Vision-related functional burden of diabetic retinopathy across severity levels in the United States

Jeffrey R. Willis, Quan V. Doan, Michelle Gleeson, Zdenka Haskova, Pradeep Ramulu, Lawrence S Morse, Ronald A. Cantrell

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

IMPORTANCE: Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. OBJECTIVE: To assess the functional burden of DR across severity levels in the United States. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. MAIN OUTCOMES AND MEASURES: Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. RESULTS: Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95% CI, 1.29-10.05; P = .02). Those with severe NPDR or PDR did not have a statistically significant greater odds of vision-related functional burden than did those with mild or moderate NPDR (aOR, 2.70; 95% CI, 0.93-7.78; P = .07). CONCLUSIONS AND RELEVANCE: Among US adults with diabetes, approximately half of those with severe NPDR or PDR had difficulty with at least one visual function task. Moreover, vision-related functional burden was significantly greater among those with severe NPDR or PDR than among those with no retinopathy. These data suggest the importance of preventing severe forms of DR to mitigate the vision-related functional burden among US adults with diabetes. Future studies should complement our study by assessing the association of worsening retinopathy with objectively measured functional outcomes.

Original languageEnglish (US)
Pages (from-to)926-932
Number of pages7
JournalJAMA Ophthalmology
Volume135
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Diabetic Retinopathy
Odds Ratio
Outcome Assessment (Health Care)
Nutrition Surveys

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Vision-related functional burden of diabetic retinopathy across severity levels in the United States. / Willis, Jeffrey R.; Doan, Quan V.; Gleeson, Michelle; Haskova, Zdenka; Ramulu, Pradeep; Morse, Lawrence S; Cantrell, Ronald A.

In: JAMA Ophthalmology, Vol. 135, No. 9, 01.09.2017, p. 926-932.

Research output: Contribution to journalArticle

Willis, Jeffrey R. ; Doan, Quan V. ; Gleeson, Michelle ; Haskova, Zdenka ; Ramulu, Pradeep ; Morse, Lawrence S ; Cantrell, Ronald A. / Vision-related functional burden of diabetic retinopathy across severity levels in the United States. In: JAMA Ophthalmology. 2017 ; Vol. 135, No. 9. pp. 926-932.
@article{3096acfa8bbe441683a9e2fb67c9dda3,
title = "Vision-related functional burden of diabetic retinopathy across severity levels in the United States",
abstract = "IMPORTANCE: Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. OBJECTIVE: To assess the functional burden of DR across severity levels in the United States. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. MAIN OUTCOMES AND MEASURES: Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. RESULTS: Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95{\%} CI, 64.0-67.3 years]; 51.1{\%} male [95{\%} CI, 47.1-55.2] and 48.9{\%} female [95{\%} CI, 44.8-52.9]), the prevalence was 72.3{\%} for no retinopathy, 25.4{\%} for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3{\%} for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2{\%} (95{\%} CI, 16.3{\%}-24.1{\%}) for those with no retinopathy, 20.4{\%} (95{\%} CI, 15.3{\%}-27.8{\%}) for those with mild and moderate NPDR, and 48.5{\%} (95{\%} CI, 25.6{\%}-71.5{\%}) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95{\%} CI, 1.29-10.05; P = .02). Those with severe NPDR or PDR did not have a statistically significant greater odds of vision-related functional burden than did those with mild or moderate NPDR (aOR, 2.70; 95{\%} CI, 0.93-7.78; P = .07). CONCLUSIONS AND RELEVANCE: Among US adults with diabetes, approximately half of those with severe NPDR or PDR had difficulty with at least one visual function task. Moreover, vision-related functional burden was significantly greater among those with severe NPDR or PDR than among those with no retinopathy. These data suggest the importance of preventing severe forms of DR to mitigate the vision-related functional burden among US adults with diabetes. Future studies should complement our study by assessing the association of worsening retinopathy with objectively measured functional outcomes.",
author = "Willis, {Jeffrey R.} and Doan, {Quan V.} and Michelle Gleeson and Zdenka Haskova and Pradeep Ramulu and Morse, {Lawrence S} and Cantrell, {Ronald A.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1001/jamaophthalmol.2017.2553",
language = "English (US)",
volume = "135",
pages = "926--932",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - Vision-related functional burden of diabetic retinopathy across severity levels in the United States

AU - Willis, Jeffrey R.

AU - Doan, Quan V.

AU - Gleeson, Michelle

AU - Haskova, Zdenka

AU - Ramulu, Pradeep

AU - Morse, Lawrence S

AU - Cantrell, Ronald A.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - IMPORTANCE: Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. OBJECTIVE: To assess the functional burden of DR across severity levels in the United States. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. MAIN OUTCOMES AND MEASURES: Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. RESULTS: Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95% CI, 1.29-10.05; P = .02). Those with severe NPDR or PDR did not have a statistically significant greater odds of vision-related functional burden than did those with mild or moderate NPDR (aOR, 2.70; 95% CI, 0.93-7.78; P = .07). CONCLUSIONS AND RELEVANCE: Among US adults with diabetes, approximately half of those with severe NPDR or PDR had difficulty with at least one visual function task. Moreover, vision-related functional burden was significantly greater among those with severe NPDR or PDR than among those with no retinopathy. These data suggest the importance of preventing severe forms of DR to mitigate the vision-related functional burden among US adults with diabetes. Future studies should complement our study by assessing the association of worsening retinopathy with objectively measured functional outcomes.

AB - IMPORTANCE: Among adults with diabetes in the United States, severe forms of diabetic retinopathy (DR) are significantly associated with a greater vision-related functional burden. OBJECTIVE: To assess the functional burden of DR across severity levels in the United States. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on 1004 participants 40 years or older with diabetes and valid ocular and sociodemographic outcomes in the National Health and Nutrition Examination Surveys (NHANES) (2005-2006 and 2007-2008). Diabetic retinopathy was based on fundus photograph grading, using the Early Treatment Diabetic Retinopathy Study severity scale. The analysis was performed from October 15, 2016, to June 15, 2017. MAIN OUTCOMES AND MEASURES: Functional difficulties secondary to vision were assessed during a household questionnaire in which participants self-reported difficulty with reading, visuospatial tasks (ie, close-up work or finding things on a crowded shelf), mobility (ie, walking down steps, stairs, or curbs), and driving. The main outcome measure was vision-related functional burden, which was defined as present for individuals reporting moderate or greater difficulty in any of the aforementioned tasks. RESULTS: Of the 1004 persons with diabetes analyzed for this study (mean age, 65.7 years [95% CI, 64.0-67.3 years]; 51.1% male [95% CI, 47.1-55.2] and 48.9% female [95% CI, 44.8-52.9]), the prevalence was 72.3% for no retinopathy, 25.4% for mild and moderate nonproliferative diabetic retinopathy (NPDR), and 2.3% for severe NPDR or proliferative diabetic retinopathy (PDR). The prevalence of vision-related functional burden was 20.2% (95% CI, 16.3%-24.1%) for those with no retinopathy, 20.4% (95% CI, 15.3%-27.8%) for those with mild and moderate NPDR, and 48.5% (95% CI, 25.6%-71.5%) for those with severe NPDR or PDR (P = .02). In multivariable analysis, the odds of vision-related functional burden were significantly greater among those with severe NPDR or PDR relative to those with no retinopathy (adjusted odds ratio [aOR], 3.59; 95% CI, 1.29-10.05; P = .02). Those with severe NPDR or PDR did not have a statistically significant greater odds of vision-related functional burden than did those with mild or moderate NPDR (aOR, 2.70; 95% CI, 0.93-7.78; P = .07). CONCLUSIONS AND RELEVANCE: Among US adults with diabetes, approximately half of those with severe NPDR or PDR had difficulty with at least one visual function task. Moreover, vision-related functional burden was significantly greater among those with severe NPDR or PDR than among those with no retinopathy. These data suggest the importance of preventing severe forms of DR to mitigate the vision-related functional burden among US adults with diabetes. Future studies should complement our study by assessing the association of worsening retinopathy with objectively measured functional outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85029558918&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029558918&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2017.2553

DO - 10.1001/jamaophthalmol.2017.2553

M3 - Article

C2 - 28750122

AN - SCOPUS:85029558918

VL - 135

SP - 926

EP - 932

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 9

ER -