As diabetes rates continue to rise across the United States, so do complications related to the disease, including diabetic retinopathy, the leading cause of blindness among US working-age adults, according to new research published in JAMA Ophthalmology.

Elizabeth Lundeen, PhD, of the CDC, and her colleagues found a marked increased in the prevalence of diabetic retinopathy in the US

Using multiple different data sources, including the National Health and Nutrition Examination Survey and Medicare fee-for-service claims, first author Elizabeth A Lundeen, PhD, chief, enterprise analytics and data sciences branch at the Centers for Disease Control and Prevention, calculated that about 9.6 million people in the US were living with diabetic retinopathy in 2021, which works out to just over 1 in 4 (26%) of patients with diabetes.

Of the 9.6 million, 1.84 million individuals, or just under 20%, were estimated to have vision-threatening forms of the diabetic retinopathy.

Lundeen and her colleagues pointed to one study carried out in 2004 found that among adults aged 40 and older, around 4.1 million and 899,000 individuals with diabetes were living with diabetic retinopathy and vision-threatening diabetic retinopathy, respectively. Their findings show that “the number of people living with diabetes-related eye disease grew substantially since prevalence was last estimated in 2004,” they wrote. They warned that the prevalence may increase in the coming decades as more young people and adults are diagnosed with diabetes.

According to some projections, over 60 million American adults, or nearly 18% of the population, could have diabetes by 2060.

Around 37 million Americans currently have diabetes, putting them at risk of diabetic retinopathy. A study of diabetes trends published in JAMA in 2021 showed that from 1999-2000 to 2017-2018, diabetes prevalence in the U.S. grew from 9.8% to 14.3% among those aged 18 and older. Glycemic control has worsened in recent years, potentially exacerbating the risk of diabetic retinopathy in this population.

Prevalence of diabetic retinopathy varied by demographic characteristics and geography, report Lundeen and her colleagues. Approximately 5.6 million males had the condition in 2021 compared with 4.04 million females. Age-, sex- and gender-standardized rates of diabetic retinopathy were also higher among Hispanic and Black individuals than white individuals, the

Black and Hispanic individuals had a higher standardized prevalence of vision-threatening diabetic retinopathy compared with white individuals. This could be due in part to poorer glycemic control in these patients, earlier age of diabetes diagnosis and longer disease duration, or disparities in quality of care received, researchers explained.

Going forward, “forecasting studies project a nearly 3-fold increase in the number of individuals in the US with [diabetic retinopathy] (from 5.5 million to 16.0 million) and vision-threatening [diabetic retinopathy] (from 1.2million to 3.4 million) between 2005 and 2050,” they added.

Xiangrong Kong, PhD, of the Wilmer Eye Institute at the Johns Hopkins School of Medicine, outlined steps to address this coming wave of cases in an accompanying editorial in JAMA Ophthalmology.

These include the development of national diabetic retinopathy screening programs, greater public health awareness of ocular comorbidities in children with diabetes, and geographically-tailored resource allocation to improve local ophthalmologic care quality. Kong wrote that prevention efforts tailored to children are necessary to prevent diabetic retinopathy and that varying prevalence rates among demographic groups should be used to prioritize attention to the condition.

Published by Ophthalmology Times