Elsevier

Ophthalmology

Volume 124, Issue 7, July 2017, Pages 977-984
Ophthalmology

Original article
The Prevalence of Diabetic Retinopathy in Australian Adults with Self-Reported Diabetes: The National Eye Health Survey

https://doi.org/10.1016/j.ophtha.2017.02.004Get rights and content

Purpose

To determine the prevalence of and factors associated with diabetic retinopathy (DR) among non-Indigenous and Indigenous Australian adults with self-reported diabetes.

Design

Population-based cross-sectional study.

Participants

Non-Indigenous Australians (50–98 years of age) and Indigenous Australians (40–92 years of age) with known diabetes.

Methods

Diabetes was determined based on self-report of previous diagnosis of the disease. Nonmydriatic fundus photographs were obtained of each eye and graded according to the modified Airlie House classification system.

Main Outcome Measures

Any DR, vision-threatening DR (VTDR), treatment coverage rates (proportion of participants with proliferative DR [PDR], clinically significant macular edema [CSME], or both who had evidence of retinal scatter and focal laser treatment).

Results

Four hundred thirty-one non-Indigenous Australians (13.9%) and 645 Indigenous Australians (37.1%) self-reported diabetes, of whom 93% (1004/1076) had retinal images that were gradable for DR. The sampling weight-adjusted prevalence of any DR and VTDR among non-Indigenous adults with self-reported diabetes was 28.5% (95% confidence interval [CI], 22.6–35.3) and 4.5% (95% CI, 2.6–7.9), respectively. Among adults 40 years of age and older, the sampling weight-adjusted prevalence of any DR and VTDR was 39.4% (95% CI, 33.1–46.1) and 9.5% (95% CI, 6.8–13.1), respectively. Longer diabetes duration was associated significantly with VTDR in the Indigenous Australian population (odds ratio [OR], 1.08 per 1-year increase; P = 0.005) and non-Indigenous Australian population (OR, 1.05 per 1-year increase; P = 0.03). The treatment coverage of PDR and CSME was 75% (56/75) in Indigenous Australians and 79% (15/19) in non-Indigenous Australians. Diabetic retinopathy was attributed as the main cause of vision loss (<6/12 in the better eye) in 9% and 19% of non-Indigenous and Indigenous Australian adults with known diabetes, respectively.

Conclusions

Three quarters of non-Indigenous and Indigenous Australian adults with PDR or CSME have received laser treatment. The prevalence of VTDR in Indigenous and non-Indigenous Australians in the present study was lower than that found in previous population-based reports, nevertheless, approximately 1 in 10 Indigenous adults with known diabetes experience VTDR. This highlights that intensified prevention strategies are required to delay or prevent avoidable vision loss resulting from DR in Indigenous Australian communities.

Section snippets

Study Population

The NEHS is a population-based, cross-sectional study of 4836 Australians (n = 3098 non-Indigenous Australians and n = 1738 Indigenous Australians) 40 to 98 years of age. The sampling methodology of the NEHS has been described in detail elsewhere.14 In brief, a multistage random-cluster sampling methodology was used to identify 30 geographic areas across 5 Australian states and 1 territory, stratified by remoteness, to obtain a representative sample of non-Indigenous Australians 50 years of age

Prevalence of Self-Reported Diabetes

A total of 4836 individuals were recruited and examined in the NEHS, including 3098 (64.1%) non-Indigenous Australians and 1738 (35.9%) Indigenous Australians. In total, 431 (13.9%) non-Indigenous Australians and 645 (37.1%) Indigenous Australians self-reported diabetes. Of these, 404 (93.7%) non-Indigenous Australians and 600 (93.0%) Indigenous Australians had retinal photographs from at least 1 eye that were gradable for DR and subsequently were included in analysis. Among the participants

Discussion

This was a nationwide study of the prevalence of DR in both Indigenous and non-Indigenous Australians who self-reported diabetes. The prevalence of VTDR among Indigenous Australians 40 years of age and older and non-Indigenous Australians 50 years of age and older was 9.5% and 4.5%, respectively. As has been found in previous population-based studies,4, 10, 24, 25 the prevalence of DR and VTDR was related strongly to duration of diabetes.

For non-Indigenous Australians with diabetes in the NEHS,

Acknowledgments

The Centre for Eye Research Australia (CERA) and Vision 2020 Australia thank the NEHS project steering committee members for their contributions (Professor Hugh Taylor, Dr. Peter van Wijngaarden, Jennifer Gersbeck, Dr. Jason Agostino, Anna Morse, Sharon Bentley, Robyn Weinberg, Christine Black, Genevieve Quilty, Louis Young, and Rhonda Stilling) and the core CERA research team who assisted with the survey field work (Joshua Foreman, Pei Ying Lee, Rosamond Gilden, Larissa Andersen, Benny

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      In our study, 97.3% of participants thought that diabetes could lead to blindness, eye disease or both and, reflecting this high level of awareness, 90.2% had attended screening within the previous year. This latter figure is higher than the 78% who self-reported adherence to the Australian DR screening guidelines in the recent National Eye Health Survey [22], a difference that may be due to between-study differences in availability of health professional advice, access to free screening [23] and/or the Hawthorne effect as our participants were recruited to a study investigating ocular complications of diabetes. Few other studies have assessed whether people with diabetes know about non-DR ophthalmic complications.

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Health and Medical Research Council (Career Development Fellowship no.: 1090466 [M.D.]); and an Australian Postgraduate Award (J.F.). The National Eye Health Survey was funded by the Department of Health of the Australian Government and also received financial contributions from Novartis Australia and in-kind support from our industry and sector partners, OPSM, Carl Zeiss, Designs for Vision, the Royal Flying Doctor Service, Optometry Australia, and the Brien Holden Vision Institute. OPSM donated sunglasses valued at $130 for each study participant. The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government.

    Author Contributions:

    Conception and design: Xie, van Wijngaarden, Taylor, Dirani

    Analysis and interpretation: Keel, Xie

    Data collection: Keel, Xie, Foreman, Dirani

    Obtained funding: none

    Overall responsibility: Keel, Xie, Foreman, van Wijngaarden, Taylor, Dirani

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