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Rising DME prevalence in SaudiMyth or Fact
Where are we vs. global prevalence?
HASSAN ALDHIBI
Senior Academic Consultant
Clinical Assistant Professor (KSU)Vitreoretinal & Uveitis
Chief Uveitis Division
KKESH
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The worldwide prevalenceof diabetes
DR
Affects most patients withdiabetes
The risk increases with
duration of diabetes Leading cause of blindness in
working-aged persons
[20 - 74]
0
100
200
300
400
2000 2030
Year
Num
ber(millions)
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Vision loss ispreventable and
treatable
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Definition: Retinal thickening caused by
the accumulation of
intraretinal fluid primarily inthe inner and outer plexiformlayersand causes swellingof the Meller cells[+/- lipoprotein deposits]
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All patients with diabetes areat risk of developing DME
The most common cause ofV L in patients with diabetes
The onset is insidious andpainless
Manifests with blurring ofcentral V A
The severity may range frommild and asymptomatic toprofound loss of vision
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CSME
Clinically Significant Macular Edema
(CSME)DME that was precisely defined by the
Early Treatment Diabetic RetinopathyStudy (ETDRS)
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Klein et al .The long term incidence of macular edema. Ophthalmology.1995
DME incidence over 10-year period
Younger Age Onset Diabetes : 20.1%
Older Age Onset Diabetes : 39.3%
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Older Age Onset DiabetesYounger Age Onset DiabetesDuration of 20
yearsDuration
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Older Age Onset
Years or More)15(Duration
Younger Age Onset
Years or More)10(Duration
PDRModerate/SevereNPDRMild
NPDRPDRModerate/Severe
NPDRMild
NPDR
74.3%63.2%6.3%69.7%20.3%1.7%
Data from Klein et al. Ophthalmology. 1984
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DME within 1 disc diameter of the
fovea 9 % of diabetic population
DME is 5 times as frequent as
PDR as a cause of visual loss
WESDR,1984
Centrill,1984
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Complications
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2,149,690 km2
Estimated population of 27 millionThe saudi nationals comprise an
estimated 16 million people
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1998 EL-Hazmi et al.Eastern Mediterranean Health Journal
IDDM [M/F] 0.23%/0.30%
NIDDM [M/F] 5.63%/4.53%
IGT [M/F] 0.50%/0.72%
> 60 years
NIDDM [M/F] 28.82% / 24.92%
IGT [M/F] 1.60% /3.56%
2004 Al-Nozha et al. 2004, Saudi Medical Journal
23.7%
2010 Al-Baghli et al., Singapore Med. J. 2010 [eastern part of Saudi Arabia] 17.2%
2011 Alqurashi et al., Ann. Saudi Med. 2011
34.1% males
27.6% females
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ShawJE,Sicree RA,Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030.Diabetes Res Clin Pract. 2010
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DR : 30- 31.3 %.SNPDR :31.3% of DM,
PDR :up to 8%
DME : 10.3%
Abu-Elasrar et al . Int Ophthalmol 1998
Khan et al. MEAJO 2010
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Taif Region Survey 2010-2011
3052 with 50 years
DM :29%DR : 35%
17% DR patients at risk of vision loss and
blindness
10% of blindness is 2ry to DR ( 3rd cause of
blindness)
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4-5 million diabetics in
KSA 400.000 patients with
Macular edema
200.000 patients with PDR
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Vision loss ispreventable and
treatable
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Untreated DME
20% to 30% of patients willexperience a doubling of the
visual angle within 3 years
The risk drops by 50% with
current treatments
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Incidence of DME increases with
Elevated levels of Hb A1C
Level of severity of DR
Duration of DM Elevated diastolic blood pressure
Abnormal lipid level
Gender (more frequent in females)
Wisconsin Epidemiologic Study of DR
Klein R et al. Ophthalmology1998;105:1801-1815
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Focal Diffuse
SystemicMetabolic Control
Argon focalLaser
NotChronic
Inflam.I.V. Anti-VEGF+/-
GridLaser
Chronic
Ischemia Traction
IV.Steriod I.V.Anti-VEGF
PPV
Combination
With Laser
Open BRB
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