Impact of diabetic retinopathy on vision-specific function.
OBJECTIVE: To assess the influence of the spectrum of diabetic retinopathy (DR) on vision-specific function in an Asian population. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Persons aged 40 to 80 years of Malay ethnicity in Singapore. METHODS: The Singapore Malay Eye Study was a population-based, cross-sectional study of 3280 Asian Malays (78.7% response rate). Five end points were considered: (1) any DR, (2) macular edema (ME), (3) clinically significant macular edema (CSME), (4) vision-threatening DR (VTDR), and (5) DR severity levels ranging from none to proliferative diabetic retinopathy (PDR). Vision function was assessed using the Vision-Specific Functioning Scale validated using Rasch analysis. MAIN OUTCOME MEASURES: Vision-specific functioning score. RESULTS: Of 357 diabetic participants in the study, 23.2% had any DR, 5.6% had ME, 5.0% had CSME, 10.6% had VTDR, and 6.2% had PDR. In linear regression models adjusting for age, gender, stroke, diabetic risk factors, and socioeconomic factors, poorer vision-specific function was associated independently with any DR (beta, -0.21; P<0.05), ME (beta, -0.48; P<0.05), CSME (beta, -0.42; P<0.05), VTDR (beta, -0.64; P<0.05), and PDR (beta, -0.92; P<0.001). When controlling further for presenting visual acuity, VTDR (beta, -0.37; P = 0.01) and PDR (beta, -0.61; P = 0.002) were the only 2 DR categories independently associated with poorer vision-specific function and PDR. Persons with VTDR and PDR were 6 to 12 times more likely to report lower participation in daily living activities than those without these DR levels. CONCLUSIONS: People with VTDR and PDR have substantial difficulty undertaking vision-specific daily activities. These findings reinforce the importance of preventative efforts targeted at the earliest DR stages to prevent progression to later stages of DR. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Lamoureux, EL; Tai, ES; Thumboo, J; Kawasaki, R; Saw, S-M; Mitchell, P; Wong, TY
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