Purpose: Diabetes Mellitus (DM) is a prevalent metabolic disorder associated with significant complications, including visual impairment. This study aimed to assess the prevalence and severity of visual impairment and its associated factors in diabetic patients in Libya. Methods: This cross-sectional study included 2365 DM patients (4730 eyes). Most participants were aged 30 - 49 (38.3%) and 50 - 69 (50.8%) with a nearly equal gender distribution (47.8% males, 52.2% females). Type 2 diabetes was predominant (92.6%), and 62.9% had HbA1c levels of 7.5% or higher. Results: Diabetic retinopathy (DR) was present in 2068 eyes (43.8%), with mild non-proliferative diabetic retinopathy (NPDR) affecting 1178 eyes (25%), moderate NPDR 476 eyes (10.1%), severe NPDR 228 eyes (4.8%), and proliferative diabetic retinopathy (PDR) 186 eyes (3.9%). Diabetic maculopathy was observed in 621 eyes (13.1%), with CSME in 287 eyes (6.07%) and non-CSME in 334 eyes (7.06%). Non-retinal conditions included cataracts in 1938 eyes (41%) and glaucoma in 252 eyes (5.3%). Visual impairment was observed in 1159 patients (49%), with 534 (23%) experiencing mild impairment, 382 (18%) moderate impairment, and 243 (12%) severe impairment; 142 patients (6%) were classified as legally blind. DR showed a strong association with visual impairment severity (p < 0.001). Cataracts, diabetic maculopathy, and glaucoma also correlated significantly with visual impairment severity (p < 0.001). The duration of diabetes and systemic comorbidities demonstrated significant associations with visual impairment (p < 0.001). Conclusions: These findings underscore the urgency for targeted public health interventions to mitigate visual impairment in Libyan individuals with DM.
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