Abstract

Introduction: Diabetic eye disease is a leading cause of vision loss in persons aged 20 to 74 years.¹Diabetic retinopathy is the most common microvascular complication of diabetes ², and can be broadly divided into two clinical stages: non proliferative (NPDR) and proliferative diabetic retinopathy (PDR). Diabetic macular edema (DME) is the leading cause of visual loss and legal blindness³ in people with diabetes mellitus affecting up to 15% of patients 15 years after diagnosis. ⁴Despite the significance of this problem, and the rising prevalence of diabetes , notably in emerging Asian countries such as India and China^5,6 there are few precise contemporary estimates of the worldwide prevalence of DR, particularly severe vision-threatening stages of the disease, including PDR and DME.

Materials and Methods: It was a cross sectional observational study where 300 cases of pre -diagnosed Diabetes with retinopathy, attending the ophthalmology OPD with their informed written consent were included in the study. In all the patients clinical examination included assessment of Visual acuity, slit lamp examination, fundus examination with +90 D lens, applanation tonometry, gonioscopy with three mirror gonioscope, direct and indirect ophthalmoscopy, Stereoscopic 30⁰ macula centered photograph (by Carl Zeiss - fundus camera),Cirrus OCT macula.

Result: Out of 600 eyes, a total of 65 (10.8%) eyes were unaffected, 493 (82.2%) were identified as NPDR - of these 225 (45.6%) were graded as minimal NPDR, 152 (25.3%) were graded as mild NPDR (25.3%), 72 (12%) as moderate NPDR, 34 (5.7%) and 10 (1.6%) as severe and very severe NPDR. A total of 37 (6.2%) were graded as PDR – of these 18 (3%) were mild to moderate PDR, 13 (2.2%) were high risk PDR and remaining 6 (1%) were advanced diabetic disease cases. A total of 5 (0.8%) eyes could not be assessed. A total of (20.1%) of females and (29.5%) males had DME, but this association was not found to be significant statistically (p=0.062).Among different age groups prevalence of DME ranged from 11.8% (30-40 years) to 31.9% (40-50 years),but association between age and prevalence of DME was not found to be significant statistically (p=0.156).Among different categories, a significant increase in prevalence of DME was observed with increasing severity of NPDR (p<0.001) with prevalence rates showing an increase from 10.7% to 70% from minimal to very severe NPDR groups. Out of the 300 patients prevalence of DME was 14.0% and 24.3% in NPDR and PDR types. Statistically, this difference was not significant (p=0.226).

Conclusion: The overall prevalence of DME in diabetics with Diabetic Retinopathy is 29%.Prevalence of DME is more in NPDR and increases with severity of NPDR. The prevalence of DME pattern of diffused retinal thickening is most followed by cystoid macular edema and serous retinal detatchment among subjects with diabetic retinopathy.

Keywords: Diabetic retinopathy, diabetes, prevalence, DME.