尿病相关视网膜病变之筛检与处置、社经因素、医疗基础设施的区域性差异。
  
  资料来源:http://www.24drs.com/
  
  Native link:Blindness Due to Diabetic Retinopathy Surges Worldwide
  

Blindness Due to Diabetic Retinopathy Surges Worldwide

By Miriam E Tucker
Medscape Medical News

Visual impairment due to diabetic retinopathy (DR) is rising worldwide, and diabetic eye disease is now the fifth most common cause of blindness, new research shows.

The findings, from a meta-analysis of all available population-based studies performed worldwide from 1990 to 2012 for the Global Burden of Disease (GBD) Study 2010, were published in the September 2016 issue of Diabetes Care by Janet L Leasher, OD, of Nova Southeastern University College of Optometry, Fort Lauderdale/Davie, Florida, and colleagues.

The number of people with visual impairment due to DR represents an increasing proportion of all cases of blindness and moderate to severe visual impairment.

In all, the researchers found, DR was responsible in one of every 39 cases of blindness and one of every 52 cases of visual impairment in 2010.

"With the alarming prevalence of vision loss due to diabetes rising more than two-thirds in the past 20 years, the precipitous global epidemic of diabetes must be addressed," said coauthor Rupert RA Bourne, MD, professor and associate director of the Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom, in a press statement.

In the Global Burden of Disease Study, blindness was defined as presenting visual acuity below 3/60 and moderate to severe visual impairment as presenting visual acuity below 6/18 but 3/60 or greater. Data were collected from 14 countries in Australasia, Central and Western Europe, North America, the Caribbean, Latin America, Oceania, and South, East, and Southeast Asia.

In 2010 worldwide, approximately 32.4 million people were blind and 191 million people were visually impaired. Of those, DR was responsible for 833,690 cases of blindness and 3.7 million of visual impairment. From 1990 to 2010, the number of people with DR-induced blindness increased by approximately 27% and the number with DR-related visual impairment by 64%.

By percentage, DR caused 2.6% of all cases of blindness and 1.9% of all visual impairment in 2010, up from 2.1% and 1.3%, respectively, in 1990. The percentage of blindness caused by DR in 2010 ranged from less than 2% in Southeast Asia and Oceania to 5.5% or greater in southern Latin America.

In general, the percentage of blindness and visual impairment attributable to DR was lower in low-income regions with younger populations such as East and Southeast Asia and higher in high-income parts of the world, with older populations, including North America and Western Europe.

A possible reason is that low-income regions may have a higher percentage of untreated cataracts or refractive error–related visual impairment, thereby reducing the proportion attributable to DR, the authors suggest. Also, in regions with poor access to medical services, people with diabetes may not live long enough to experience DR, they point out.

And, "unfortunately, diabetic retinopathy usually does not have any symptoms in the early stages," noted Dr Leasher.

"People diagnosed with diabetes should have a dilated eye health exam at least every year and be advised by their eye care practitioner for their personal situation," she advised. "Patients should work closely with their healthcare provider to determine the best methods to control their blood sugar levels," she added.

Overall, "it is imperative to plan for a greater share of blindness and visual impairment due to DR and to develop strategies to prevent DR and subsequent vision loss," she and her colleagues write.

Such strategies include the following:

  • Develop evidence-based, cost-effective DR screening strategies.

  • Improve systemic risk-factor control (such as glucose and blood pressure).

  • Increase health education and awareness of the risk of DR-related visual loss.

  • Prevent and treat DR through expanded use of laser treatments, intravitreal steroid injections, and anti-VEGF drugs.

  • Reduce regional differences in screening and management of diabetes and DR, socioeconomic factors, and medical infrastructure.

This study was partially funded by the Bill & Melinda Gates Foundation, Fight for Sight, the Fred Hollows Foundation, and the Brien Holden Vision Institute. The authors have no relevant financial relationships.

    
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