因糖尿病視網膜病變致盲的全球現況急升


  新研究顯示,因糖尿病視網膜病變(DR)導致的視力缺損情況正在全球增加,糖尿病引起的眼科疾病目前已是常見致盲原因的第5位。
  
  這些研究結果來自於針對1990-2012年間、全球為了「Global Burden of Disease (GBD) Study 2010」進行之人口基礎研究的統合分析,由佛羅里達Nova Southeastern大學眼科視光學院Janet L Leasher醫師等人發表於2016年9月的糖尿病照護期刊。
  
  因糖尿病視網膜病變導致視力不佳的人數,於所有致盲案例與中度到嚴重視力不佳案例中的比率持續上升。
  
  總之,研究人員發現,2010年時,糖尿病視網膜病變影響約39分之一的致盲案例與52分之一的視力不佳案例。
  
  共同作者、英國劍橋Anglia Ruskin大學視力與眼科研究小組副主任/教授Rupert RA Bourne醫師表示,糖尿病引起的視力損失比過去20年增加了三分之二以上,急劇惡化的全球流行糖尿病是必須解決的問題。 
  
  在「Global Burden of Disease Study」這項研究中,眼盲定義為:呈現視敏度低於3/60,中到重度視力不佳定義為:呈現視敏度低於6/18但是大於等於3/60。收集的資料來自澳洲、中歐和西歐、北美、加勒比海、拉丁美洲、大洋洲、南亞、東亞和東南亞的14國。 
  
  2010年時,全球約有3,240萬人眼盲、1億9,100萬人視力不佳,其中,糖尿病視網膜病變影響833,690例的眼盲與370萬例的視力不佳。從1990-2010年,糖尿病視網膜病變引起眼盲的人數增加達將近27%、糖尿病視網膜病變相關的視力不佳人數增加達64%。
  
  按百分比而言,2010年時,所有眼盲案例的2.6%是糖尿病視網膜病變引起,引起1.9%的視力不佳,分別比1990年的2.1%與1.3%增加。2010年時,糖尿病視網膜病變引起的眼盲百分比範圍,從東南亞與大洋洲的小於2%到南拉丁美洲的5.5%以上。
  
  一般來說,歸因於糖尿病視網膜病變的眼盲與視力不佳之百分比,在低收入地區與年輕人口比較低,例如東南亞,在高收入地區與年長人口比較高,包括北美與西歐。
  
  作者們認為,一個可能原因是,低收入地區有較高比率之未治療的白內障或屈光異常相關的視覺障礙,因此減少了歸因於糖尿病視網膜病變的百分比,此外,因為貧窮區域的醫療服務資源有限,糖尿病患可能無法活到發生糖尿病視網膜病變時。
  
  Leasher 醫師指出,而且不幸的是,糖尿病視網膜病變在初期時通常沒有症狀。
  
  她建議,診斷有糖尿病的患者應至少每年進行散瞳健康檢查,並由他們的眼科醫師根據個別狀況提供建議。患者應與其照護者密切合作,以確認控制其血糖值的最佳方法。
  
  整體而言,他們寫道,當務之急是要對歸因於糖尿病視網膜病變的眼盲與視力不佳進行規劃、發展預防糖尿病視網膜病變與後續視力損失的策略。
  這類策略包括:
  * 發展實證基礎、具有成本效益的糖尿病視網膜病變篩檢策略。
  * 改善全身性風險因素控制(例如血糖與血壓)。
  * 增加對於糖尿病相關視網膜病變視力損失之風險的警覺與衛教。
  * 透過雷射治療、玻璃體內類固醇注射、抗VEGF藥物,預防與治療糖尿病相關視網膜病變。
  * 減少糖尿病與糖尿病相關視網膜病變之篩檢與處置、社經因素、醫療基礎設施的區域性差異。
  
  資料來源:http://www.24drs.com/
  
  Native link:Blindness Due to Diabetic Retinopathy Surges Worldwide
  

Blindness Due to Diabetic Retinopathy Surges Worldwide

By Miriam E Tucker
Medscape Medical News

Visual impairment due to diabetic retinopathy (DR) is rising worldwide, and diabetic eye disease is now the fifth most common cause of blindness, new research shows.

The findings, from a meta-analysis of all available population-based studies performed worldwide from 1990 to 2012 for the Global Burden of Disease (GBD) Study 2010, were published in the September 2016 issue of Diabetes Care by Janet L Leasher, OD, of Nova Southeastern University College of Optometry, Fort Lauderdale/Davie, Florida, and colleagues.

The number of people with visual impairment due to DR represents an increasing proportion of all cases of blindness and moderate to severe visual impairment.

In all, the researchers found, DR was responsible in one of every 39 cases of blindness and one of every 52 cases of visual impairment in 2010.

"With the alarming prevalence of vision loss due to diabetes rising more than two-thirds in the past 20 years, the precipitous global epidemic of diabetes must be addressed," said coauthor Rupert RA Bourne, MD, professor and associate director of the Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom, in a press statement.

In the Global Burden of Disease Study, blindness was defined as presenting visual acuity below 3/60 and moderate to severe visual impairment as presenting visual acuity below 6/18 but 3/60 or greater. Data were collected from 14 countries in Australasia, Central and Western Europe, North America, the Caribbean, Latin America, Oceania, and South, East, and Southeast Asia.

In 2010 worldwide, approximately 32.4 million people were blind and 191 million people were visually impaired. Of those, DR was responsible for 833,690 cases of blindness and 3.7 million of visual impairment. From 1990 to 2010, the number of people with DR-induced blindness increased by approximately 27% and the number with DR-related visual impairment by 64%.

By percentage, DR caused 2.6% of all cases of blindness and 1.9% of all visual impairment in 2010, up from 2.1% and 1.3%, respectively, in 1990. The percentage of blindness caused by DR in 2010 ranged from less than 2% in Southeast Asia and Oceania to 5.5% or greater in southern Latin America.

In general, the percentage of blindness and visual impairment attributable to DR was lower in low-income regions with younger populations such as East and Southeast Asia and higher in high-income parts of the world, with older populations, including North America and Western Europe.

A possible reason is that low-income regions may have a higher percentage of untreated cataracts or refractive error–related visual impairment, thereby reducing the proportion attributable to DR, the authors suggest. Also, in regions with poor access to medical services, people with diabetes may not live long enough to experience DR, they point out.

And, "unfortunately, diabetic retinopathy usually does not have any symptoms in the early stages," noted Dr Leasher.

"People diagnosed with diabetes should have a dilated eye health exam at least every year and be advised by their eye care practitioner for their personal situation," she advised. "Patients should work closely with their healthcare provider to determine the best methods to control their blood sugar levels," she added.

Overall, "it is imperative to plan for a greater share of blindness and visual impairment due to DR and to develop strategies to prevent DR and subsequent vision loss," she and her colleagues write.

Such strategies include the following:

  • Develop evidence-based, cost-effective DR screening strategies.

  • Improve systemic risk-factor control (such as glucose and blood pressure).

  • Increase health education and awareness of the risk of DR-related visual loss.

  • Prevent and treat DR through expanded use of laser treatments, intravitreal steroid injections, and anti-VEGF drugs.

  • Reduce regional differences in screening and management of diabetes and DR, socioeconomic factors, and medical infrastructure.

This study was partially funded by the Bill & Melinda Gates Foundation, Fight for Sight, the Fred Hollows Foundation, and the Brien Holden Vision Institute. The authors have no relevant financial relationships.

    
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