The Burden of Premature Vision Loss: Working-Age Vulnerability to Proliferative Diabetic Retinopathy in Indonesia
Article Sidebar
Main Article Content
Abstract
Background: Diabetic retinopathy (DR) poses a critical threat to the productive workforce in developing nations. While disease duration and hyperglycemia are established risk factors, the distinct clinical aggression of young-onset Type 2 diabetes remains under-characterized in resource-limited settings. This study aimed to identify independent predictors of Proliferative Diabetic Retinopathy (PDR), specifically evaluating the differential risk profiles between working-age and elderly patients.
Methods: A retrospective cross-sectional study was conducted on 118 patients with confirmed DR (NPDR=41; PDR=77) at a tertiary eye center in Indonesia. Multivariate logistic regression was performed to determine independent predictors, adjusting for potential confounders including hypertension and gender.
Results: The cohort exhibited a high prevalence of advanced disease (65.3% PDR). Multivariate analysis revealed that age ≥60 years was significantly associated with a reduced risk of PDR (aOR 0.280; 95% CI 0.098–0.803; p=0.017), indicating an approximately 3.6-fold higher risk in the working-age demographic (40–59 years). Diabetes duration ≥10 years (aOR 3.805; p=0.006) and HbA1c ≥7.2% (aOR 3.856; p=0.006) were confirmed as robust independent predictors.
Conclusion: Working-age patients exhibit a significantly more aggressive disease phenotype independent of diabetes duration and glycemic control. These findings suggest that current age thresholds may underestimate risk in younger populations, supporting the need for intensified retinal screening immediately upon diagnosis for early-onset patients to mitigate the socioeconomic impact of premature blindness.
Keywords
Diabetic Retinopathy, Diabetes Mellitus, Risk Assessment, Severity of Illness Index, Blindness
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
2. Shen Z, Wu Q, Wang Z, Chen G, Lin B. Diabetic retinopathy prediction by ensemble learning based on biochemical and physical data. Sensors. 2021;21(11):3663. doi:10.3390/s21113663.
3. V D, N R, J KK. Prevalence of diabetic retinopathy among type 2 diabetes mellitus in tertiary care centre. Journal of Case Reports and Scientific Images. 2020;2(2):17–20. doi:10.22271/27080056.2020.v2.i2a.20.
4. Novian Adi Saputra, Weni Helvinda, Khalilul Rahman. Prevalence and risk factors of diabetic retinopathy in a tertiary hospital in padang, indonesia. Bioscientia Medicina : Journal of Biomedicine and Translational Research. 2024;9(1):6045–57. doi:10.37275/bsm.v9i1.1173.
5. Lu VI, Patnaik JL, Scott RA, Lynch AM, Smith JM, Mandava N, et al. Risk factors and outcomes of delayed presentation of diabetic retinopathy patients to a county hospital. Translational Vision Science & Technology. 2023;12(9):8. doi:10.1167/tvst.12.9.8.
6. Kibirige D, Chamba N, Andia-Biraro I, Kilonzo K, Laizer SN, Sekitoleko I, et al. Indicators of optimal diabetes care and burden of diabetes complications in africa: a systematic review and meta-analysis. BMJ Open. 2022;12(11):e060786. doi:10.1136/bmjopen-2022-060786.
7. Li Y, Zhang D, Ren Q, Su X, Sun Z. Prevalence and risk factors of diabetic retinopathy in diabetic patients. Medicine. 2020;99(9):e19236. doi:10.1097/md.0000000000019236.
8. Middleton TL, Constantino MI, Molyneaux L, D’Souza M, Twigg SM, Wu T, et al. Youngâ€onset type 2 diabetes and younger current age: increased susceptibility to retinopathy in contrast to other complications. Diabetic Medicine. 2020;37(6):991–9. doi:10.1111/dme.14238.
9. Alharbi AD, Alotayk NI, Alaboudi AA, Alammar A y, Aldekhail MI, Alharbi MA, et al. Prevalence and visual consequences of non-adherent patients receiving anti-vascular endothelial growth factor (vegf) injections at king fahad specialist hospital (kfsh), qassim region. Cureus. 2023; doi:10.7759/cureus.44340.
10. PoráÄová J, Nagy M, Mydlárová BlaÅ¡Äáková M, KoneÄná M, Sedlák V, Zahatňanská M, et al. Diabetes mellitus and its influence on the incidence and process of diabetic retinopathy. Central European Journal of Public Health. 2023;31(Suppl 1):S4–9. doi:10.21101/cejph.a7838.
11. Zhang X, Huang Y, Xu N, Feng W, Qiao J, Liu M. Low serum dehydroepiandrosterone levels are associated with diabetic retinopathy in patients with type 2 diabetes mellitus. Journal of Diabetes Investigation. 2023;14(5):675–85. doi:10.1111/jdi.13997.
12. Kang Q, Yang C. Oxidative stress and diabetic retinopathy: molecular mechanisms, pathogenetic role and therapeutic implications. Redox Biology. 2020;37:101799. doi:10.1016/j.redox.2020.101799.
13. Queiroz RAM, Souza CEL de, Khouri LLMB, Santos SV, Barros GL, Silva MAC, et al. Diabetes mellitus and hypothyroidism: features of clinical and pathogenetic relationships. Advances in Research. 2025;26(2):457–71. doi:10.9734/air/2025/v26i21313.
14. Tang A, Zhang Y, Wu L, Lin Y, Lv L, Zhao L, et al. Klotho’s impact on diabetic nephropathy and its emerging connection to diabetic retinopathy. Frontiers in Endocrinology. 2023;14. doi:10.3389/fendo.2023.1180169.
15. DÃaz-Coránguez M, Lin CM, Liebner S, Antonetti DA. Norrin restores blood-retinal barrier properties after vascular endothelial growth factor–induced permeability. Journal of Biological Chemistry. 2020;295(14):4647–60. doi:10.1074/jbc.RA119.011273.
16. Bijelic R, Balaban J, Milicevic S, Sipka S. The association of obesity and microvascular complications with glycemic control in patients with type 2 diabetes mellitus. Medical Archives. 2020;74(1):14. doi:10.5455/medarh.2020.74.14-18.
17. Zegeye AF, Temachu YZ, Mekonnen CK. Prevalence and factors associated with diabetes retinopathy among type 2 diabetic patients at northwest amhara comprehensive specialized hospitals, northwest ethiopia 2021. BMC Ophthalmology. 2023;23(1):9. doi:10.1186/s12886-022-02746-8.
18. Wondmeneh TG, Mohammed JA. Prevalence of diabetic retinopathy and its associated risk factors among adults in ethiopia: a systematic review and meta-analysis. Scientific Reports. 2024;14(1):28266. doi:10.1038/s41598-024-78596-9.
19. Singhal A, Saxena D, G A, Ahada RS, Kurian NM, Singh AP, et al. Micro- and macrovascular complications in early-onset type 2 diabetes in indians: prevalence and predictors in a prospective cross-sectional study. Endocrine Connections. 2025;14(8). doi:10.1530/EC-25-0226.
20. Hill S, Mullins P, Murphy R, Schmiedel O, Vaghefi E, Ramke J, et al. Risk factors for progression to referable diabetic eye disease in people with diabetes mellitus in auckland, new zealand: a 12-year retrospective cohort analysis. Asia-Pacific Journal of Ophthalmology. 2021;10(6):579–89. doi:10.1097/APO.0000000000000464.
21. Å ulak M, Jevnikar K, DrnovÅ¡ek F, Vrhovec L, UrbanÄiÄ M, PotrÄ M, et al. A stepwise implementation of the slovenian national diabetic retinopathy screening program – evaluation of the first 4.5 years. European Journal of Ophthalmology. 2025;35(2):660–8. doi:10.1177/11206721241267029.
22. Park J, Hwang JH, Kang MJ, Sim HE, Kim JS, Ko KS. Effects of glycemic variability on the progression of diabetic retinopathy among patients with type 2 diabetes. Retina. 2021;41(7):1487–95. doi:10.1097/iae.0000000000003049.
23. Medina-RamÃrez SA, Soriano-Moreno DR, Tuco KG, Castro-DÃaz SD, Alvarado-Villacorta R, Pachecoâ€Mendoza J, et al. Prevalence and incidence of diabetic retinopathy in patients with diabetes of latin america and the caribbean: a systematic review and meta-analysis. Plos One. 2024;19(4):e0296998. doi:10.1371/journal.pone.0296998.