Dr Megha Luthra


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Dr Megha Luthra

  1. 1. Epidemiological Correlates of Diabetic Retinopathy- a Study from Dehradun<br />Dr Megha Luthra*, Dr Saurabh Luthra**, Dr Gaurav Luthra** & Dr M C Luthra**<br />*SGRRIM&HS, Dehradun**Drishti Eye Centre, Dehradun<br />
  2. 2. BACKGROUND<br /><ul><li>Diabetes mellitus is a major cause of avoidable blindness in both developing and developed countries. Patients with diabetic retinopathy (DR) are 25 times more likely to become blind than non-diabetics (1).
  3. 3. India has 31.7 million diabetics (2).In the Andhra Pradesh Eye Disease Study (APEDS) of self-reported diabetics, the prevalence of DR was 22.4% (3).In the Chennai Urban Rural Epidemiology Study (CURES), the overall prevalence of DR as 17.6% (4).
  4. 4. After several years of diabetes nearly 100% of IDDM patients and 60% of NIDDM patients develop retinopathy. Average expectancy of a diabetic (40-50 years) is gradually increasing with improved care (5).</li></li></ul><li>OBJECTIVES OF THIS STUDY<br />To find out the prevalence of Diabetes and Diabetic Retinopathy among patients attending retina service in Drishti Eye Centre, Dehradun. <br />To study epidemiological factors associated with DR.<br />
  5. 5. METHODOLOGY<br />This is a clinic-based cross-sectional study<br />All patients attending the retina service of Drishti Eye Centre, Dehradun from July to October 2010 were included.<br /> Diabetic patients were interviewed, examined and investigated for correlates of DR.<br />Data was analyzed with help of spss 10.0 software.<br />Statistical Methods used were percentages and Chi Square Test.<br />
  6. 6. RESULT<br />A total of 732 patients attended the retina service from 16th July to 21st October 2010<br />149 patients (20.3%) had known diabetes out of which 100 (67.1%) showed signs of diabetic retinopathy <br />Variables that are significantly associated with DR include age (4th and 5th decades of life), female sex, very low and very high income, no or high education, high BP, high Cholesterol, longer duration of diabetes (> 5 years), use of insulin, irregular eye screening and unknown glycosylated hemoglobin (HbA1c)<br />
  7. 7. RESULT<br />
  8. 8. RESULT<br />
  9. 9. RESULT<br />
  10. 10. DISCUSSION<br />Hypertension increases the risk and progression of DR. Tight control of blood pressure results in 34% reduction in progression of retinopathy (5).<br />The prevalence and severity of DR increases with increasing age in type 1 DM but not in type 2 DM. There is a direct correlation between the frequency and severity of DR and the duration of DM (6).<br /> Decrease in glycosylated hemoglobin levels was associated with a significant decrease in the progression of DR as well as the incidence of PDR.Intensive diabetic control leads to reduction in the development and progression of all diabetic complications (7,8).<br />A positive correlation exists between serum lipids and risk of DR in type 2 DM. Recently, Gupta et al. have reported reduction in severity by using atorvastatin as an adjunct to macular photocoagulation (9).<br />Although educational attainment was inversely associated with retinopathy in women in the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR), socioeconomic status was not associated with increased risk of worsening of retinopathy. Once the level of glycemia is accounted for, social factors have little or no influence on this complication of diabetes (10).<br />
  11. 11. CONCLUSION<br />The main predictors for DR as affirmed by this study are high BP, high cholesterol, longer duration of disease, use of insulin, irregular eye screenings of diabetics and poor glycaemic control.<br />This provides the major thrust areas for physicians and not just ophthalmologists for prevention of DM <br />
  12. 12.
  13. 13. REFERENCES<br />National society to prevent blindness. In: Visual problems in the US data analysis definition, data sources, detailed data tables, analysis, interpretation. New York: National society to prevent blindness; 1980; 1-46.<br />Wild S, Roglic G, Green A. Global prevalence of diabetes, estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.   <br />Dandona L, Dandona R, Naduvilath TJ. Population based assessment of diabetic retinopathy in an urban population in southern India. Br J Ophthalmol 1999;83:937-40.<br />Rema M, Premkumar S, Anitha B. Prevalence of diabetic retinopathy in urban India: The Chennai Urban Rural Epidemiology Study (CURES) eye study. Invest Ophthalmol Vis Sci 2005;46:2328-33. <br />Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. Diabetic retinopathy: An update. Indian J Ophthalmol [serial online] 2008 [cited 2010 Oct 28];56:179-88.<br />Klein R, Klein BE, Moss SE. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, II: Prevalence and high risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520-6. <br />The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin - dependent diabetes mellitus. N Engl J Med 1993;329:977-86.<br />EDIC research group. Retinopathy and nephropathy in type 1 diabetes patients four years after trial of intensive therapy. N Engl J Med 2000;342:381-9<br />Gupta A, Gupta V, Thapar S, Bhansali A. Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema. Am J Ophthalmol 2004;137:675-82.<br />Klein R, Klein BE, Jensen SC, Moss SE. The relation of socioeconomic factors to the incidence of proliferative diabetic retinopathy and loss of vision. Ophthalmology 1994;101:68-76.  <br />