Rates of Progression in Diabetic Retinopathy During Different Time Periods
A systematic review and meta-analysis
- Tien Y. Wong, MD, PHD1,2,
- Mkaya Mwamburi, MD, PHD3,4,
- Ronald Klein, MD, MPH5,
- Michael Larsen, MD, PHD6,
- Harry Flynn, MD7,
- Marisol Hernandez-Medina, MD, MPH3,
- Gayatri Ranganathan, MSC3,
- Barbara Wirostko, MD8,
- Andreas Pleil, PHD8 and
- Paul Mitchell, MD, PHD9
- 1Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia;
- 2Singapore Eye Research Institute, National University of Singapore, Singapore;
- 3United BioSource Corporation, Lexington, Massachusetts;
- 4Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts;
- 5Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
- 6Department of Ophthalmology, Glostrup Hospital and Kennedy Center, National Eye Clinic, University of Copenhagen, Copenhagen, Denmark;
- 7Bascom Palmer Eye Institute, University of Miami, Miami, Florida;
- 8Pfizer, New York, New York;
- 9Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia.
- Corresponding author: Tien Y. Wong, twong{at}unimelb.edu.au.
Abstract
OBJECTIVE This meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends.
RESEARCH DESIGN AND METHODS This systematic literature review and meta-analysis of prospective studies assesses progression of retinopathy among diabetic patients without treatment for retinopathy at baseline. Studies published between 1975 to February 2008 were identified. Outcomes of interest were rates of progression to PDR and/or SVL. Pooled baseline characteristics and outcome measures were summarized using weighted averages of counts and means. Baseline characteristics and outcomes were compared between two periods: 1975–1985 and 1986–2008.
RESULTS A total of 28 studies comprising 27,120 diabetic patients (mean age 49.8 years) were included. After 4 years, pooled incidence rates for PDR and SVL were 11.0 and 7.2%, respectively. Rates were lower among participants in 1986–2008 than in 1975–1985. After 10 years, similar patterns were observed. Participants in 1986–2008 studies had lower proportions of PDR and non-PDR at all time points than participants in 1975–1985 studies.
CONCLUSIONS Since 1985, diabetic patients have lower rates of progression to PDR and SVL. These findings may reflect an increased awareness of retinopathy risk factors; earlier identification and initiation of care for patients with retinopathy; and improved medical management of glucose, blood pressure, and serum lipids. Differences in baseline characteristics, particularly in the prevalence and severity of retinopathy, could also have contributed to these temporal differences.
Footnotes
-
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
-
- Received March 30, 2009.
- Accepted August 23, 2009.
- © 2009 by the American Diabetes Association.
