Оценочные показатели количества слепых или слабовидящих людей вследствие диабетической ретинопатии на Южном Урале

    Relevance

    Diabetes mellitus (DM) and its complications are among the leading causes of blindness and vision impairment in the workin-age population. The number of people with diabetes has significantly increased in recent decades, particularly in low- and middle-income countries [1]. According to the latest statistics from the International Diabetes Federation, more than half a billion people worldwide are living with the disease [2, 3].

    Diabetic retinopathy (DR) is one of the most prevalent microvascular complications of diabetes. Global DR research, including systematic evaluation of treatment outcomes and potential complications, has been ongoing for nearly 3 decades. In 2020 DR was listed as one of the leading causes of blindness among people aged 50 and older [4, 5]. Using Delphi method to assess 85 global eye care challenges, DR was identified as one of the top 6 priorities for treatment and early detection [6]. Previous populationbased studies have shown that DR is one of predominant causes of blindness and visual impairment in the working age population [7–10]. According to the authors, among people with disabilities due to diabetic retinopathy in the Republic of Kazakhstan, 62.5% are city residents and 75.94% are people of working age [11].

    Purpose

    To assess the prevalence of blindness and visual impairment due to diabetic retinopathy in the Southern Urals population.

    Material and methods

    In 2015–2017, the «Ural Eye and Medical Study» (UEMS), a population-based cross-sectional study, was conducted by the Ufa Eye Research Institute to assess the prevalence of eye diseases in the population of the Southern Urals aged 40 years and older. The inclusion criteria were as follows: voluntary consent to participate in the study, age 40+ years, permanent residence in the study areas.

    The study was conducted in accordance with the principles of the Helsinki Declaration, Good Clinical Practice (GCP) guidelines and current regulations, all participants provided informed written consent. For each participant an individual research card was completed, reflecting all of the characteristics being studied.

    A total of 5,899 (80,5%) individuals out of 7328 eligible individuals took part in the UEMS study. All participants were asked to complete a questionnaire assessing 683 different criteria, 293 of which were related to demographic characteristics, social status, lifestyle, bad habits. In addition, a number of physical examinations were performed, including blood pressure measurement, hand grip strength assessment, anthropometric evaluation and spirometry test, etc.

    Ophthalmic examinations included autorefractometry (Auto-2Ref/Keratometer HRK-7000A Huvitz Co, Ltd., Korea), slit lamp biomicroscopy of the anterior segment and non-contact tonometry. Additionally, spectral-domain optical coherence tomography (OCT) (RS-3000, NIDEK co., Ltd., Japan), corneal topography (Pentacam HR, Typ70900, OCULUS, Optikgeräte GmbH Co., Wetzlar, Germany), computerized perimetry (PTS 1000 Perimeter, Optopol Technology Co., Zawiercie, Poland), and fundus photography (VISUCAM 500, Carl Zeiss Meditec AG, Jena, Germany) were performed.

    Diagnosed diabetes mellitus was based on fasting glucose level of ≥7.0 mmol/L or the patient’s medical history.

    DR was diagnosed based on OCT data and ocular fundus photography. OCT scans were utilized to examine the optic nerve head and macular area of the retina for signs of macular edema or other manifestations of the disease. The study used WHO-approved classification of diabetic retinopathy (1991), which distinguishes between non-proliferative, preproliferative and proliferative forms. The degree of visual impairment among the study participants was assessed based on World Health Organization’s classification (for simplicity, all respondents with moderate and severe visual impairment were combined into one group) [12]. Visual acuity in the better or only eye was taken into account.

    Data entry and their statistical processing was performed using the IBM SPSS Statistics software package. Confidence intervals (CI) were calculated using the continuity-corrected Wilson method.

    Results and discussion

    A total of 5893 participants, with a mean age of 59.0±10.7 years (range: 40 to 94 years) were included in the study to analyze the prevalence of visual impairment causes. Mild visual impairment was detected in 184 participants (3.1%; 95% CI%: 2.7–3.6), moderate to severe visual impairment in 182 participants (3.1%; 95% CI%: 2.7–3.5), and 11 participants were blind (0.19%; 95% CI%: 0.10–0.34).

    Diabetes was diagnosed in 577 patients (11,4%; 95% CI%: 10,5–12,2). DR was observed in 99 patients (1,9%; 95% CI%: 1,6–2,3), with the incidence rate of 17,2 % (95% CI%: 14,1– 20,2). Of this 99, 65 (65.7%) had mild non-proliferative form of DR, 25 (25.3%) – moderate non-proliferative, 5 patients (5.1%) had severe non-proliferative form and 4 (4.0%) – proliferative. Diabetic macular edema was found in 12 (12%) individuals.

    4 participants (0.07%) had moderate to severe visual impairment due to DR, but none were blind. Of the 182 participants with moderate and severe visual impairment in the total sample size, 4 (2,2%) suffered visual impairment due to diabetic retinopathy.

    In the present study, DR ranked sixth among the causes of moderate to severe visual impairment, after cataract (n=109; 59.9%; 95% CI%: 52.7–67.1), late age-related macular degeneration (n=14; 7.7%; 95% CI%: 3.8–11.6); myopic maculopathy (n=11; 6.0%; 95% CI%: 2.6–9.5), glaucoma (n=9; 4.9%; 95% CI%: 1.8–8.1), non-glaucomatous optic nerve damage (n=5; 2.7%; 95% CI%: 0,4–5,1).

    According to a meta-analysis estimating the global number of people blind or visually impaired due to diabetic retinopathy, provided by Vision Loss Expert Group, in 2020, there were approximately 3.28 million people worldwide (95% CI%: 2.41–4.34) with moderate to severe visual impairment due to DR and 1.07 million people (95% CI%: 0.76–1.51) blinded by DR [5]. Thus, in 2020 DR was the cause of blindness in 2,5% of people worldwide (95% CI%: 1.77–3.52), the global prevalence of moderate to severe visual impairment due to DR in persons aged 50 years and older was 0.16% (95% CI%: 0.12–0.21) (Table). The highest prevalence of moderate to severe visual impairment was observed in North Africa and the Middle East (0.41%; 95% CI%: 0.30–0.55) and Latin America and the Caribbean (0.30%; 95% CI%: 0.22–0.40). The lowest rates were found in high-income regions (0.08%; 95% CI%: 0.06–0.11) and in Central and Eastern Europe, Central Asia (0.09%; 95% CI%: 0.07–0.13).

    The global prevalence of blindness due to DR in people aged 50 years and older was 0.05% (95% CI%: 0.03–0.07). The regions with the highest prevalence of DR-related blindness were Latin America and the Caribbean (0.15%; 95% CI%: 0.10–0.21). The lowest prevalence of blindness associated with diabetic retinopathy was found in Central and Eastern Europe and Central Asia (0.01%; 95% CI%: 0.01–0.01]).

    Thus, Ural Eye and Medical Study showed that the number of people with moderate to severe visual impairment due to diabetic retinopathy is comparable to that in high-income countries and lower than in the other regions. The study did not identify any people in the Southern Urals population who were blinded due to diabetic retinopathy.

    Conclusions

    The prevalence rate of moderate and severe visual impairment associated with diabetic retinopathy in the Southern Urals population was 0.07%, which is comparable to global estimates and data obtained from other world regions. None of the study participants were found to be blind due to DR, while global prevalence of DR-related blindness is estimated at 0.05%.

    Информация об авторах

    Сонгромитра Панда-Йонас – доктор Частной клиники профессора Йонаса и Доктора Панда-Йонас, Гейдельберг, Германия, drsjonas@ gmail.com, https://orcid.org/000-00300709-863X

    Низамутдинова Айгуль Маратовна – научный сотрудник отдела офтальмологической и медицинской эпидемиологии, Уфимский НИИ глазных болезней ФГБОУ ВО БГМУ Минздрава России, i-aigul-u@yandex.ru, https://orcid.org/0000-0003-2502-2313

    Борн Руперт – профессор Института исследования зрения и глазных болезней, Университет Англия Раскин, Кембридж, Англия, eyesecretary.cpm@gmail.com, https://orcid.org/0000-0002-8169-1645

    Йонас Йост Бруно – профессор, Госпиталь Фонда Ротшильда, Институт близорукости, Париж, Франция, jost.jonas@medma.uniheidelberg.de, https://orcid.org/0000-0003-2972-5227

    Аuthor’s сontribution:

    Panda-Jonas S. – writing, review & editing, methodology, investigation.

    Nizamutdinova A.M. – writing – original draft, review & editing.

    Bourne R. – writing, review & editing, validation, supervision, resources, project administration, methodology, investigation, conceptualization.

    Jonas J.B. – writing, review & editing, validation, methodology, investigation, formal analysis, data curation, conceptualization.

    Вклад авторов:

    Панда-Йонас С. – написание, рецензирование и редактирование, методология, исследование.

    Низамутдинова А.M. – написание оригинального текста, рецензирование и редактирование.

    Борн Р. – написание, рецензирование и редактирование, валидация, администрирование проекта, методология, исследования, концепция и дизайн исследования.

    Йонас Й.Б. – написание, рецензирование и редактирование, валидация, методология, исследование, формальный анализ, обработка данных, концепция и дизайн исследования.

    Financial transparency: Аuthors have no financial interest in the submitted materials or methods.

    Финансирование: Авторы не получали конкретный грант на это исследование от какого-либо финансирующего агентства в государственном, коммерческом и некоммерческом секторах.

    Conflict of interest: Тhere is no conflict of interest.

    Конфликт интересов: Отсутствует.

    Поступила: 15.04.2025

    Переработана: 29.04.2025

    Принята к печати: 30.05.2025

    Originally received: 15.04.2025

    Final revision: 29.04.2025

    Accepted: 30.05.2025

    Information about the authors

    Songhomitra Panda-Jonas – doctor, Privatpraxis Prof Jonas und Dr.

    Panda-Jonas, Heidelberg, Germany, drsjonas@gmail.com, https://orcid.org/000-00300709-863X

    Aigul M. Nizamutdinova – scientific researcher of the Department of Ophthalmological and Medical Epidemiology, Ufa Eye Research Institute, i-aigul-u@yandex.ru, https://orcid.org/0000-0003-2502-2313

    Bourne Rupert – professor, Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, England, eyesecretary. cpm@gmail.com, https://orcid.org/0000-0002-8169-1645

    Jost B. Jonas – professor, Rothschild Foundation Hospital, Institute of Myopia, Paris, France, jost.jonas@medma.uni-heidelberg.de, https://orcid.org/0000-0003-2972-5227