Reply

Abstract

The primary objective of our manuscript was to report the prevalence of any diabetic retinopathy (DR) and vision-threatening DR among Indigenous (aged ≥40 years) and non-Indigenous (aged ≥50 years) Australians with known diabetes.1Keel S. Xie J. Foreman J. et al.The prevalence of diabetic retinopathy in Australian adults with self-reported diabetes: the National Eye Health Survey.Ophthalmology. 2017; 124: 977-984Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Given the substantial burden of diabetes in Australia, coupled with a paucity of recent national population-based prevalence data on DR, this study was clearly warranted to assist planning for eye health care delivery in Australia. It was duly acknowledged in the manuscript that the authors did not investigate a comprehensive range of known and potential DR risk factors (e.g., hemoglobin A1c, blood pressure, lipid profiles, body mass index, and income status). Therefore, associations of risk factors, including age and educational attainment, with DR and vision-threatening DR should be evaluated with caution. Furthermore, like other population-based surveys, the National Eye Health Survey used a cross-sectional design and, therefore, causal relationships between age and DR cannot be inferred. Nonetheless, the point raised in the letter to the editor regarding the relationship between age and DR is an interesting one. In the National Eye Health Survey, older age was associated with a reduced odds of any DR. This finding is in line with that of the Singapore Malay Eye Study2Wong T.Y. Cheung N. Tay W.T. et al.Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study.Ophthalmology. 2008; 115: 1869-1875Abstract Full Text Full Text PDF PubMed Scopus (324) Google Scholar and the Wisconsin Epidemiologic Study,3Klein R. Klein B.E. Moss S.E. et al.The Wisconsin Epidemiologic Study of Diabetic Retinopathy. X. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is 30 years or more.Arch Ophthalmol. 1989; 107: 244-249Crossref PubMed Scopus (342) Google Scholar but contrasts with other population-based reports.4Giloyan A. Harutyunyan T. Petrosyan V. The prevalence of and major risk factors associated with diabetic retinopathy in Gegharkunik province of Armenia: cross-sectional study.BMC Ophthalmol. 2015; 15: 46Crossref PubMed Scopus (19) Google Scholar, 5Namperumalsamy P. Kim R. Vignesh T.P. et al.Prevalence and risk factors for diabetic retinopathy: a population-based assessment from Theni District, south India.Postgrad Med J. 2009; 85: 643-648Crossref PubMed Scopus (60) Google Scholar We can only speculate that the observed differences in the associations between age and DR may be explained by variations in genetic and environmental factors between populations and/or differences in the methodologies used between studies. It is also possible that this finding may be partly explained by the established relationship between age and image gradability, where a decreasing media clarity in the older age groups may lead to a detection bias. It is clear that additional studies are needed to further elucidate the relationship with age and DR and this work may have implications in the development of specifically tailored interventions. However, irrespective of the outcomes of these studies the overall message from our manuscript would likely remain; intensified prevention strategies are required to cope with the increasing burden of diabetes and DR. Re: Keel et al.: The prevalence of diabetic retinopathy in Australian adults with self-reported diabetes: The National Eye Health Survey (Ophthalmology. 2017;124:977-984)OphthalmologyVol. 125Issue 2PreviewWe congratulate Keel et al1 for their interesting paper on estimating the prevalence of diabetic retinopathy (DR) in non-Indigenous Australians and Indigenous Australians with self-reported diabetes. Collectively, these findings will be greatly useful in the future planning of healthcare resource allocation. Full-Text PDF