Diabetic Retinopathy: Epidemiology

Prof S. Resnikoff MD PhD

ICO Director of Eye Care Delivery - Geneva

BHVI - Sydney

2nd International Course in Visual Health

February 14th – 15th, 2020, Querétaro

Outline

1. Epidemiology of Diabetes

2. Risk factors for developing DR and complications

3. Burden: absolute numbers and prevalence trends

4. Morbidity vs Disability

5. Estimating magnitude and treatment needs

Diabetes MellitusNo Diabetic Retinopathy

without Diabetes Mellitus

463 million people living with Diabetes (2019)

IDF Atlas 2019

Prevalence of Diabetes (age-standardized, 2019)

IDF Atlas 2019

Risk Factors for DR and complications

• Type 1 Diabetes >>> Type 2 Diabetes

• Risk of PDR x 15

• Risk of DME x 5

• Ethnicity:

• Highest Risk: Afro-Americans

• Lowest Risk: Asians

• Diabetes duration (especially > 20yrs)

• Hyperglycemia HbA1C

• Hypertension

• Dyslipidemia

RE

Other

AMD

Glaucoma

CODR

Tra

RE

Other

AMD

Glaucoma CODR Tra

RE

Other

AMD

Glaucoma

CODR Tra

Cataract Cataract Cataract

Blindness

(PVA < 0.05)

Mod. & Severe VI

(PVA 0.3 – 0.05)

Visual Impairment

(PVA < 0.3)

Diabetic Retinopathy: 6rd cause of Blindness

and Visual Impairment (World, 2015)

2.2% 1.5%1.3%

0.8 Million 2.9 Million 3.7 Million

Probably Underestimated because of survey methodology

Prevalence of VI due to DR

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

1990 1995 2000 2005 2010 2015 2020

Trends 1990 – 2020

CE Eur HIC LAC NAME

SA WP SSA Wolrd

China

World

Eastern EU

HIC

S. Asia

Lat Am

-100% -50% 0% 50% 100%

Cat

DR

AMD

Other

Glau

RE

CO

Tra

Changes in Prevalence 1990 - 2020

DR

Morbidity: people having DR (any stage)

• Global estimate: 160 million people (aged 20 -

70) with any stage of Diabetic Retinopathy in

2020*

Yau JWY et al.. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care, 2012

Vision Impaired

3.7 Million (2%)

Estimating DR magnitude

Prevalence among people with Diabetes:

• Any DR = 35.4%

• Vision Threatening DR = 11.7%

• Proliferative DR (PDR) = 7.2%

• Macular Oedema (DME) = 7.5%

* Yau JW, Rogers SL, Kawasaki R, et al.

Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. Mar 2012;35(3):556-564.

Estimating DR magnitude in Mexico

Estimated number of patients in Mexico (Prev: 15.2%):

• Any DR: 12.8 million DM x 35.4% = 4.5 million

• Vision Threatening DR: 12.8 x 11.7% = 1.5 million

• Proliferative DR (PDR): 12.8 x 7.2% = 900,000

• Macular Oedema (DME): 12.8 x 7.5% = 960,000

Yau JWY, et al. 2012 and IDF Atlas 2019

13 million patients to screen/year

1.5 million chronic care patients to manage