Downward Trend of Vision-threatening DR Found Among Those 65 and Older

Relative to other age cohorts, the 65 and older cohort experienced the highest prevalence of disease in all years evaluated. However, the incidence rates within this cohort suggest that this level of prevalence is unlikely to persist, as the incidence of vision-threatening DR and DME fell below that of the 46 to 64 age cohort in 2021, and PDR incidence ended lower than both the 46 to 64 and 26 to 45 age cohorts. Photo: Steven Ferrucci, OD. Click image to enlarge. Tracking how the severity of diabetic retinopathy (DR) affects a patient’s risk of progressing to vision-threatening forms remains crucial to understanding ways to combat its effects best, especially among affected young adults. Researchers based at the University of Pennsylvania in Philadelphia sought to better understand the current prevalence and incidence of diabetic retinal disease and its vision-threatening forms, diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR), across all age cohorts in the US.The study team found no evidence to suggest that the diabetic retinal disease epidemic was worsening among young adults compared with other age groups. While the prevalence and incidence of disease increased across all age groups over 20 years, the ≥65 age group experienced the largest reductions in incidence of vision-threatening disease and PDR specifically.This retrospective cohort study, which was published in Ophthalmology Retina, comprised of members of commercial and Medicare Advantage health plans between 2000 and 2022. The researchers created cohorts of patients aged ≤25, 26 to 45, 46 to 64, and ≥65 from all patients with diabetes mellitus.Regression models revealed that age cohorts remained proportional with respect to overall diabetic retinal disease prevalence and incidence over the 20 years analyzed. The age cohort 25 and younger was always the lowest, followed by the 26 to 45, 46 to 64 and ≤65 cohorts, respectively.From the observed years of 2001 to 2021:Age ≤25: prevalence=3.0% to 4.5%, incidence=5.1 to 11.1 cases/1,000 person years (py)Ages 26 to 45: prevalence=6.3% to 10.9%, incidence=9.7 to 21.0 cases/1,000 pyAges 46 to 64: prevalence=10.6% to 15.7%, incidence=14.7 to 30.9 cases/1,000 pyAge ≥65: prevalence=13.2% to 23.1%, incidence=20.0 to 39.2 cases/1,000 pySimilar proportional relationships were seen for vision-threatening DR and DME prevalence. However, vision-threatening DR and DME incidence saw differences with the ≥65 age cohort (2022 vision-threatening DR=6.0 cases/1,000 py; DME=5.0), ending lower than the 44 to 64 age cohort (2022 vision-threatening DR=7.1 cases/1,000 py, DME=5.5 cases/1,000 py).PDR prevalence was highest in the ≥65 cohort (3.7%) until 2021, when it became similar to the 46 to 64 age cohort (3.5%). PDR incidence also declined significantly in the ≥65 cohort (2.3 cases/1,000 py), ending lower than the 46 to 64 cohort (3.8 cases/1,000 py) and similar to the 26 to 44 cohort (2.6 cases/1,000 py), but still higher than the ≤25 cohort (0.6 cases/1,000 py).“Taken together, it seems the concern over the increase in diabetic retinal disease in young adults is one that should be shared across all ages, in which the increases seen in those ≤25 are proportional (or even less) than those of other age cohorts,” the study authors wrote in their paper. “Despite this cross-age concern, directing additional resources to protecting the youngest who might be at risk of blindness across the longest life span is reasonable.”While the database used is national in scope, the research team noted that their study is not a statistical representation of the US population and may not generalize to other populations, including uninsured individuals or those covered by other forms of insurance (e.g., the Veterans Administration Health System). They suggested that future studies should examine whether the time from DM diagnosis to eye disease among these groups is changing.Click here for the journal source. Chang AY, Yu Y, Cardillo S, et al. Trends in prevalence and incidence of diabetic retinal disease across age cohorts. Ophthalmol Retina. March 9, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.