Diabetic Retinopathy: Epidemiology
Prof S. Resnikoff MD PhD
ICO Director of Eye Care Delivery - Geneva
BHVI - Sydney
2nd International Course in Visual Health
February 14th – 15th, 2020, Querétaro
Outline
1. Epidemiology of Diabetes
2. Risk factors for developing DR and complications
3. Burden: absolute numbers and prevalence trends
4. Morbidity vs Disability
5. Estimating magnitude and treatment needs
Diabetes MellitusNo Diabetic Retinopathy
without Diabetes Mellitus
463 million people living with Diabetes (2019)
IDF Atlas 2019
Prevalence of Diabetes (age-standardized, 2019)
IDF Atlas 2019
Risk Factors for DR and complications
• Type 1 Diabetes >>> Type 2 Diabetes
• Risk of PDR x 15
• Risk of DME x 5
• Ethnicity:
• Highest Risk: Afro-Americans
• Lowest Risk: Asians
• Diabetes duration (especially > 20yrs)
• Hyperglycemia HbA1C
• Hypertension
• Dyslipidemia
RE
Other
AMD
Glaucoma
CODR
Tra
RE
Other
AMD
Glaucoma CODR Tra
RE
Other
AMD
Glaucoma
CODR Tra
Cataract Cataract Cataract
Blindness
(PVA < 0.05)
Mod. & Severe VI
(PVA 0.3 – 0.05)
Visual Impairment
(PVA < 0.3)
Diabetic Retinopathy: 6rd cause of Blindness
and Visual Impairment (World, 2015)
2.2% 1.5%1.3%
0.8 Million 2.9 Million 3.7 Million
Probably Underestimated because of survey methodology
Prevalence of VI due to DR
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
1990 1995 2000 2005 2010 2015 2020
Trends 1990 – 2020
CE Eur HIC LAC NAME
SA WP SSA Wolrd
China
World
Eastern EU
HIC
S. Asia
Lat Am
-100% -50% 0% 50% 100%
Cat
DR
AMD
Other
Glau
RE
CO
Tra
Changes in Prevalence 1990 - 2020
DR
Morbidity: people having DR (any stage)
• Global estimate: 160 million people (aged 20 -
70) with any stage of Diabetic Retinopathy in
2020*
Yau JWY et al.. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care, 2012
Vision Impaired
3.7 Million (2%)
Estimating DR magnitude
Prevalence among people with Diabetes:
• Any DR = 35.4%
• Vision Threatening DR = 11.7%
• Proliferative DR (PDR) = 7.2%
• Macular Oedema (DME) = 7.5%
* Yau JW, Rogers SL, Kawasaki R, et al.
Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. Mar 2012;35(3):556-564.
Estimating DR magnitude in Mexico
Estimated number of patients in Mexico (Prev: 15.2%):
• Any DR: 12.8 million DM x 35.4% = 4.5 million
• Vision Threatening DR: 12.8 x 11.7% = 1.5 million
• Proliferative DR (PDR): 12.8 x 7.2% = 900,000
• Macular Oedema (DME): 12.8 x 7.5% = 960,000
Yau JWY, et al. 2012 and IDF Atlas 2019
13 million patients to screen/year
1.5 million chronic care patients to manage