Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

doi:10.18502/jovr.v14i3.4790

Review

. 2019 Jul 18;14(3):321-335.

doi: 10.18502/jovr.v14i3.4790. eCollection 2019 Jul-Sep.

Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

Affiliations

¹ MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.
² Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
⁴ Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
⁶ Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁷ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

PMID: 31660112
PMCID: PMC6815336
DOI: 10.18502/jovr.v14i3.4790

Review

Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

Golnoush Sadat Mahmoudi Nezhad et al. J Ophthalmic Vis Res. 2019.

. 2019 Jul 18;14(3):321-335.

doi: 10.18502/jovr.v14i3.4790. eCollection 2019 Jul-Sep.

Authors

Affiliations

¹ MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.
² Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
⁴ Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
⁶ Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁷ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

PMID: 31660112
PMCID: PMC6815336
DOI: 10.18502/jovr.v14i3.4790

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.

Results: A 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 ( $P$ < 0.001), density of specialists ( $P$ = 0.004), subspecialists ( $P$ < 0.001), and sampling site ( $P$ = 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.

Keywords: Diabetic Retinopathy; Epidemiology; Human Development; Iran; Access to Health Care.

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Conflict of interest statement

There is no conflict of interest.

Figures

**Figure 1**
Flow diagram summarizing the systematic search and review process for identifying evidence regarding the prevalence and diabetic retinopathy. Inclusion and exclusion criteria are provided in the text.

**Figure 2**
Forest plot of diabetic retinopathy prevalence by Human Development Index categories and source of data (clinic vs population-based studies). CI, confidence interval; ES, estimation of diabetic retinopathy prevalence (%); HDI, Human Development Index.

**Figure 3**
Forest plot of cumulative incidence rate of diabetic retinopathy. CI, confidence interval; ES, estimation of diabetic retinopathy incidence (%)

**Figure 4**
Scatter plot of the linear correlation of prevalence and the Human Development Index. DR, diabetic retinopathy

See this image and copyright information in PMC

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References

1. Buch H., Vinding T., la Cour M., Appleyard M., Jensen G. B., Nielsen N. V. Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study. Ophthalmology. 2004;111(1):53–61. doi: 10.1016/j.ophtha.2003.05.010. - DOI - PubMed
1. Brazionis L., Jenkins A., Keech A., Ryan C., Brown A., Boffa J., Bursell S. Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project. Diabetic Medicine. 2018;35(5):630–639. doi: 10.1111/dme.13596. - DOI - PubMed
1. Tan G. S., Gan A., Sabanayagam C., Tham Y. C., Neelam K., Mitchell P., Wang J. J., Lamoureux E. L., Cheng C., Wong T. Y. Ethnic Differences in the Prevalence and Risk Factors of Diabetic Retinopathy. Ophthalmology. 2018;125(4):529–536. doi: 10.1016/j.ophtha.2017.10.026. - DOI - PubMed
1. Cheung N., Mitchell P., Wong T. Y. Diabetic retinopathy. The Lancet. 2010;376(9735):124–136. doi: 10.1016/S0140-6736(09)62124-3. - DOI - PubMed
1. Flaxman S. R., Bourne R. R., Resnikoff S., Ackland P., Braithwaite T., Cicinelli M. V., Das A., Jonas J. B., Keeffe J., Kempen J. H., Leasher J., Limburg H., Naidoo K., Pesudovs K., Silvester A., Stevens G. A., Tahhan N., Wong T. Y., Taylor H. R., Bourne R., Ackland P., Arditi A., Barkana Y., Bozkurt B., Braithwaite T., Bron A., Budenz D., Cai F., Casson R., Chakravarthy U., Choi J., Cicinelli M. V., Congdon N., Dana R., Dandona R., Dandona L., Das A., Dekaris I., Del Monte M., deva J., Dreer L., Ellwein L., Frazier M., Frick K., Friedman D., Furtado J., Gao H., Gazzard G., George R., Gichuhi S., Gonzalez V., Hammond B., Hartnett M. E., He M., Hejtmancik J., Hirai F., Huang J., Ingram A., Javitt J., Jonas J., Joslin C., Keeffe J., Kempen J., Khairallah M., Khanna R., Kim J., Lambrou G., Lansingh V. C., Lanzetta P., Leasher J., Lim J., LIMBURG H., Mansouri K., Mathew A., Morse A., Munoz B., Musch D., Naidoo K., Nangia V., Palaiou M., Parodi M. B., Pena F. Y., Pesudovs K., Peto T., Quigley H., Raju M., Ramulu P., Rankin Z., Resnikoff S., Reza D., Robin A., Rossetti L., Saaddine J., Sandar M., Serle J., Shen T., Shetty R., Sieving P., Silva J. C., Silvester A., Sitorus R. S., Stambolian D., Stevens G., Taylor H., Tejedor J., Tielsch J., Tsilimbaris M., van Meurs J., Varma R., Virgili G., Wang Y. X., Wang N., West S., Wiedemann P., Wong T., Wormald R., Zheng Y. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(12):e1221–e1234. doi: 10.1016/S2214-109X(17)30393-5. - DOI - PubMed

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[1] Buch H., Vinding T., la Cour M., Appleyard M., Jensen G. B., Nielsen N. V. Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study. Ophthalmology. 2004;111(1):53–61. doi: 10.1016/j.ophtha.2003.05.010. - DOI - PubMed

[2] Buch H., Vinding T., la Cour M., Appleyard M., Jensen G. B., Nielsen N. V. Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study. Ophthalmology. 2004;111(1):53–61. doi: 10.1016/j.ophtha.2003.05.010. - DOI - PubMed

[3] Brazionis L., Jenkins A., Keech A., Ryan C., Brown A., Boffa J., Bursell S. Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project. Diabetic Medicine. 2018;35(5):630–639. doi: 10.1111/dme.13596. - DOI - PubMed

[4] Brazionis L., Jenkins A., Keech A., Ryan C., Brown A., Boffa J., Bursell S. Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project. Diabetic Medicine. 2018;35(5):630–639. doi: 10.1111/dme.13596. - DOI - PubMed

[5] Tan G. S., Gan A., Sabanayagam C., Tham Y. C., Neelam K., Mitchell P., Wang J. J., Lamoureux E. L., Cheng C., Wong T. Y. Ethnic Differences in the Prevalence and Risk Factors of Diabetic Retinopathy. Ophthalmology. 2018;125(4):529–536. doi: 10.1016/j.ophtha.2017.10.026. - DOI - PubMed

[6] Tan G. S., Gan A., Sabanayagam C., Tham Y. C., Neelam K., Mitchell P., Wang J. J., Lamoureux E. L., Cheng C., Wong T. Y. Ethnic Differences in the Prevalence and Risk Factors of Diabetic Retinopathy. Ophthalmology. 2018;125(4):529–536. doi: 10.1016/j.ophtha.2017.10.026. - DOI - PubMed

[7] Cheung N., Mitchell P., Wong T. Y. Diabetic retinopathy. The Lancet. 2010;376(9735):124–136. doi: 10.1016/S0140-6736(09)62124-3. - DOI - PubMed

[8] Cheung N., Mitchell P., Wong T. Y. Diabetic retinopathy. The Lancet. 2010;376(9735):124–136. doi: 10.1016/S0140-6736(09)62124-3. - DOI - PubMed

[9] Flaxman S. R., Bourne R. R., Resnikoff S., Ackland P., Braithwaite T., Cicinelli M. V., Das A., Jonas J. B., Keeffe J., Kempen J. H., Leasher J., Limburg H., Naidoo K., Pesudovs K., Silvester A., Stevens G. A., Tahhan N., Wong T. Y., Taylor H. R., Bourne R., Ackland P., Arditi A., Barkana Y., Bozkurt B., Braithwaite T., Bron A., Budenz D., Cai F., Casson R., Chakravarthy U., Choi J., Cicinelli M. V., Congdon N., Dana R., Dandona R., Dandona L., Das A., Dekaris I., Del Monte M., deva J., Dreer L., Ellwein L., Frazier M., Frick K., Friedman D., Furtado J., Gao H., Gazzard G., George R., Gichuhi S., Gonzalez V., Hammond B., Hartnett M. E., He M., Hejtmancik J., Hirai F., Huang J., Ingram A., Javitt J., Jonas J., Joslin C., Keeffe J., Kempen J., Khairallah M., Khanna R., Kim J., Lambrou G., Lansingh V. C., Lanzetta P., Leasher J., Lim J., LIMBURG H., Mansouri K., Mathew A., Morse A., Munoz B., Musch D., Naidoo K., Nangia V., Palaiou M., Parodi M. B., Pena F. Y., Pesudovs K., Peto T., Quigley H., Raju M., Ramulu P., Rankin Z., Resnikoff S., Reza D., Robin A., Rossetti L., Saaddine J., Sandar M., Serle J., Shen T., Shetty R., Sieving P., Silva J. C., Silvester A., Sitorus R. S., Stambolian D., Stevens G., Taylor H., Tejedor J., Tielsch J., Tsilimbaris M., van Meurs J., Varma R., Virgili G., Wang Y. X., Wang N., West S., Wiedemann P., Wong T., Wormald R., Zheng Y. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(12):e1221–e1234. doi: 10.1016/S2214-109X(17)30393-5. - DOI - PubMed

[10] Flaxman S. R., Bourne R. R., Resnikoff S., Ackland P., Braithwaite T., Cicinelli M. V., Das A., Jonas J. B., Keeffe J., Kempen J. H., Leasher J., Limburg H., Naidoo K., Pesudovs K., Silvester A., Stevens G. A., Tahhan N., Wong T. Y., Taylor H. R., Bourne R., Ackland P., Arditi A., Barkana Y., Bozkurt B., Braithwaite T., Bron A., Budenz D., Cai F., Casson R., Chakravarthy U., Choi J., Cicinelli M. V., Congdon N., Dana R., Dandona R., Dandona L., Das A., Dekaris I., Del Monte M., deva J., Dreer L., Ellwein L., Frazier M., Frick K., Friedman D., Furtado J., Gao H., Gazzard G., George R., Gichuhi S., Gonzalez V., Hammond B., Hartnett M. E., He M., Hejtmancik J., Hirai F., Huang J., Ingram A., Javitt J., Jonas J., Joslin C., Keeffe J., Kempen J., Khairallah M., Khanna R., Kim J., Lambrou G., Lansingh V. C., Lanzetta P., Leasher J., Lim J., LIMBURG H., Mansouri K., Mathew A., Morse A., Munoz B., Musch D., Naidoo K., Nangia V., Palaiou M., Parodi M. B., Pena F. Y., Pesudovs K., Peto T., Quigley H., Raju M., Ramulu P., Rankin Z., Resnikoff S., Reza D., Robin A., Rossetti L., Saaddine J., Sandar M., Serle J., Shen T., Shetty R., Sieving P., Silva J. C., Silvester A., Sitorus R. S., Stambolian D., Stevens G., Taylor H., Tejedor J., Tielsch J., Tsilimbaris M., van Meurs J., Varma R., Virgili G., Wang Y. X., Wang N., West S., Wiedemann P., Wong T., Wormald R., Zheng Y. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(12):e1221–e1234. doi: 10.1016/S2214-109X(17)30393-5. - DOI - PubMed

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Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

Affiliations

Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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References

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