Huang Olivia S, Tay Wan Ting, Ong Peng Guan, Sabanayagam Charumathi, Cheng Ching-Yu, Tan Gavin S, Cheung Gemmy C M, Lamoureux Ecosse L, Wong Tien Y
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore Center for Eye Research Australia, University of Melbourne, Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia.
Br J Ophthalmol. 2015 Dec;99(12):1614-21. doi: 10.1136/bjophthalmol-2014-306492. Epub 2015 May 7.
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.
确定未诊断的糖尿病视网膜病变（DR），尤其是在一个多民族亚洲队列中威胁视力的DR（VTDR）的患病率和危险因素。
对居住在新加坡的3353名华人、3280名马来人和3400名印度人（应答率73.6%）进行基于人群的调查，年龄在40 - 80岁。糖尿病（DM）定义为随机血糖≥11.1 mmol/L、使用糖尿病药物或既往医生诊断。根据改良的艾利屋分类法，从视网膜照片中对DR严重程度进行分级。VTDR定义为存在严重非增殖性DR（NPDR）、增殖性DR（PDR）或临床显著性黄斑水肿（CSMO），采用眼病患病率研究组的定义。在结构化访谈中，若参与者报告无既往医生诊断，则被视为“未诊断”。
在10033名参与者中，2376人患有DM（23.7%），其中805人（33.9%）患有DR。在2376名患有DM的人中，11.1%（n = 263）未被诊断。在805名患有DR的人中，671人（83.3%）未被诊断。在212名患有VTDR的人中，59人（27.3%）未被诊断。在多变量模型中，与未诊断的VTDR相关的因素是低密度脂蛋白（LDL）胆固醇水平较高（OR = 1.53，95%CI 0.99至2.35，p = 0.
