DME in Saudi Arabia - Myth or Fact

7/31/2019 DME in Saudi Arabia - Myth or Fact

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Rising DME prevalence in SaudiMyth or Fact

Where are we vs. global prevalence?

HASSAN ALDHIBI

Senior Academic Consultant

Clinical Assistant Professor (KSU)Vitreoretinal & Uveitis

Chief Uveitis Division

KKESH


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The worldwide prevalenceof diabetes

DR

Affects most patients withdiabetes

The risk increases with

duration of diabetes Leading cause of blindness in

working-aged persons

[20 - 74]

0

100

200

300

400

2000 2030

Year

Num

ber(millions)


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Vision loss ispreventable and

treatable


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Definition: Retinal thickening caused by

the accumulation of

intraretinal fluid primarily inthe inner and outer plexiformlayersand causes swellingof the Meller cells[+/- lipoprotein deposits]


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All patients with diabetes areat risk of developing DME

The most common cause ofV L in patients with diabetes

The onset is insidious andpainless

Manifests with blurring ofcentral V A

The severity may range frommild and asymptomatic toprofound loss of vision


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CSME

Clinically Significant Macular Edema

(CSME)DME that was precisely defined by the

Early Treatment Diabetic RetinopathyStudy (ETDRS)


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Klein et al .The long term incidence of macular edema. Ophthalmology.1995

DME incidence over 10-year period

Younger Age Onset Diabetes : 20.1%

Older Age Onset Diabetes : 39.3%


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Older Age Onset DiabetesYounger Age Onset DiabetesDuration of 20

yearsDuration


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Older Age Onset

Years or More)15(Duration

Younger Age Onset

Years or More)10(Duration

PDRModerate/SevereNPDRMild

NPDRPDRModerate/Severe

NPDRMild

NPDR

74.3%63.2%6.3%69.7%20.3%1.7%

Data from Klein et al. Ophthalmology. 1984


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DME within 1 disc diameter of the

fovea 9 % of diabetic population

DME is 5 times as frequent as

PDR as a cause of visual loss

WESDR,1984

Centrill,1984


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Complications


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2,149,690 km2

Estimated population of 27 millionThe saudi nationals comprise an

estimated 16 million people


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1998 EL-Hazmi et al.Eastern Mediterranean Health Journal

IDDM [M/F] 0.23%/0.30%

NIDDM [M/F] 5.63%/4.53%

IGT [M/F] 0.50%/0.72%

> 60 years

NIDDM [M/F] 28.82% / 24.92%

IGT [M/F] 1.60% /3.56%

2004 Al-Nozha et al. 2004, Saudi Medical Journal

23.7%

2010 Al-Baghli et al., Singapore Med. J. 2010 [eastern part of Saudi Arabia] 17.2%

2011 Alqurashi et al., Ann. Saudi Med. 2011

34.1% males

27.6% females


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ShawJE,Sicree RA,Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030.Diabetes Res Clin Pract. 2010


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DR : 30- 31.3 %.SNPDR :31.3% of DM,

PDR :up to 8%

DME : 10.3%

Abu-Elasrar et al . Int Ophthalmol 1998

Khan et al. MEAJO 2010


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Taif Region Survey 2010-2011

3052 with 50 years

DM :29%DR : 35%

17% DR patients at risk of vision loss and

blindness

10% of blindness is 2ry to DR ( 3rd cause of

blindness)


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4-5 million diabetics in

KSA 400.000 patients with

Macular edema

200.000 patients with PDR


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Vision loss ispreventable and

treatable


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Untreated DME

20% to 30% of patients willexperience a doubling of the

visual angle within 3 years

The risk drops by 50% with

current treatments
http://www.jirehdesign.com/


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Incidence of DME increases with

Elevated levels of Hb A1C

Level of severity of DR

Duration of DM Elevated diastolic blood pressure

Abnormal lipid level

Gender (more frequent in females)

Wisconsin Epidemiologic Study of DR

Klein R et al. Ophthalmology1998;105:1801-1815


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Focal Diffuse

SystemicMetabolic Control

Argon focalLaser

NotChronic

Inflam.I.V. Anti-VEGF+/-

GridLaser

Chronic

Ischemia Traction

IV.Steriod I.V.Anti-VEGF

PPV

Combination

With Laser

Open BRB


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DME in Saudi Arabia - Myth or Fact