Association Between the Severity of Diabetic Retinopathy and Falls in an Asian Population With Diabetes: The Singapore Epidemiology of Eye Diseases Study.

Gupta P ，Aravindhan A ，Gand ATL ，Man REK ，Fenwick EK ，Mitchell P ，Tan N ，Sabanayagam C ，Wong TY ，Cheng CY ，Lamoureux EL ... -  《-》

Ethnic Differences in the Prevalence and Risk Factors of Diabetic Retinopathy: The Singapore Epidemiology of Eye Diseases Study.

To evaluate the prevalence and risk factors for diabetic retinopathy (DR) in the Singapore Epidemiology of Eye Diseases (SEED) Study. Population-based, cross-sectional study. Persons of Malay, Indian, and Chinese ethnicity aged 40+ years, living in Singapore. Diabetes was defined as nonfasting plasma glucose ≥200 mg/dl (11.1 mmol/l), glycated hemoglobin A1c (HbA1c) >6.5%, self-reported physician-diagnosed diabetes, or the use of glucose-lowering medication. Retinal photographs, were graded for the presence and severity of DR using the modified Airlie House classification system. Diabetic retinopathy, diabetic macular edema (DME), vision-threatening diabetic retinopathy (VTDR), defined as the presence of severe nonproliferative or proliferative DR, or clinically significant macular edema (CSME). Of the 10 033 subjects, 2877 (28.7%) had diabetes and gradable photographs for analysis. The overall age-standardized prevalence (95% confidence interval [CI]) was 28.2% (25.9-30.6) for any DR, 7.6% (6.5-9.0) for DME, and 7.7% (6.6-9.0) for VTDR. Indians had a higher prevalence of any DR (30.7% vs. 26.2% in Chinese and 25.5% in Malays, P = 0.012); a similar trend was noted for any DME (P = 0.001) and CSME (P = 0.032). Independent risk factors for any DR were Indian ethnicity (odds ratio [OR], 1.41; 95% CI, 1.09-1.83, vs. Chinese), diabetes duration (OR, 1.10; 95% CI, 1.08-1.11, per year), HbA1c (OR, 1.25; 95% CI, 1.18-1.32, per %), serum glucose (OR, 1.03; 95% CI, 1.00-1.06, per mmol/l), and systolic blood pressure (OR, 1.14; 95% CI, 1.09-1.19, per 10 mmHg). Diastolic blood pressure (OR, 0.74; 95% CI, 0.65-0.84, per 10 mmHg increase), total cholesterol (OR, 0.87; 95% CI, 0.80-0.95, per mmol/l increase), and low-density lipoprotein (LDL) cholesterol (OR, 0.83; 95% CI, 0.74-0.92, per mmol/l increase) were associated with lower odds of any DR. Risk factors were largely similar across the 3 ethnic groups. Indian Singaporeans have a higher prevalence of DR and DME compared with Chinese and Malays. Major risk factors for DR in this study were similar across the 3 ethnic groups. Addressing these risk factors may reduce the impact of DR in Asia, regardless of ethnicity.

Tan GS ，Gan A ，Sabanayagam C ，Tham YC ，Neelam K ，Mitchell P ，Wang JJ ，Lamoureux EL ，Cheng CY ，Wong TY ... -  《-》

Prevalence and determinants of undiagnosed diabetic retinopathy and vision-threatening retinopathy in a multiethnic Asian cohort: the Singapore Epidemiology of Eye Diseases (SEED) study.

To determine the prevalence and risk factors of undiagnosed diabetic retinopathy (DR), in particular vision-threatening DR (VTDR) in a multiethnic Asian cohort. A population-based survey of 3353 Chinese, 3280 Malays and 3400 Indians (73.6% response) aged 40-80 years residing in Singapore. Diabetes mellitus (DM) was defined as random glucose ≥11.1 mmol/L, use of diabetic medication or a previous physician diagnosis. DR severity was graded from retinal photographs following the modified Airlie House classification. VTDR was defined as the presence of severe non-proliferative DR (NPDR), proliferative DR (PDR) or clinically significant macular oedema (CSMO), using the Eye Diseases Prevalence Research Group definition. Participants were deemed 'undiagnosed' if they reported no prior physician diagnosis in structured interviews, in those with the condition. Of 10 033 participants, 2376 had DM (23.7%), of which 805 (33.9%) had DR. Among 2376 with DM, 11.1% (n=263) were undiagnosed. Among 805 with DR, 671 (83.3%) were undiagnosed. Among 212 with VTDR, 59 (27.3%) were undiagnosed. In multivariate models, factors associated with undiagnosed VTDR were higher low-density lipoprotein (LDL) cholesterol (OR=1.53, 95% CI 0.99 to 2.35, p=0.05) and absence of visual impairment or blindness in any eye in terms of best-corrected vision OR=3.00, 95% CI 1.47 to 6.11, p=0.003). In this community, a quarter with VTDR is undiagnosed, and 8 in 10 with any DR are undiagnosed, compared with only 1 in 10 with DM undiagnosed. These findings suggest that screening for diabetes is successful, while screening for DR is currently inadequate in our population. Public health strategies to aid early diagnosis of DR in Singapore are urgently warranted to reduce blindness due to diabetes.

Huang OS ，Tay WT ，Ong PG ，Sabanayagam C ，Cheng CY ，Tan GS ，Cheung GC ，Lamoureux EL ，Wong TY ... -  《-》

Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes.

Man REK ，Fenwick EK ，Gan ATL ，Sabanayagam C ，Gupta P ，Aravindhan A ，Wong TY ，Tan GSW ，Lamoureux EL ... -  《-》

Are myopic eyes less likely to have diabetic retinopathy?

Eyes with myopia may be less likely to develop diabetic retinopathy (DR). The relationship between refractive error, ocular biometry, and DR therefore was investigated. Population-based, cross-sectional study. Persons with diabetes from the Singapore Malay Eye Study (SiMES). Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Spherical equivalent refraction (SE) was assessed using an autokeratorefractometer and subjective refraction. Axial length (AL) and anterior chamber depth (ACD) were measured by IOLMaster (Carl Zeiss Meditec AG, Jena, Germany). Diabetic retinopathy was graded from retinal photographs. Any DR was defined by characteristic lesions defined by the Early Treatment Diabetic Retinopathy Study (ETDRS); moderate DR by ETDRS retinopathy severity scores of 43 or higher; and vision-threatening retinopathy by severe nonproliferative retinopathy, proliferative DR, or clinically significant macular edema. Of 3280 adult Malay participants (78.7% response), 629 persons with diabetes contributed to this analysis. In multivariate analyses adjusting for age, gender, education, height, cataract, hypertension, hemoglobin A1c, and other factors, eyes with myopic SE were less likely to have any DR (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.84-0.96; P = 0.002, per 1-diopter [D] decrease), moderate DR (OR, 0.83; 95% CI, 0.73-0.93; P = 0.001, per 1-D decrease), and vision-threatening DR (OR, 0.77; 95% CI, 0.67-0.88; P<0.001, per 1-D decrease). Eyes with longer AL were less likely to have any DR (OR, 0.86; 95% CI, 0.75-0.99; P = 0.041, per 1-mm increase), moderate DR (OR, 0.80; 95% CI, 0.62-1.05; P = 0.11, per 1-mm increase), and vision-threatening DR (OR, 0.63; 95% CI, 0.40-0.99; P = 0.044, per mm increase). Eyes with deeper ACD were less likely to have moderate DR (OR, 0.32; 95% CI, 0.16-0.64; P = 0.001, per 1-mm increase) and vision-threatening DR (OR, 0.14; 95% CI, 0.06-0.36; P = 0.001, per 1-mm increase). Myopic refraction and longer AL are associated with a lower risk of DR, particularly vision-threatening retinopathy, without any evidence of a threshold.

Lim LS ，Lamoureux E ，Saw SM ，Tay WT ，Mitchell P ，Wong TY ... -  《-》