Abstract
Purpose To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.Methods Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. ResultsA total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI ( < 0.001), density of specialists ( = 0.004), subspecialists ( < 0.001), and sampling site ( = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
Highlights
Diabetic retinopathy (DR) is the leading cause of vision loss in adults aged 20-74 years, and remains one of the foremost causes of blindness and visual impairment worldwide.[1,2,3,4] Despite significant development in the prevention and control of DR, the proportion of DR increased by 7.7% among all declining causes of blindness between 1990 and 2015.[5]
The only study on this subject assessed the association between the Human Development Index (HDI) and the number of studies published on DR.[9]
We provided appropriate tables and graphs for showing our results
Summary
Diabetic retinopathy (DR) is the leading cause of vision loss in adults aged 20-74 years, and remains one of the foremost causes of blindness and visual impairment worldwide.[1,2,3,4] Despite significant development in the prevention and control of DR, the proportion of DR increased by 7.7% among all declining causes of blindness between 1990 and 2015.[5] The prevalence of DR strongly correlates with both the duration of diabetes and the level of glycemic control.[6] timely management of DR stemming from screening programs, appropriate referral for treatment, and improving healthcare accessibility are important in preserving vision in diabetics.[7]. To the best of our knowledge, no study has investigated the correlation between human development and DR. HDI is abstracted from income, education, and life expectancy markers and ranks areas into different levels of human development.[10]
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