Incidence and Risk Factors for Blindness in Adults With Diabetes: The Israeli National Diabetes Registry (INDR)

Miri Lutski*, Tamy Shohat, Nisim Mery, Inbar Zucker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To estimate the 3-year incidence of blindness among diabetes patients aged ≥18 years; to compare blindness incidence rates of persons with and without diabetes; and to investigate risk factors associated with diabetic retinopathy (DR), age-related macular degeneration (ARMD), glaucoma, and cataract-related blindness. Design: Cohort study. Methods: The Israeli National Diabetes Registry for 2012 was cross-linked with the database of blindness certifications obtained from the National Registry of the Blind. Blindness was defined as the receipt of an official certificate of blindness (a visual acuity of 3/60 or worse, or a visual field loss of <20 degrees in the better eye.) Incidence rates of blindness, overall and by main cause of blindness, were calculated for the years 2013-2015. Standardized morbidity ratios (SMRs) for 2013 were calculated, using the nondiabetic population as a reference. A multinomial logistic model was used to identify covariates associated with the incidence of blindness by main cause of blindness. Results: The 3-year incidence rates were 31.0 and 8.4 per 10 000 for overall and DR-related blindness, respectively. The SMR for overall blindness in people with diabetes was significantly higher than in the general nondiabetic population (1.39; 95% confidence interval: 1.27–1.53); however, the SMRs for ARMD, glaucoma, and cataract were not statistically significant. Poor metabolic control, insulin treatment, long diabetes duration, and chronic kidney disease were associated with DR-related blindness. Low socioeconomic status (SES) was associated with both cataract and DR-related blindness. Conclusions: Optimum metabolic control of diabetes is important for prevention of DR-related blindness. SES-related disparities in blindness risk should be explored and reduced by directing efforts to provide appropriate treatment for all diabetic patients in order to prevent unnecessary blindness.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalAmerican Journal of Ophthalmology
StatePublished - Apr 2019


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