Subscribe to RSS
DOI: 10.1055/a-2108-6758
Diabetic Retinopathy – a Common Disease
Article in several languages: English | deutschAuthors

Abstract
Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus and one of the leading causes of visual impairment in working age individuals in the western world. The treatment of DR depends on its severity, so it is of great importance to detect patients as early as possible, in order to initiate early treatment and preserve vision. Despite currently insufficient screening participation, patients with diabetes already visit ophthalmological practices and clinics above average. Their medical care, including DR diagnostics and treatment has been making up an increasing proportion of ophthalmic activity for years. Since the prevalence of diabetes is increasing dramatically worldwide and a further increase is also predicted for Germany, the challenge for ophthalmologists is likely to grow considerably. As the same time, the diagnostic possibilities for differentiating DR and the therapeutic measures, especially with IVOM therapy, are becoming more and more complex, which increases the time burden in everyday clinical practice. The hope to avoid healthcare deficits and to further improve screening rates and visual acuity prognosis in patients with DR is based, among other things, on camera-assisted screening supported by artificial intelligence. Better diabetes management to reduce the prevalence of DR, as well as longer-acting drugs to treat DR, could also improve the care and help reduce the burden on ophthalmology practices.
Publication History
Received: 11 May 2023
Accepted: 19 May 2023
Article published online:
04 September 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1
Saeedi P,
Petersohn I,
Salpea P.
et al.
Global and regional diabetes prevalence estimates for 2019 and projections for 2030
and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.
Diabetes Res Clin Pract 2019; 157: 107843
Reference Ris Wihthout Link
- 2
Ogurtsova K,
Guariguata L,
Barengo NC.
et al.
IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021. Diabetes
Res Clin Pract 2022; 183: 109118
Reference Ris Wihthout Link
- 3
Diaz-Valencia PA,
Bougnères P,
Valleron AJ.
Global epidemiology of type 1 diabetes in young adults and adults: a systematic review.
BMC Public Health 2015; 15: 255
Reference Ris Wihthout Link
- 4
Tuomi T,
Groop LC,
Zimmet PZ.
et al.
Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes mellitus
in adults with a non-insulin-dependent onset of disease. Diabetes 1993; 42: 359-362
Reference Ris Wihthout Link
- 5
Ahlqvist E,
Storm P,
Käräjämäki A.
et al.
Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven
cluster analysis of six variables. Lancet Diabetes Endocrinol 2018; 6: 361-369
Reference Ris Wihthout Link
- 6
Ponto KA,
Koenig J,
Peto T.
et al.
Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: results
from the Gutenberg Health Study (GHS). Diabetologia 2016; 59: 1913-1919
Reference Ris Wihthout Link
- 7
Schuster AK,
Wolfram C,
Pfeiffer N.
et al.
Augenheilkunde 2019 – Wo stehen wir?. Ophthalmologe 2019; 116: 829-837
Reference Ris Wihthout Link
- 8
Rathmann W,
Giani G.
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
Diabetes Care 2004; 27: 2568-2569
Reference Ris Wihthout Link
- 9
World Health Organization (WHO).
TADDS: tool for the assessment of diabetic retinopathy and diabetes management systems.
Im Internet (Stand: 17.04.2023): https://www.who.int/publications/i/item/tadds-tool-for-the-assessment-of-diabetic-retinopathy-and-diabetes-management-systems
Reference Ris Wihthout Link
- 10
Hainsworth DP,
Bebu I,
Aiello LP.
et al.
Risk Factors for Retinopathy in Type 1 Diabetes: The DCCT/EDIC Study. Diabetes Care
2019; 42: 875-882
Reference Ris Wihthout Link
- 11
Basina M,
Maahs DM.
Age at type 1 diabetes onset: a new risk factor and call for focused treatment. The
Lancet 2018; 392: 453-454
Reference Ris Wihthout Link
- 12
Teo ZL,
Tham YC,
Yu M.
et al.
Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic
Review and Meta-analysis. Ophthalmology 2021; 128: 1580-1591
Reference Ris Wihthout Link
- 13
Li JQ,
Welchowski T,
Schmid M.
et al.
Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic
review and meta-analysis. Eur J Epidemiol 2020; 35: 11-23
Reference Ris Wihthout Link
- 14
Teo ZL,
Tham YC,
Yu M.
et al.
Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy?
A global perspective. Eye (Lond) 2020; 34: 1255-1261
Reference Ris Wihthout Link
- 15
Hristova E,
Koseva D,
Zlatarova Z.
et al.
Diabetic Retinopathy Screening and Registration in Europe-Narrative Review. Healthcare
(Basel) 2021; 9: 745
Reference Ris Wihthout Link
- 16
Schmidt C,
Reitzle L,
Dreß J.
et al.
[Prevalence and incidence of documented diabetes based on health claims data-reference
analysis for diabetes surveillance in Germany]. Bundesgesundheitsblatt Gesundheitsforschung
Gesundheitsschutz 2020; 63: 93-102
Reference Ris Wihthout Link
- 17
Hesse L,
Grüsser M,
Hoffstadt K.
et al.
[Population-based study of diabetic retinopathy in Wolfsburg]. Ophthalmologe 2001;
98: 1065-1068
Reference Ris Wihthout Link
- 18
Hammes HP,
Welp R,
Kempe HP.
et al.
Risk Factors for Retinopathy and DME in Type 2 Diabetes-Results from the German/Austrian
DPV Database. PLoS One 2015; 10: e0132492
Reference Ris Wihthout Link
- 19
Hammes HP,
Kerner W,
Hofer S.
et al.
Diabetic retinopathy in type 1 diabetes – a contemporary analysis of 8,784 patients.
Diabetologia 2011; 54: 1977-1984
Reference Ris Wihthout Link
- 20
Groos S,
Kretschmann J,
Weber A.
et al.
Qualitätsbericht 2021: Disease-Management-Programme in Nordrhein. Im Internet (Stand:
17.07.2023): https://www.kgnw.de/service/dmp/dmp-nordrhein-qualitaetsbericht-2021
Reference Ris Wihthout Link
- 21
Blum M,
Kloos C,
Müller N.
et al.
[Prevalence of diabetic retinopathy. Check-up program of a public health insurance
company in Germany 2002–2004]. Ophthalmologe 2007; 104: 499-500 502–504
Reference Ris Wihthout Link
- 22
Huppertz E,
Pieper L,
Klotsche J.
et al.
Diabetes Mellitus in German Primary Care: quality of glycaemic control and subpopulations
not well controlled – results of the DETECT study. Exp Clin Endocrinol Diabetes 2009;
117: 6-14
Reference Ris Wihthout Link
- 23
Heller T,
Blum M,
Spraul M.
et al.
[Diabetic co-morbidities: prevalences in Germany]. Dtsch Med Wochenschr 2014; 139:
786-791
Reference Ris Wihthout Link
- 24
Goffrier B,
Schulz M,
Bätzing-Feigenbaum J.
Administrative Prävalenzen und Inzidenzen des Diabetes mellitus von 2009 bis 2015.
Versorgungsatlas-Bericht Nr. 17/03. 23.02.2017. Im Internet (Stand: 17.07.2023): https://www.versorgungsatlas.de/themen/alle-analysen-nach-datum-sortiert/?tab=6&uid=79
Reference Ris Wihthout Link
- 25
Wilke RGH,
Finger RP,
Sachs HG.
[Real-life Data on the Treatment of Diabetic Macular Oedema in Germany]. Klin Monbl
Augenheilkd 2017; 234: 1502-1507
Reference Ris Wihthout Link
- 26
Stefanickova J,
Cunha-Vaz J,
Ulbig M.
et al.
A noninterventional study to monitor patients with diabetic macular oedema starting
treatment with ranibizumab (POLARIS). Acta Ophthalmol 2018; 96: e942-e949
Reference Ris Wihthout Link
- 27
Faatz H,
Rothaus K,
Westhues D.
et al.
[Treatment adherence and effectiveness of anti-Vascular Endothelial Growth Faktor
(VEGF) treatment of diabetic macular edema in the clinical routine: Comparison between
cooperative and unicentric organization of treatment]. Ophthalmologe 2020; 117: 557-565
Reference Ris Wihthout Link
- 28
Finger RP,
Fimmers R,
Holz FG.
et al.
Incidence of blindness and severe visual impairment in Germany: projections for 2030.
Invest Ophthalmol Vis Sci 2011; 52: 4381-4389
Reference Ris Wihthout Link
- 29
Antonetti DA,
Klein R,
Gardner TW.
Diabetic retinopathy. N Engl J Med 2012; 366: 1227-1239
Reference Ris Wihthout Link
- 30
Antonetti DA,
Silva PS,
Stitt AW.
Current understanding of the molecular and cellular pathology of diabetic retinopathy.
Nat Rev Endocrinol 2021; 17: 195-206
Reference Ris Wihthout Link
- 31
Yau JWY,
Rogers SL,
Kawasaki R.
et al.
Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;
35: 556-564
Reference Ris Wihthout Link
- 32
Lachin JM,
Genuth S,
Nathan DM.
et al.
Effect of glycemic exposure on the risk of microvascular complications in the diabetes
control and complications trial–revisited. Diabetes 2008; 57: 995-1001
Reference Ris Wihthout Link
- 33
Zhao M,
Gelize E,
Levy R.
et al.
Mineralocorticoid Receptor Pathway and Its Antagonism in a Model of Diabetic Retinopathy.
Diabetes 2021; 70: 2668-2682
Reference Ris Wihthout Link
- 34
Reid LJ,
Gibb FW,
Colhoun H.
et al.
Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy
progression compared with multiple daily injections of insulin. Diabetologia 2021;
64: 1725-1736
Reference Ris Wihthout Link
- 35
Zhang P,
Kumar A,
Katz LS.
et al.
Induction of the ChREBPβ Isoform Is Essential for Glucose-Stimulated β-Cell Proliferation.
Diabetes 2015; 64: 4158-4170
Reference Ris Wihthout Link
- 36
Do DV,
Han G,
Abariga SA.
et al.
Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev 2023;
(03) CD006127
Reference Ris Wihthout Link
- 37
Keech AC,
Mitchell P,
Summanen PA.
et al.
Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD
study): a randomised controlled trial. Lancet 2007; 370: 1687-1697
Reference Ris Wihthout Link
- 38
Meer E,
Bavinger JC,
Yu Y.
et al.
Association of Fenofibrate Use and the Risk of Progression to Vision-Threatening Diabetic
Retinopathy. JAMA Ophthalmol 2022; 140: 529-532
Reference Ris Wihthout Link
- 39
Li Y,
Su X,
Ye Q.
et al.
The predictive value of diabetic retinopathy on subsequent diabetic nephropathy in
patients with type 2 diabetes: a systematic review and meta-analysis of prospective
studies. Ren Fail 2021; 43: 231-240
Reference Ris Wihthout Link
- 40
Cosentino F,
Grant PJ,
Aboyans V.
et al.
2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed
in collaboration with the EASD. Eur Heart J 2020; 41: 255-323
Reference Ris Wihthout Link
- 41
Ziemssen F,
Lemmen K,
Bertram B.
et al.
[National guidelines for treatment of diabetic retinopathy: Second edition of the
national guidelines for treatment of diabetic retinopathy]. Ophthalmologe 2016; 113:
623-638
Reference Ris Wihthout Link
- 42
Wang J,
Xin X,
Luo W.
et al.
Anemia and Diabetic Kidney Disease Had Joint Effect on Diabetic Retinopathy Among
Patients With Type 2 Diabetes. Invest Ophthalmol Vis Sci 2020; 61: 25
Reference Ris Wihthout Link
- 43
[Anonymous]
Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment
Diabetic Retinopathy Study Research Group. Ophthalmology 1991; 98 (5 Suppl): 766-785
Reference Ris Wihthout Link
- 44
Writing Committee for the Diabetic Retinopathy Clinical Research Network.
Fong DS,
Strauber SF,
Aiello LP.
et al.
Comparison of the modified Early Treatment Diabetic Retinopathy Study and mild macular
grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol
2007; 125: 469-480
Reference Ris Wihthout Link
- 45
[Anonymous]
Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy
Study report number 1. Early Treatment Diabetic Retinopathy Study research group.
Arch Ophthalmol 1985; 103: 1796-1806
Reference Ris Wihthout Link
- 46
Zhang X,
Saaddine JB,
Chou CF.
et al.
Prevalence of diabetic retinopathy in the United States, 2005–2008. JAMA 2010; 304:
649-656
Reference Ris Wihthout Link
- 47
Claessen H,
Kvitkina T,
Narres M.
et al.
Markedly Decreasing Incidence of Blindness in People With and Without Diabetes in
Southern Germany. Diabetes Care 2018; 41: 478-484
Reference Ris Wihthout Link
- 48
Scanlon PH.
The English National Screening Programme for diabetic retinopathy 2003–2016. Acta
Diabetol 2017; 54: 515-525
Reference Ris Wihthout Link
- 49
Bertram B,
Gante C,
Hilgers RD.
[Increase in examinations for cataracts, glaucoma, diabetic retinopathy and age-related
macular degeneration: Comparative cross-sectional study between 2010 and 1997 in ophthalmological
practices]. Ophthalmologe 2014; 111: 757-764
Reference Ris Wihthout Link
- 50
Schuster AK,
Wolfram C,
Pfeiffer N.
et al.
[Ophthalmology 2019-where do we stand?: An analysis of the treatment situation in
Germany]. Ophthalmologe 2019; 116: 829-837
Reference Ris Wihthout Link
- 51
Schuster AK,
Wolfram C,
Bertram B.
et al.
[Who visits an ophthalmologist and how often? Results of the German nationwide adult
health survey (DEGS1)]. Ophthalmologe 2018; 115: 1042-1049
Reference Ris Wihthout Link
- 52
Kreft D,
McGuinness MB,
Doblhammer G.
et al.
Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between
2004 and 2013 – A prospective cohort study based on health claims data. PLoS One 2018;
13: e0195426
Reference Ris Wihthout Link
- 53
Baumeister SE,
Schomerus G,
Andersen RM.
et al.
Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012.
Nutr Metab Cardiovasc Dis 2015; 25: 906-915
Reference Ris Wihthout Link
- 54
Wenzel M,
Schayan K,
Wirbelauer C.
et al.
Ambulante und stationäre Intraokularchirurgie 2020/21: Ergebnisse der aktuellen Umfrage
im Corona-Jahr von BDOC, BVA, DGII und DOG. Im Internet (Stand: 17.07.2023): http://bdoc.info/dl/aktuelles_ambulante-intraokularchirurgie_wenzel-et-al-umfrage-2020.pdf
Reference Ris Wihthout Link
- 55
Wenzel M,
Kohnen T,
Scharrer A.
et al.
Umfrage von DGII, BVA und BDOC zur ambulanten Intraokularchirurgie 2009. 2010. Im
Internet (Stand: 17.07.2023): https://www.dgii.org/uploads/jahresband/2010/Wenzel.pdf
Reference Ris Wihthout Link
- 56
König SF,
Spital G,
Ziemssen F.
et al.
[Photo-based examination for diabetic eye pathologies in a German ophthalmological
practice without personal doctor-patient contact]. Ophthalmologie 2023; 120: 301-308
Reference Ris Wihthout Link
- 57
Paul S,
Tayar A,
Morawiec-Kisiel E.
et al.
[Use of artificial intelligence in screening for diabetic retinopathy at a tertiary
diabetes center]. Ophthalmologie 2022; 119: 705-713
Reference Ris Wihthout Link
- 58
Stebbins K,
Kieltyka S,
Chaum E.
Follow-Up Compliance for Patients Diagnosed with Diabetic Retinopathy After Teleretinal
Imaging in Primary Care. Telemed J E Health 2021; 27: 303-307
Reference Ris Wihthout Link
- 59
Channa R,
Wolf RM,
Abràmoff MD.
et al.
Effectiveness of artificial intelligence screening in preventing vision loss from
diabetes: a policy model. NPJ Digit Med 2023; 6: 53
Reference Ris Wihthout Link
- 60
Rajalakshmi R,
Subashini R,
Anjana RM.
et al.
Automated diabetic retinopathy detection in smartphone-based fundus photography using
artificial intelligence. Eye (Lond) 2018; 32: 1138-1144
Reference Ris Wihthout Link
- 61
Kumari S,
Venkatesh P,
Tandon N.
et al.
Selfie fundus imaging for diabetic retinopathy screening. Eye (Lond) 2022; 36: 1988-1993
Reference Ris Wihthout Link
- 62
Ryu G,
Lee K,
Park D.
et al.
A deep learning model for identifying diabetic retinopathy using optical coherence
tomography angiography. Sci Rep 2021; 11: 23024
Reference Ris Wihthout Link
- 63
Maturi RK,
Glassman AR,
Josic K.
et al.
Effect of Intravitreous Anti-Vascular Endothelial Growth Factor vs. Sham Treatment
for Prevention of Vision-Threatening Complications of Diabetic Retinopathy: The Protocol
W Randomized Clinical Trial. JAMA Ophthalmol 2021; 139: 701-712
Reference Ris Wihthout Link