Survey of diabetic retinopathy evaluation and progression

Anjali Patil¹, Sagar Petkar^2*, D K Sindal³, V H Karambelkar⁴

¹Assistant Professor,²Jr. Resident, ³Professor and HOD, ⁴Professor, Krishna institute of Medical sciences deemed university, Karad, malakapur, Satara, Maharashtra, INDIA.

Email: petkarsaagar@yahoo.in

Abstract            Objectives: 1) To study age and sex distribution in diabetic population. 2) To study association between duration of “Diabetes Mellitus” and “Diabetic Retinopathy.” Result: 1) Maximum number of Patients were in the 41 to 60 Years age group. 2) In case group male to female ratio is 3.4:1 3) Number of Cases of NIDDM with duration more than 5 years shown to have maximum chance of DR.

Keywords: diabetes, diabetic retinopathy, hard exudates.

INTRODUCTION

Diabetes Mellitus is a disease as old man kind itself and is a major health care challenge not only in developed countries, but also in developing nations. The chronic nature of diabetes and its tendency to affect various target organs, has led some people to rightfully call it a “Disease of Complications”¹ Diabetes Mellitus is associated with damage to small blood vessels in the retina resulting in changes within the retina, in front of retina and within the vitreous cavity resulting in loss of vision.² Diabetic Retinopathy is now the most common cause of legal blindness in individuals between the ages of 22 to 65 years. Twenty years after the onset of diabetes nearly all patients with type I and more than 60% of those with Type II will have retinopathy. The risk of developing blindness from diabetic retinopathy increases with the duration of diabetes.² Early treatment using laser photocoagulation has been shown to reduce blindness due to diabetic retinopathy by at least 60% and figure will improve further, as patients at risk are identified early, the earlier the better. Also the early treatment with focal photocoagulation for CSME reduces the risk of severe visual loss and increase the chances of visual improvement, decrease the frequency of persistent macular oedema and causes only minor visual field defect.²

MATERIALS AND METHODS

Study Design

This is a hospital based case control study.

Inclusion Criteria

1. Patients diagnosed with diabetes mellitus
2. Patients giving consent to be the part of the study

Exclusion Criteria

1. Patients not giving consent to be the part of the study.
2. Patients diagnosed with hypertension.
3. Patients with chronic kidney disease.

Methodology

A standard clinical proforma was used in all cases with salient points in history, clinical features, anterior segment examination on torch light and slit lamp, dilated fundus examination by indirect ophthalmoscopy and on the slit lamp using 90D and 78D lenses. Fasting and post prandial blood sugar levels were also obtained.

Statistical test: Chi square test.

OBSERVATIONS AND RESULT

Table 1: Age wise distribution of 300 Patients in study Population

X²= 6.84                   P <0.001                  df =4

Maximum number of Patients were in the 41 to 60 years age group.

Table 2: Distribution of sex in study Population

     X²= 0.017                            df = 1

The study group of patients visiting to Retinal Clinic referred by Ophthalmalogists and Physicians comprised of 112 males and 38 females in control group and 116 males and 34 females in case groups. In case group male to female ratio is 3.4:1

Table 4: Duration of NIDDM in control group and case group

X²= 3.85                   P<0.5                       df =1

Number of Cases of NIDDM with duration more than 5 years shown to have maximum chance of DR.

DISCUSSION

Diabetes is acommon metabolic disorder. It affects approximately 12 million people at all ages and is a major cause of legal blindness (in United States, now in developing countries as well), end stage renal disease, cardiovascular disease and peripheral neuropathies.³.The present study was carried out on the patients attending retinal clinic at Prathamesh Laser Center, Miraj and included 150 patients with diabetes but no evidence of diabetic retinopathy (Control group) and 150 patients with one or both eyes having diabetic retinopathy (Case Group). In our study, we examined patients verying from 14 years to 80 years of Age. Table No.1 shows, Maximum number of patients having diabetic retinopathy were from group 40 to 60 years. Thus our study correlates with the study of Ricky Sharma form Arvind Eye Hospital, in which mean age of patients was 55.4 years.(2) Importance is given to the age because macular disease in general is more common in older age groups so also the proliferative retinopathy.⁴ Table No.2 Shows that more number of males had diabetic retinopathy than females. In Ricky Sharma’s study also, the number of male patients (61.6%) exceeded the female patients (38.4%). However, why male patients tend to fare more badly is not clear. Hormonal, Genetic, social or Psychological factors may contribute to this increased risk.⁴ Duration of diabetes is pre dominant factor in determining the prevalence of both non proliferative retinopathy and proliferative retinopathy, and age of onset is subordinate.⁵ Also it is important determinant for predicting relative risk of acquiring diabetic complications, Kanski, also mentioned duration of diabetes as one of the risk factor for diabetic retinopathy. Highest prevalence of retinopathy is among patients with Type I diabetes. However, in our study, as number of patients with Type I diabetes were very few⁶ test of significance could not be applied and hence they were not considered separetly further. But Table No.3 shows that maximum number of patients with duration more than five years had retinopathy.

SUMMARY AND CONCLUSION

Diabetic eye disease is becoming an increasing problem in developing countries, due to longer life expectancy and higher incidence of diabetes. The use of photocoagulation to treat diabetic retinopathy has gained widespread acceptance in ophthalmic practice since its introduction in 1959 by Meyer Schwickerath. Majority of patients were male and from age group 40-60 years, maximum number of patients with duration more than five years had retinopathy.

REFERENCES

1. Levin, H.E, O’ Neal L. Diabetic foot 4^th Edn. 1988 St. Louis, Mosby.
2. Community Eye Health, An Internation Journal to promote eye health worldwide. Vol.9 Issue No.20, 1996.
3. Bridges, Jr. R.M. Deitch, E.A. Pathophysiology and treatment. Diabetic foot infants.
4. H.J. Bodansky, A.G. Cudworth et al, Diabetic Retinopathy and its relation to type of diabetes: Review of a retinal clinic population.
5. Bengt Jerneld, M.D. and Peep Algere, M.D. Relationships of duration and onset of diabetes to prevalence of diabetic retinopathy.
6. Cordeizo, M.F, et al. Relationship of diabetic micro vascular complications to outcome in preretinal photocoagulation treatment of proliferative diabetic retinopathy. Eye 11(Pt 4): 531-536, 1997.




 

 

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