Thomas R L, John Rebecca, Bunce Catey, Xing Wen, Zekite Antra, Flanagan Declan, Williams Gwyn Samuel, Reynolds Rhianon, Owens David
Diabetes Resaerch Unit, Cymru, Swansea University, Swansea, UK
NHS Wales Shared Services Partnership, Cardiff, UK.
BMJ Open. 2025 Jan 21;15(1):e090597. doi: 10.1136/bmjopen-2024-090597.
This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor.
Retrospective database analysis.
England and Wales.
Individuals certified as SI or SSI.
Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy.
Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment.
In England, from 2010 to 2020, there was a small but significant reduction (p<0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100 000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100 000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100 000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100 000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100 000 by 2016/2017 before increasing to 55.5 per 100 000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period.
The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. Continuing attempts to limit the incidence of vision impairment due to diabetic retinopathy remain a priority.
本研究旨在报告2010年至2020年期间，即新冠疫情之前，英格兰和威尔士视力损害（SI）和严重视力损害（SSI）认证的趋势。重点关注糖尿病性视网膜病变/黄斑病变这一关键致病因素。
回顾性数据库分析。
英格兰和威尔士。
被认证为SI或SSI的个体。
英格兰和威尔士因任何原因导致的视力损害认证趋势，特别关注糖尿病性视网膜病变。
记录英格兰和威尔士眼科医生做出的视力损害认证，并将副本发送至摩尔菲尔兹眼科医院进行流行病学分析。对2009年4月至2020年3月这11年间在英格兰和威尔士完成的所有证书进行年度查询和分析。该分析涵盖所有原因，包括主要原因是糖尿病眼病或糖尿病眼病是多种病理中的一个促成原因的情况。采用泊松回归分析视力损害认证趋势随时间的变化。
在英格兰，2010年至2020年期间，因任何原因导致的SI和SSI总体认证率有小幅但显著的下降（p<0.001），从每10万人43.4次认证降至每10万人41.7次认证。相反，在威尔士，最初观察到下降，从2009/2010年的每10万人50.6次降至2014/2015年的每10万人40.1次。到2019/2020年，该比率随后增至每10万人51.8次；然而，这在统计学上不显著（p=0.087）。威尔士的个体认证率比英格兰高9%（1.09（95%可信区间1.07，1.10））。对于糖尿病性视网膜病变，在研究期间，英格兰的认证率从每10万人72.8次显著降至41.3次；在威尔士，认证率最初从每10万人82.3次降至2016/2017年的47.1次，然后在2019/2020年增至每10万人55.5次。尽管有这种波动，但研究期间威尔士因糖尿病性视网膜病变导致的认证显著减少。
研究结果强调了了解认证率区域差异的重要性，特别是在糖尿病性视网膜病变的背景下。尽管威尔士有波动，但两个地区因糖尿病性视网膜病变导致的认证总体减少表明，迫切需要持续开展公共卫生举措，以预防与糖尿病相关的视力损害。然而，为了真实反映视力损害负担及其各种原因，确保所有符合条件的人都获得认证是一个前提条件。持续努力限制糖尿病性视网膜病变导致的视力损害发生率仍然是一个优先事项。
