Original Research

Global Prevalence and Major Risk Factors of Diabetic Retinopathy

  1. Joanne W.Y. Yau, MBBS1,
  2. Sophie L. Rogers, MEPID1,
  3. Ryo Kawasaki, PHD1,
  4. Ecosse L. Lamoureux, PHD1,2,
  5. Jonathan W. Kowalski, PHARMD3,
  6. Toke Bek, PHD4,
  7. Shih-Jen Chen, PHD5,
  8. Jacqueline M. Dekker, PHD6,
  9. Astrid Fletcher, PHD7,
  10. Jakob Grauslund, MD8,
  11. Steven Haffner, PHD9,
  12. Richard F. Hamman, PHD10,
  13. M. Kamran Ikram, PHD11,
  14. Takamasa Kayama, MD12,
  15. Barbara E.K. Klein, PHD13,
  16. Ronald Klein, PHD13,
  17. Sannapaneni Krishnaiah, MD14,
  18. Korapat Mayurasakorn, MD15,
  19. Joseph P. O’Hare, MD16,
  20. Trevor J. Orchard, MD17,
  21. Massimo Porta, PHD18,
  22. Mohan Rema, MD19,
  23. Monique S. Roy, MD20,
  24. Tarun Sharma, MD21,
  25. Jonathan Shaw, PHD22,
  26. Hugh Taylor, AC23,
  27. James M. Tielsch, PHD24,
  28. Rohit Varma, MD25,
  29. Jie Jin Wang, PHD26,
  30. Ningli Wang, MD27,
  31. Sheila West, PHD28,
  32. Liang Xu, PHD29,
  33. Miho Yasuda, PHD30,
  34. Xinzhi Zhang, PHD31,
  35. Paul Mitchell, PHD26,
  36. Tien Y. Wong, PHD1,2,32⇓ and
  37. for the Meta-Analysis for Eye Disease (META-EYE) Study Group*
  1. 1Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  2. 2Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  3. 3Global Health Outcomes Strategy and Research, Allergan Inc., Irvine, California
  4. 4Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
  5. 5Department of Ophthalmology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
  6. 6Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
  7. 7Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, U.K.
  8. 8Department of Ophthalmology, Odense University Hospital, Odense, Denmark
  9. 9Shavano Park, Texas
  10. 10Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
  11. 11Departments of Epidemiology and Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
  12. 12National Cancer Center/Department of Neurosurgery, Advanced Molecular Epidemiology Research Institute, Faculty of Medicine, Yamagata University, Yamagata, Japan
  13. 13Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
  14. 14Center for Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India
  15. 15Department of Social Medicine, Samutsakhon General Hospital, Samutsakhon, Thailand
  16. 16Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K.
  17. 17Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  18. 18Department of Internal Medicine, University of Turin, Turin, Italy
  19. 19Department of Ophthalmology, Madras Diabetes Research Foundation, Chennai, India
  20. 20Institute of Ophthalmology and Visual Science, University of New Jersey, Newark, New Jersey
  21. 21Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
  22. 22Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  23. 23Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
  24. 24Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  25. 25Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
  26. 26Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
  27. 27Beijing Tongren Hospital, Capital Medical University, Beijing, China
  28. 28Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
  29. 29Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  30. 30Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  31. 31Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  32. 32Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  1. Corresponding author: Tien Y. Wong, ophwty{at}nus.edu.sg.
Diabetes Care 2012 Mar; 35(3): 556-564. https://doi.org/10.2337/dc11-1909

Abstract

OBJECTIVE To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.

RESEARCH DESIGN AND METHODS A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years.

RESULTS A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes.

CONCLUSIONS There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

Footnotes

  • This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-1909/-/DC1.

  • ↵* A complete list of the study group can be found in the Supplementary Data online.

  • The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Eye Institute or the National Institutes of Health. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Received October 25, 2011.
  • Accepted December 5, 2011.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Global Prevalence and Major Risk Factors of Diabetic Retinopathy
Joanne W.Y. Yau, Sophie L. Rogers, Ryo Kawasaki, Ecosse L. Lamoureux, Jonathan W. Kowalski, Toke Bek, Shih-Jen Chen, Jacqueline M. Dekker, Astrid Fletcher, Jakob Grauslund, Steven Haffner, Richard F. Hamman, M. Kamran Ikram, Takamasa Kayama, Barbara E.K. Klein, Ronald Klein, Sannapaneni Krishnaiah, Korapat Mayurasakorn, Joseph P. O’Hare, Trevor J. Orchard, Massimo Porta, Mohan Rema, Monique S. Roy, Tarun Sharma, Jonathan Shaw, Hugh Taylor, James M. Tielsch, Rohit Varma, Jie Jin Wang, Ningli Wang, Sheila West, Liang Xu, Miho Yasuda, Xinzhi Zhang, Paul Mitchell, Tien Y. Wong, for the Meta-Analysis for Eye Disease (META-EYE) Study Group
Diabetes Care Mar 2012, 35 (3) 556-564; DOI: 10.2337/dc11-1909
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