Rising DME prevalence in Saudi Myth or Fact

Where are we vs. global prevalence?

HASSAN ALDHIBI Senior Academic Consultant Clinical Assistant Professor (KSU) Vitreoretinal & Uveitis Chief Uveitis Division KKESH

400
Number (millions)

The worldwide prevalence of diabetes DR

Affects most patients with diabetes The risk increases with duration of diabetes Leading cause of blindness in working-aged persons [20 - 74]

300 200 100 0 2000 Year 2030

Vision loss is preventable and treatable

Definition:

Retinal thickening caused by the accumulation of intraretinal fluid primarily in the inner and outer plexiform layers and causes swelling of the Meller cells [+/- lipoprotein deposits]

All patients with diabetes are at risk of developing DME The most common cause of V L in patients with diabetes The onset is insidious and painless Manifests with blurring of central V A The severity may range from mild and asymptomatic to profound loss of vision

Clinically Significant Macular Edema

(CSME)
DME that was precisely defined by the Early Treatment Diabetic Retinopathy Study (ETDRS)

CSME

DME incidence over 10-year period

Younger Age Onset Diabetes : 20.1% Older Age Onset Diabetes : 39.3%

Klein et al .The long term incidence of macular edema. Ophthalmology.1995

Younger Age Onset Diabetes

Duration <5 years
ID 0%

Older Age Onset Diabetes

Duration <5 years
NID 3% ID 5%-8%

Duration of 20 years
ID 32%

Duration of 20 years
NID 18% ID 38%

Data from Klein et al. Ophthalmology. 1984

Younger Age Onset

(Duration 10 Years or More)

Mild NPDR 1.7% Moderate/Severe NPDR 20.3% PDR

Older Age Onset (Duration 15 Years or More)

Mild NPDR 6.3% Moderate/Severe NPDR 63.2% PDR

69.7%

74.3%

Data from Klein et al. Ophthalmology. 1984

Approaches 32 - 38% in adults with DM duration for 20 years or more

Mild NPDR
Moderate to severe

NPDR

3% PDR 71%

38%

Flavio EH, Knudtson MD, Klein BE, Klein R. Am J Ophthalmol. 2008;145:700706.

DME within 1 disc diameter of the fovea 9 % of diabetic population

WESDR,1984

DME is 5 times as frequent as PDR as a cause of visual loss

Centrill,1984

Complications

2,149,690 km2

Estimated population of 27 million The saudi nationals comprise an estimated 16 million people

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

ShawJE,Sicree RA,Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010

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

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)

4-5 million diabetics in KSA 400.000 patients with Macular edema 200.000 patients with PDR

Vision loss is preventable and treatable

Untreated DME 20% to 30% of patients will experience a doubling of the visual angle within 3 years The risk drops by 50% with current treatments

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. Ophthalmology 1998;105:1801-1815

Focal Open BRB

Argon focal Laser Not Chronic
I.V. Anti-VEGF +/Grid Laser

Diffuse
Systemic Metabolic Control

Chronic

Inflam.
IV.Steriod

Ischemia I.V. Anti-VEGF

Traction

PPV

Combination With Laser