Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India

Rehana Khan; Shruti Chandra; Ramachandran Rajalakshmi; Padmaja Kumari Rani; Giridhar Anantharaman; Alok Sen; Abhishek Desai; Rupak Roy; Sundaram Natarajan; Lanin Chen; Gajendra Chawla; Umesh Chandra Behera; Lingam Gopal; Sarega Gurudas; Sobha Sivaprasad; Rajiv Raman

doi:10.1038/s41598-020-67350-6

Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India

Rehana Khan, Shruti Chandra, Ramachandran Rajalakshmi, Padmaja Kumari Rani, Giridhar Anantharaman, Alok Sen, Abhishek Desai, Rupak Roy, Sundaram Natarajan, Lanin Chen, Gajendra Chawla, Umesh Chandra Behera, Lingam Gopal, Sarega Gurudas, Sobha Sivaprasad, Rajiv Raman

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Abstract

To provide the real-world outcomes of people with proliferative diabetic retinopathy (PDR) in India and highlight opportunities for improvement of their disease status and to evaluate their visual acuity (VA) status. A multicenter retrospective study in which ten centers in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. This study population were of Indian nationality. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to 10 years were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, diabetic retinopathy status in both eyes. Available follow-up data on VA were collected at 6 months post baseline, 5 years and 10 years within a ± 3 months window. Evaluating the presenting VA of people with PDR, short-term outcomes at 6 months and the incidence of visual impairment (VI) at 5 and 10 years are the main outcome of the study. Data was available for 516, 424 and 455 patients at baseline, 5 years and 10 years respectively. Gender and duration of diabetes did not have statistically significant effect on VI outcomes. Eyes receiving treatment early in the disease course (i.e. baseline VA ≥ 6/12) had significantly better VA outcomes at 10 years versus eyes treated at a later stage (i.e. baseline VA < 6/12) (p = <0.0001). On comparing eyes with stable treated PDR and persistent PDR at end of 10 year follow up, a significantly higher percentage of eyes in the stable treated group maintained VA of ≥ 6/12 (55.1% vs. 24.2%) (p = < 0.0001), indicating persistent disease activity due to inadequate treatment results in worse VA outcomes. We found no trend in VI or blindness with increasing levels of age at both 5- and 10-year time points (p > 0.05). The age standardized incidence for VI was 11.10% (95% CI 8.1, 14.2) and for blindness was found to be 7.7% (95% CI 5.2, 10.3). Our results suggest that despite robust recent clinical trial results showing that pan retinal photocoagulation is an excellent treatment for PDR, people with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

Original language	English
Article number	10513
Number of pages	8
Journal	Scientific Reports
Volume	10
Issue number	1
DOIs	https://doi.org/10.1038/s41598-020-67350-6
Publication status	Published - 29 Jun 2020
Externally published	Yes

Bibliographical note

Publisher Copyright:© 2020, The Author(s).
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the articleΓÇÖs Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the articleΓÇÖs Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Funder

This work was part of ORNATE India study which is supported by Global Challenges Research Fund and UK Research and Innovation through the Medical Research Council grant number MR/P027881/1. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Funding

This work was part of ORNATE India study which is supported by Global Challenges Research Fund and UK Research and Innovation through the Medical Research Council grant number MR/P027881/1. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

Funders	Funder number
Medical Research Council	MR/P027881/1
National Institute for Health and Care Research

ASJC Scopus subject areas

General

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Khan, R., Chandra, S., Rajalakshmi, R., Rani, P. K., Anantharaman, G., Sen, A., Desai, A., Roy, R., Natarajan, S., Chen, L., Chawla, G., Behera, U. C., Gopal, L., Gurudas, S., Sivaprasad, S., & Raman, R. (2020). Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India. Scientific Reports, 10(1), Article 10513. https://doi.org/10.1038/s41598-020-67350-6

Khan, R, Chandra, S, Rajalakshmi, R, Rani, PK, Anantharaman, G, Sen, A, Desai, A, Roy, R, Natarajan, S, Chen, L, Chawla, G, Behera, UC, Gopal, L, Gurudas, S, Sivaprasad, S & Raman, R 2020, 'Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India', Scientific Reports, vol. 10, no. 1, 10513. https://doi.org/10.1038/s41598-020-67350-6

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AU - Behera, Umesh Chandra

AU - Gopal, Lingam

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AU - Sivaprasad, Sobha

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N2 - To provide the real-world outcomes of people with proliferative diabetic retinopathy (PDR) in India and highlight opportunities for improvement of their disease status and to evaluate their visual acuity (VA) status. A multicenter retrospective study in which ten centers in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. This study population were of Indian nationality. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to 10 years were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, diabetic retinopathy status in both eyes. Available follow-up data on VA were collected at 6 months post baseline, 5 years and 10 years within a ± 3 months window. Evaluating the presenting VA of people with PDR, short-term outcomes at 6 months and the incidence of visual impairment (VI) at 5 and 10 years are the main outcome of the study. Data was available for 516, 424 and 455 patients at baseline, 5 years and 10 years respectively. Gender and duration of diabetes did not have statistically significant effect on VI outcomes. Eyes receiving treatment early in the disease course (i.e. baseline VA ≥ 6/12) had significantly better VA outcomes at 10 years versus eyes treated at a later stage (i.e. baseline VA < 6/12) (p = <0.0001). On comparing eyes with stable treated PDR and persistent PDR at end of 10 year follow up, a significantly higher percentage of eyes in the stable treated group maintained VA of ≥ 6/12 (55.1% vs. 24.2%) (p = < 0.0001), indicating persistent disease activity due to inadequate treatment results in worse VA outcomes. We found no trend in VI or blindness with increasing levels of age at both 5- and 10-year time points (p > 0.05). The age standardized incidence for VI was 11.10% (95% CI 8.1, 14.2) and for blindness was found to be 7.7% (95% CI 5.2, 10.3). Our results suggest that despite robust recent clinical trial results showing that pan retinal photocoagulation is an excellent treatment for PDR, people with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

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Prevalence and incidence of visual impairment in patients with proliferative diabetic retinopathy in India

Abstract

Bibliographical note

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Funding

ASJC Scopus subject areas

UN SDGs

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