Concerning Trends in Vision Impairment for Adults With Diabetes?

Declines in vision impairment among people with diabetes appear to have plateaued, according to 20-year CDC data, and there's now even a hint of an increase in more recent years.

Over the two-decade period from 1999 to 2019, there was a slight change in the prevalence of adults with diabetes who reported vision impairment, a non-significant decline from 21.5% to 20.7% (annual percent change [APC] -0.47, P=0.2), reported Elizabeth Lundeen, PhD, MPH, of the Vision Health Initiative at CDC in Atlanta, at the American Diabetes Association (ADA) annual meeting.

But a closer look using 3-year moving averages showed a different story:

• 1999-2012: 21.5% to 17.7% (APC -1.60, P<0.001)
• 2012-2018: 17.7% to 20.7% (APC 3.15, P=0.2)

"While our findings of an increasing trend over the last decade did not reach statistical significance, it could be an early warning that trends in vision impairment among those with diabetes are headed in the wrong direction," Lundeen said in a statement. "Additional research will help us better understand the causes of this recent upward trend and design effective interventions to prevent vision loss in individuals with diabetes around the country."

Diabetes is the leading cause of vision loss in people ages 18 to 64, according to the ADA, and by 2030, it's anticipated that there will be a 48% increase in the number of individuals with diabetic retinopathy.

In their poster presentation, Lundeen's group pointed out that the apparent rise in vision impairment over the last decade came against the backdrop of reports indicating that there was a decrease in glycemic control among adults with diabetes between 2015 to 2018, which may have contributed to rising rates of vision impairment.

Previous National Health and Nutrition Examination Survey data found that only 44% of adults had an HbA1c under 7% between 1999-2002. Although this later rose to 56.7% in 2003-2006 -- and peaked in 2007-2010 -- the proportion of patients achieving an HbA1c under 7% slowly declined, dropping off to 51.8% in 2011-2014 and down to 50.5% by 2015-2018.

Over the 20-year period, half of adults with diabetes said they saw an eye doctor within the past year, and that rate held steady from 1999 to 2018. According to the ADA, an annual routine eye exam could prevent 95% of vision loss caused by diabetes.

The cross-sectional, nationally representative data was collected from the U.S. National Health Interview Survey. Annual prevalence was age-standardized to the 2010 U.S. Census.

A total of 52,166 adults with self-reported diabetes were included, defined as a doctor or healthcare professional having told them that they have diabetes. Vision impairment was considered as trouble seeing, even with glasses or contact lenses.

"Future research could further explore determinants of these recent trends, potentially including glycemic management, vision screening, and healthcare utilization," Lundeen's group wrote.

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