Webb Elizabeth M, Rheeder Paul, Roux Polla
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Ophthalmologica. 2016;235(3):141-9. doi: 10.1159/000443972. Epub 2016 Mar 10.
The aim of the study was to determine the prevalence of diabetic retinopathy, maculopathy and visual loss in primary care patients and to identify associated risk factors.
We conducted a cluster randomised trial at primary care clinics in the Tshwane district in South Africa. Grades of retinopathy and maculopathy (with fundus camera) and visual acuity (Snellen chart) were assessed and, using mobile screening and teleophthalmology, clinical and biochemical testing was conducted to obtain information about glycaemic control and microvascular complications.
The prevalence rates for any retinopathy, preproliferative retinopathy and proliferative retinopathy were 24.9, 19.5 and 5.5%, respectively. The prevalence rates of diabetic maculopathy, observable maculopathy and referable maculopathy were 20.8, 11.8 and 9.0%, respectively. The presence of retinopathy was associated with high body mass index, systolic blood pressure, being on insulin treatment, high HbA1c and the presence of neuropathy. High systolic blood pressure, being on insulin treatment, high HbA1c level and high low-density lipoprotein cholesterol level as well as the presence of albuminuria were significant in predicting any diabetic maculopathy. Laser photocoagulation was given to 8.3% of patients from the mobile unit and 12% of patients were referred to the nearest hospital with an outpatient eye clinic for follow-up treatment of various other eye conditions. Using the WHO categories, the study found that 78.1% of diabetes patients had normal vision, 19.3% were visually impaired and 2.2% were severely impaired or blind.
High prevalence rates for diabetic retinopathy, maculopathy and visual loss were found and associations were identified.
本研究旨在确定初级保健患者中糖尿病视网膜病变、黄斑病变和视力丧失的患病率，并识别相关危险因素。
我们在南非茨瓦内地区的初级保健诊所进行了一项整群随机试验。评估视网膜病变和黄斑病变的分级（使用眼底照相机）以及视力（斯内伦视力表），并通过移动筛查和远程眼科进行临床和生化检测，以获取有关血糖控制和微血管并发症的信息。
任何视网膜病变、增殖前期视网膜病变和增殖性视网膜病变的患病率分别为24.9%、19.5%和5.5%。糖尿病黄斑病变、可观察到的黄斑病变和可转诊的黄斑病变的患病率分别为20.8%、11.8%和9.0%。视网膜病变的存在与高体重指数、收缩压、接受胰岛素治疗、高糖化血红蛋白以及神经病变的存在有关。高收缩压、接受胰岛素治疗、高糖化血红蛋白水平、高低密度脂蛋白胆固醇水平以及蛋白尿的存在对于预测任何糖尿病黄斑病变具有重要意义。移动单位为8.3%的患者进行了激光光凝治疗，12%的患者被转诊至最近的设有眼科门诊的医院，以便对各种其他眼部疾病进行后续治疗。根据世界卫生组织的分类，研究发现78.1%的糖尿病患者视力正常，19.3%的患者视力受损，2.2%的患者严重受损或失明。
研究发现糖尿病视网膜病变、黄斑病变和视力丧失的患病率较高，并确定了相关关联。
