Causes and risk factors of visual impairment in type 2 diabetes mellitus at King Hussein Medical Center

Abstract EN

Objectives: To investigate the causes of severe visual impairment among Jordanians with type II diabetes mellitus and its associated systemic factors.

Methods: A prospective study conducted at King Hussein Medical Center between January 2016 and May 2017.

After getting the ethical approval and taking a consent form, all patients with type II diabetes mellitus who attended the medical retina clinic in the ophthalmology department and found to have best corrected visual acuity (BCVA) of less than 6/12 in the best eye were included in the study.

The patients were subjected to detailed ophthalmic exam including best corrected visual acuity using Snellen chart, anterior segment exam using slit lamp bio-microscopy, intra- ocular pressure measurement using Golmann applanation tonometry and posterior segment exam using 78 and 90 diopter lens.

The patients were divided into two groups; Group A where the best corrected vision in the good eye is 6/60 or worse and Group B where vision in the good eye is less than 6/12 and better than 6/60.

The outcome of ocular exam in both groups was recorded and compared and the overall data were analyzed using the Excel.

Results: Ninety- three patients aged between 43 and 80 years (mean 63.1± 12) were included in the study, 55% of them were males with a ratio of 1.2: 1.

The duration of Diabetes Mellitus (DM) ranged between 5 and 30 years (mean 14.4± 5 years).The hemoglobin A1c (HbA1c) ranged between 6.2% and 12% (mean 8.7± 1.2).

Sixty- five patient (70%) had BCVA less than 6/12 and better than 6/60 while 28 patients (30%) had BCVA of 6/60 or less.

In Group A, 20 patients (70.4%) had proliferative diabetic retinopathy (PDR) while the remaining patients had non- proliferative diabetic retinopathy (NPDR).

On the other hand PDR was found only in 11 patients (16.9%) in Group B, 46 patients (70.8%) in this group had NPDR and 8 patients (12.3%) had no DR.

Macular edema was found in 86.2% of patients with severe visual impairment.

Hypertension, hyperlipidemia, and renal failure were present in 46%, 19% and 13% of the patients, respectively, and showed statistically significant association with severe visual loss (P value <0.01).

Age more than 63 years and duration of DM more than 10 years also showed significant association.

Conclusion: legal blindness is frequently found among Jordanian diabetics at king Hussein Medical Centre.

The most common ocular finding in patients with severe visual impairment (best corrected visual acuity is 6/60 or less) is macular edema.

Hypertension, hyperlipidemia , renal failure, age more than 63 years and duration of DM more than 10 years showed statistically significant association.