Willis Jeffrey R, Doan Quan V, Gleeson Michelle, Haskova Zdenka, Ramulu Pradeep, Morse Lawrence, Cantrell Ronald A
UC Davis Eye Center, University of California, Davis, Sacramento.
Genentech Inc, South San Francisco, California.
JAMA Ophthalmol. 2017 Sep 1;135(9):926-932. doi: 10.1001/jamaophthalmol.2017.2553.
Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden.
To assess the functional burden of DR across severity levels in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017.
Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks.
Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95% CI, 1.29-10.05; P = .02). Those with severe NPDR or PDR did not have a statistically significant greater odds of vision-related functional burden than did those with mild or moderate NPDR (aOR, 2.70; 95% CI, 0.93-7.78; P = .07).
Among US adults with diabetes, approximately half of those with severe NPDR or PDR had difficulty with at least one visual function task. Moreover, vision-related functional burden was significantly greater among those with severe NPDR or PDR than among those with no retinopathy. These data suggest the importance of preventing severe forms of DR to mitigate the vision-related functional burden among US adults with diabetes. Future studies should complement our study by assessing the association of worsening retinopathy with objectively measured functional outcomes.
在美国患有糖尿病的成年人中，严重形式的糖尿病性视网膜病变（DR）与更大的视力相关功能负担显著相关。
评估美国不同严重程度的DR的功能负担。
设计、设置和参与者：这项横断面研究基于美国国家健康与营养检查调查（NHANES）（2005 - 2006年和2007 - 2008年）中1004名40岁及以上患有糖尿病且有有效眼部和社会人口统计学结果的参与者。糖尿病性视网膜病变基于眼底照片分级，采用早期治疗糖尿病性视网膜病变研究严重程度量表。分析于2016年10月15日至2017年6月15日进行。
在家庭问卷调查中评估视力导致的功能困难，参与者自行报告在阅读、视觉空间任务（即近距离工作或在拥挤货架上找东西）、行动能力（即下台阶、楼梯或路缘）和驾驶方面的困难。主要结局指标是视力相关功能负担，定义为在上述任何一项任务中报告有中度或更大困难的个体。
在本研究分析的1004名糖尿病患者中（平均年龄65.7岁[95%CI，64.0 - 67.3岁]；男性51.1%[95%CI，47.1 - 55.2]，女性48.9%[95%CI，44.8 - 52.9]），无视网膜病变的患病率为72.3%，轻度和中度非增殖性糖尿病性视网膜病变（NPDR）的患病率为25.4%，重度NPDR或增殖性糖尿病性视网膜病变（PDR）的患病率为2.3%。无视网膜病变者视力相关功能负担的患病率为20.2%（95%CI，16.3% - 24.1%），轻度和中度NPDR者为20.4%（95%CI，15.3% - 27.8%），重度NPDR或PDR者为48.5%（95%CI，25.6% - 71.5%）（P = 0.02）。在多变量分析中，重度NPDR或PDR者相对于无视网膜病变者，视力相关功能负担的几率显著更高（调整后的优势比[aOR]，3.59；95%CI，1.29 - 10.05；P = 0.02）。重度NPDR或PDR者与轻度或中度NPDR者相比，视力相关功能负担的几率在统计学上没有显著更高（aOR，2.70；95%CI，0.93 - 7.78；P = 0.07）。
在美国患有糖尿病的成年人中，重度NPDR或PDR患者中约有一半在至少一项视觉功能任务上存在困难。此外，重度NPDR或PDR患者的视力相关功能负担明显高于无视网膜病变者。这些数据表明预防严重形式的DR对于减轻美国患有糖尿病的成年人的视力相关功能负担的重要性。未来的研究应通过评估视网膜病变恶化与客观测量的功能结局之间的关联来补充我们的研究。
