Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia.
Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia.
Ophthalmology. 2017 Jul;124(7):977-984. doi: 10.1016/j.ophtha.2017.02.004. Epub 2017 Mar 15.
To determine the prevalence of and factors associated with diabetic retinopathy (DR) among non-Indigenous and Indigenous Australian adults with self-reported diabetes.
Population-based cross-sectional study.
Non-Indigenous Australians (50-98 years of age) and Indigenous Australians (40-92 years of age) with known diabetes.
Diabetes was determined based on self-report of previous diagnosis of the disease. Nonmydriatic fundus photographs were obtained of each eye and graded according to the modified Airlie House classification system.
Any DR, vision-threatening DR (VTDR), treatment coverage rates (proportion of participants with proliferative DR [PDR], clinically significant macular edema [CSME], or both who had evidence of retinal scatter and focal laser treatment).
Four hundred thirty-one non-Indigenous Australians (13.9%) and 645 Indigenous Australians (37.1%) self-reported diabetes, of whom 93% (1004/1076) had retinal images that were gradable for DR. The sampling weight-adjusted prevalence of any DR and VTDR among non-Indigenous adults with self-reported diabetes was 28.5% (95% confidence interval [CI], 22.6-35.3) and 4.5% (95% CI, 2.6-7.9), respectively. Among adults 40 years of age and older, the sampling weight-adjusted prevalence of any DR and VTDR was 39.4% (95% CI, 33.1-46.1) and 9.5% (95% CI, 6.8-13.1), respectively. Longer diabetes duration was associated significantly with VTDR in the Indigenous Australian population (odds ratio [OR], 1.08 per 1-year increase; P = 0.005) and non-Indigenous Australian population (OR, 1.05 per 1-year increase; P = 0.03). The treatment coverage of PDR and CSME was 75% (56/75) in Indigenous Australians and 79% (15/19) in non-Indigenous Australians. Diabetic retinopathy was attributed as the main cause of vision loss (<6/12 in the better eye) in 9% and 19% of non-Indigenous and Indigenous Australian adults with known diabetes, respectively.
Three quarters of non-Indigenous and Indigenous Australian adults with PDR or CSME have received laser treatment. The prevalence of VTDR in Indigenous and non-Indigenous Australians in the present study was lower than that found in previous population-based reports, nevertheless, approximately 1 in 10 Indigenous adults with known diabetes experience VTDR. This highlights that intensified prevention strategies are required to delay or prevent avoidable vision loss resulting from DR in Indigenous Australian communities.
确定报告患有糖尿病的非土著和土著澳大利亚成年人中糖尿病性视网膜病变（DR）的流行情况及其相关因素。
基于人群的横断面研究。
年龄在 50-98 岁之间的非土著澳大利亚人（50-98 岁）和年龄在 40-92 岁之间的土著澳大利亚人（40-92 岁）。
根据以前对疾病的诊断来确定糖尿病。对每只眼睛进行非散瞳眼底照相，并根据改良的 Airlie House 分类系统进行分级。
任何 DR、威胁视力的 DR（VTDR）、治疗覆盖率（增殖性 DR [PDR]、临床显著黄斑水肿 [CSME] 或两者均有视网膜散射和局灶性激光治疗证据的参与者比例）。
431 名非土著澳大利亚人（13.9%）和 645 名土著澳大利亚人（37.1%）自我报告患有糖尿病，其中 93%（1004/1076）的视网膜图像可进行 DR 分级。报告患有糖尿病的非土著成年人中任何 DR 和 VTDR 的抽样权重调整后患病率分别为 28.5%（95%可信区间[CI]，22.6-35.3）和 4.5%（95% CI，2.6-7.9）。在 40 岁及以上的成年人中，任何 DR 和 VTDR 的抽样权重调整后患病率分别为 39.4%（95% CI，33.1-46.1）和 9.5%（95% CI，6.8-13.1）。在土著澳大利亚人群中，糖尿病病程延长与 VTDR 显著相关（优势比[OR]，每增加 1 年增加 1.08；P=0.005）和非土著澳大利亚人群（OR，每增加 1 年增加 1.05；P=0.03）。PDR 和 CSME 的治疗覆盖率在土著澳大利亚人为 75%（56/75），在非土著澳大利亚人为 79%（15/19）。糖尿病性视网膜病变是导致已知糖尿病的非土著和土著澳大利亚成年人视力丧失（较好眼视力<6/12）的主要原因，分别占 9%和 19%。
四分之三的 PDR 或 CSME 非土著和土著澳大利亚成年人已接受激光治疗。本研究中土著和非土著澳大利亚人中 VTDR 的患病率低于以前基于人群的报告，但仍有约 10%的已知患有糖尿病的土著成年人患有 VTDR。这表明需要加强预防策略，以延缓或预防因 DR 导致的土著澳大利亚社区中可避免的视力丧失。
