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Ronald Klein - One of the best experts on this subject based on the ideXlab platform.
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prevalence of diabetic Retinopathy in the united states 2005 2008
JAMA, 2010Co-Authors: Xinzhi Zhang, Barbara E. K. Klein, Jinan B Saaddine, Chiufang Chou, Mary Frances Cotch, Yiling J Cheng, Linda S Geiss, Edward W Gregg, Ann L Albright, Ronald KleinAbstract:Context The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic Retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic Retinopathy exists. Objectives To describe the prevalence and risk factors of diabetic Retinopathy among US adults with diabetes aged 40 years and older. Design, Setting, and Participants Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A1c of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. Main Outcome Measurements Diabetic Retinopathy and vision-threatening diabetic Retinopathy. Results The estimated prevalence of diabetic Retinopathy and vision-threatening diabetic Retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic Retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic Retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic Retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic Retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A1c level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). Conclusion In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic Retinopathy and vision-threatening diabetic Retinopathy was high, especially among Non-Hispanic black individuals.
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three year incidence and cumulative prevalence of Retinopathy the atherosclerosis risk in communities study
American Journal of Ophthalmology, 2007Co-Authors: Ronald Klein, Barbara E. K. Klein, Tien Yin Wong, Mary Frances Cotch, F Amirul M Islam, David Couper, Larry D Hubbard, Richey A SharrettAbstract:Purpose To describe the three-year incidence and cumulative prevalence of Retinopathy and its risk factors. Design Population-based, prospective cohort study in four US communities. Methods In the Atherosclerosis Risk in Communities (ARIC) Study, 981 participants had retinal photography of one randomly selected eye at the third examination (1993 to 1995) and three years later at the fourth examination (1996). Photographs were graded on both occasions for Retinopathy signs (for example, microaneurysm, retinal hemorrhage, and/or cotton-wool spots). Incidence was defined as participants without Retinopathy at the third examination who developed Retinopathy at the fourth examination, and cumulative prevalence was defined to include incident Retinopathy as well as participants who had Retinopathy at both the third and fourth examinations. Results The three-year incidence and cumulative prevalence of any Retinopathy in the whole cohort was 3.8% and 7.7%, respectively. In multivariable analysis, incident Retinopathy was related to higher mean arterial blood pressure (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0 to 2.3, per standard deviation increase in risk factor levels), fasting serum glucose (OR 1.6, 95% CI 1.3 to 2.1), serum total cholesterol (OR 1.4, 95% CI 1.0, 2.0), and plasma fibrinogen (OR 1.4, 95% CI 1.1 to 1.9). Among persons without diabetes, the three-year incidence and cumulative prevalence of nondiabetic Retinopathy was 2.9% and 4.3%, respectively. Incident nondiabetic Retinopathy was related to higher mean arterial blood pressure (OR 1.4, 95% CI 0.9 to 2.3) and fasting serum glucose (OR 1.5, 95% CI 1.0 to 2.3). Among persons with diabetes, the three-year incidence and cumulative prevalence of diabetic Retinopathy was 10.1% and 27.2%, respectively. Conclusions Retinopathy signs occur frequently in middle-aged people, even in those without diabetes. Hypertension and hyperglycemia are risk factors for incident Retinopathy.
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familial aggregation of severity of diabetic Retinopathy in mexican americans from starr county texas
Diabetes Care, 2005Co-Authors: Michael D Hallman, Ronald Klein, Barbara E. K. Klein, Charles J Huber, Victor H Gonzalez, Craig L HanisAbstract:OBJECTIVE —Diabetic Retinopathy is a major cause of blindness. To determine whether Retinopathy itself or only its severity aggregates in families, we examined the occurrence and severity of diabetic Retinopathy in Mexican-American siblings with type 2 diabetes. RESEARCH DESIGN AND METHODS —Using stereoscopic fundus photography of seven standard fields, we measured Retinopathy in 656 type 2 diabetic patients from 282 Mexican-American families from Starr County, Texas. Retinopathy severity was scored using the Early Treatment of Diabetic Retinopathy Study system and classified as no Retinopathy, early nonproliferative diabetic Retinopathy (NPDR-E), moderate-to-severe nonproliferative diabetic Retinopathy (NPDR-S), or proliferative diabetic Retinopathy (PDR). RESULTS —Of 249 siblings of randomly selected probands with Retinopathy, 169 (67.9%) had Retinopathy, compared with 95 of 125 siblings of unaffected probands (76.0%; P = 0.11). Proband Retinopathy class was associated ( P = 0.03) with sibling Retinopathy class, with significant odds ratios (ORs) for NPDR-E versus no Retinopathy (OR 0.57 [95% CI 0.35–0.93]) and PDR versus NPDR-E (2.02 [1.13–3.63]); the contrast of NPDR-S versus NPDR-E approached significance (1.78 [0.99–3.20]). With the more severe classes (PDR and NPDR-S) combined in one group and the less severe ones (none and NPDR-E) in another, more severe proband Retinopathy was associated with more severe sibling Retinopathy (1.72 [1.03–2.88]). CONCLUSIONS —More severe diabetic Retinopathy showed evidence of familial aggregation, but the occurrence of diabetic Retinopathy per se did not. The factors involved in the onset of diabetic Retinopathy may differ from those involved in its progression to more severe forms.
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the relationship of diabetic Retinopathy to preclinical diabetic glomerulopathy lesions in type 1 diabetic patients the renin angiotensin system study
Diabetes, 2005Co-Authors: Ronald Klein, Scot E. Moss, Bernard Zinman, Robert Gardiner, Samy Suissa, Sandra Donnelly, Alan R Sinaiko, Michael S Kramer, Paul Goodyer, Trudy StrandAbstract:Few epidemiological data exist regarding the correlation of anatomic measures of diabetic Retinopathy and nephropathy, especially early in the disease processes. The aim of this study was to examine the association of severity of diabetic Retinopathy with histological measures of diabetic nephropathy in normoalbuminuric patients with type 1 diabetes. The study included participants ( n = 285) in the Renin-Angiotensin System Study (RASS; a multicenter diabetic nephropathy primary prevention trial) who were aged ≥16 years and had 2–20 years of type 1 diabetes with normal baseline renal function measures. Albumin excretion rate (AER), blood pressure, serum creatinine, and glomerular filtration rate (GFR) were measured using standardized protocols. Diabetic Retinopathy was determined by masked grading of 30° color stereoscopic fundus photographs of seven standard fields using the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. Baseline renal structural parameters, e.g., fraction of the glomerulus occupied by the mesangium or mesangial fractional volume [Vv(Mes/glom)] and glomerular basement membrane width, were assessed by masked electron microscopic morphometric analyses of research percutaneous renal biopsies. No Retinopathy was present in 36%, mild nonproliferative diabetic Retinopathy in 53%, moderate to severe nonproliferative diabetic Retinopathy in 9%, and proliferative diabetic Retinopathy in 2% of the cohort. Retinopathy was not related to AER, blood pressure, serum creatinine, or GFR. All renal anatomical end points were associated with increasing severity of diabetic Retinopathy, while controlling for other risk factors. These data demonstrate a significant association between diabetic Retinopathy and preclinical morphologic changes of diabetic nephropathy in type 1 diabetic patients.
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the prevalence of diabetic Retinopathy among adults in the united states
Archives of Ophthalmology, 2004Co-Authors: John H Kempen, Ronald Klein, Scot E. Moss, B J Ocolmain, M C Leske, S M Haffner, Hugh R Taylor, Richard F HammanAbstract:Objective: To determine the prevalence of diabetic Retinopathy among adults 40 years and older in the United States.Methods: Pooled analysis of data from 8 population-based eye surveys was used to estimate the prevalence, among persons with diabetes mellitus (DM), of Retinopathy and of vision-threatening Retinopathy-defined as proliferative or severe nonproliferative Retinopathy and/or macular edema. Within strata of age, race/ethnicity, and gender, US prevalence rates were estimated by multiplying these values by the prevalence of DM reported in the 1999 National Health Interview Survey and the 2000 US Census population.Results: Among an estimated 10.2 million US adults 40 years and older known to have DM, the estimated crude prevalence rates for Retinopathy and vision-threatening Retinopathy were 40.3% and 8.2%, respectively. The estimated US general population prevalence rates for Retinopathy and vision-threatening Retinopathy were 3.4% (4.1 million persons) and 0.75% (899000 persons). Future projections suggest that diabetic Retinopathy will increase as a public health problem, both with aging of the US population and increasing age-specific prevalence of DM over time.Conclusion: Approximately 4.1 million US adults 40 years and older have diabetic Retinopathy; 1 of every 12 persons with DM in this age group has advanced, vision-threatening Retinopathy.
Chong Lee - One of the best experts on this subject based on the ideXlab platform.
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relative sensitivity and specificity of 10 2 visual fields multifocal electroretinography and spectral domain optical coherence tomography in detecting hydroxychloroquine and chloroquine Retinopathy
Clinical Ophthalmology, 2014Co-Authors: David J Browning, Chong LeeAbstract:BACKGROUND The purpose of this study was to determine the relative sensitivity and specificity of 10-2 visual fields (10-2 VFs), multifocal electroretinography (mfERG), and spectral domain optical coherence tomography (SD-OCT) in detecting hydroxychloroquine Retinopathy. METHODS A total of 121 patients taking hydroxychloroquine (n=119) or chloroquine (n=2) with 10-2 VF, mfERG, and SD-OCT tests were retrospectively reviewed. Rates of test abnormality were determined. RESULTS Retinopathy was present in 14 and absent in 107. Eleven of 14 (78.6%) patients with Retinopathy were overdosed. Twelve (85.7%) had cumulative dosing greater than 1,000 g. The sensitivities of 10-2 VF, mfERG, and SD-OCT in detecting Retinopathy were 85.7%, 92.9%, and 78.6%, respectively. The specificities of 10-2 VF, mfERG, and SD-OCT in detecting Retinopathy were 92.5%, 86.9%, and 98.1%, respectively. Positive predictive values of 10-2 VF, mfERG, and SD-OCT in detecting Retinopathy were less than 30% for all estimates of hydroxychloroquine Retinopathy prevalence. Negative predictive values were >99% for all tests. CONCLUSION Based on published estimates of hydroxychloroquine Retinopathy prevalence, all three tests are most reliable when negative, allowing confident exclusion of Retinopathy in patients taking ≤6.5 mg/kg/day. Each test is less useful in allowing a confident diagnosis of Retinopathy when positive, especially in patients taking ≤6.5 mg/kg/day.
Tiago Eugenio Faria E Arantes - One of the best experts on this subject based on the ideXlab platform.
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macular and peripapillary spectral domain optical coherence tomography changes in sickle cell Retinopathy
Retina-the Journal of Retinal and Vitreous Diseases, 2015Co-Authors: Fabiana Brasileiro, Thayze T Martins, Silvio B Campos, Joao Lins De Andrade Neto, Vasco Bravofilho, Aderson S Araujo, Tiago Eugenio Faria E ArantesAbstract:PURPOSE To assess peripapillary retinal nerve fiber layer, macular ganglion cell complex, and total macular thicknesses using spectral domain optical coherence tomography on sickle cell disease patients with and without sickle Retinopathy. METHOD Nineteen eyes of 11 patients with hemoglobin sickle cell disease, 65 eyes of 36 patients with hemoglobin SS disease, and 48 eyes of 24 healthy subjects underwent spectral domain optical coherence tomography scanning (RTVue). Eyes of patients with sickle cell disease were classified into 3 groups according to posterior segment changes: no Retinopathy (n = 64), nonproliferative Retinopathy (n = 12), and proliferative Retinopathy (n = 8). RESULTS The central fovea in eyes with proliferative Retinopathy was thickened compared with control group, sickle cell disease without Retinopathy, and nonproliferative Retinopathy (P = 0.004); a difference between proliferative Retinopathy and sickle cell disease without Retinopathy groups was still present after age adjustment (P = 0.014). Eyes with proliferative changes showed higher ganglion cell complex focal loss of volume compared with control group (P = 0.002), even after age adjustment (P = 0.004). Thinning of the nasal retinal nerve fiber layer quadrant was observed in eyes with proliferative Retinopathy (P 0.05). CONCLUSION Peripheral changes secondary to proliferative sickle Retinopathy were associated with thinning of macular inner retinal layers and thickening of central fovea.
Scot E. Moss - One of the best experts on this subject based on the ideXlab platform.
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the relationship of diabetic Retinopathy to preclinical diabetic glomerulopathy lesions in type 1 diabetic patients the renin angiotensin system study
Diabetes, 2005Co-Authors: Ronald Klein, Scot E. Moss, Bernard Zinman, Robert Gardiner, Samy Suissa, Sandra Donnelly, Alan R Sinaiko, Michael S Kramer, Paul Goodyer, Trudy StrandAbstract:Few epidemiological data exist regarding the correlation of anatomic measures of diabetic Retinopathy and nephropathy, especially early in the disease processes. The aim of this study was to examine the association of severity of diabetic Retinopathy with histological measures of diabetic nephropathy in normoalbuminuric patients with type 1 diabetes. The study included participants ( n = 285) in the Renin-Angiotensin System Study (RASS; a multicenter diabetic nephropathy primary prevention trial) who were aged ≥16 years and had 2–20 years of type 1 diabetes with normal baseline renal function measures. Albumin excretion rate (AER), blood pressure, serum creatinine, and glomerular filtration rate (GFR) were measured using standardized protocols. Diabetic Retinopathy was determined by masked grading of 30° color stereoscopic fundus photographs of seven standard fields using the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. Baseline renal structural parameters, e.g., fraction of the glomerulus occupied by the mesangium or mesangial fractional volume [Vv(Mes/glom)] and glomerular basement membrane width, were assessed by masked electron microscopic morphometric analyses of research percutaneous renal biopsies. No Retinopathy was present in 36%, mild nonproliferative diabetic Retinopathy in 53%, moderate to severe nonproliferative diabetic Retinopathy in 9%, and proliferative diabetic Retinopathy in 2% of the cohort. Retinopathy was not related to AER, blood pressure, serum creatinine, or GFR. All renal anatomical end points were associated with increasing severity of diabetic Retinopathy, while controlling for other risk factors. These data demonstrate a significant association between diabetic Retinopathy and preclinical morphologic changes of diabetic nephropathy in type 1 diabetic patients.
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the prevalence of diabetic Retinopathy among adults in the united states
Archives of Ophthalmology, 2004Co-Authors: John H Kempen, Ronald Klein, Scot E. Moss, B J Ocolmain, M C Leske, S M Haffner, Hugh R Taylor, Richard F HammanAbstract:Objective: To determine the prevalence of diabetic Retinopathy among adults 40 years and older in the United States.Methods: Pooled analysis of data from 8 population-based eye surveys was used to estimate the prevalence, among persons with diabetes mellitus (DM), of Retinopathy and of vision-threatening Retinopathy-defined as proliferative or severe nonproliferative Retinopathy and/or macular edema. Within strata of age, race/ethnicity, and gender, US prevalence rates were estimated by multiplying these values by the prevalence of DM reported in the 1999 National Health Interview Survey and the 2000 US Census population.Results: Among an estimated 10.2 million US adults 40 years and older known to have DM, the estimated crude prevalence rates for Retinopathy and vision-threatening Retinopathy were 40.3% and 8.2%, respectively. The estimated US general population prevalence rates for Retinopathy and vision-threatening Retinopathy were 3.4% (4.1 million persons) and 0.75% (899000 persons). Future projections suggest that diabetic Retinopathy will increase as a public health problem, both with aging of the US population and increasing age-specific prevalence of DM over time.Conclusion: Approximately 4.1 million US adults 40 years and older have diabetic Retinopathy; 1 of every 12 persons with DM in this age group has advanced, vision-threatening Retinopathy.
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the wisconsin epidemiologic study of diabetic Retinopathy xvii the 14 year incidence and progression of diabetic Retinopathy and associated risk factors in type 1 diabetes
Ophthalmology, 1998Co-Authors: Ronald Klein, Scot E. Moss, Barbara E. K. Klein, Karen J CruickshanksAbstract:Abstract Objective To examine the 14-year incidence and progression of diabetic Retinopathy and macular edema and its relation to various risk factors. Design Population-based incidence study. Setting The study was conducted in an 11-county area in southern Wisconsin. Participants Six hundred thirty-four insulin-taking persons with diabetes diagnosed before age 30 years participated in baseline, 4-year, 10-year, and 14-year follow-up examinations. Main outcome measures The 14-year progression of Retinopathy, progression to proliferative Retinopathy, and incidence of macular edema were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study Retinopathy severity scheme. Results The 14-year rate of progression of Retinopathy was 86%, regression of Retinopathy was 17%, progression to proliferative Retinopathy was 37%, and incidence of macular edema was 26%. Progression of Retinopathy was more likely with less severe Retinopathy, being male, having higher glycosylated hemoglobin or diastolic blood pressure at baseline, an increase in the glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of proliferative Retinopathy or incidence of macular edema was associated with more severe baseline Retinopathy, higher glycosylated hemoglobin at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examination. The increased risk of proliferative Retinopathy was associated with the presence of hypertension at baseline, whereas the increased risk of a participant having macular edema develop was associated with the presence of gross proteinuria at baseline. Lower glycosylated hemoglobin at baseline was associated with improvement in Retinopathy. Conclusions These data suggest relatively high 14-year rates of progression of Retinopathy and incidence of macular edema. These data also suggest that a reduction of hyperglycemia and hypertension may result in a beneficial decrease in the progression to proliferative Retinopathy.
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is there an ethnic difference in the effect of risk factors for diabetic Retinopathy
Annals of Epidemiology, 1993Co-Authors: Steven M Haffner, Scot E. Moss, Braxton D Mitchell, Michael P Stern, Helen P Hazuda, Judith K Patterson, W A J Van Heuven, Ronald KleinAbstract:Mexican Americans have an increased prevalence and incidence of non-insulin-dependent diabetes mellitus (NIDDM). In addition, Mexican American diabetic subjects have an increased prevalence of Retinopathy relative to Caucasian diabetic subjects. In Mexican American diabetic subjects, established risk factors may have a stronger effect on diabetic Retinopathy, compared to Caucasian diabetic subjects. In this report, we compare the effect of established risk factors (age at examination, gender, age at diagnosis of diabetes, duration of diabetes, glycemia, type of therapy, systolic and diastolic blood pressure, and hypertension prevalence) between Caucasian diabetic subjects (n = 478), a low-risk population for NIDDM (Wisconsin Epidemiologic Study of Diabetic Retinopathy), and Mexican American diabetic subjects (n = 231), a high-risk population for NIDDM (San Antonio Heart Study). Retinopathy was classified into two categories (any or none) as assessed by seven standard stereoscopic retinal photographs read at the University of Wisconsin Reading Center. Mexican American diabetic subjects in Texas had an increased prevalence of any Retinopathy (odds ratio = 1.71, 95% confidence interval: 1.25, 2.34), compared to Caucasian diabetic subjects in Wisconsin. Longer duration of diabetes, more severe glycemia, earlier age at diagnosis, and insulin therapy were associated with diabetic Retinopathy in both Mexican Americans and Caucasians. Socioeconomic status was not associated with prevalence of Retinopathy. Moreover, the effect of risk factors for Retinopathy was similar in both ethnic groups. These findings suggest that a differential effect of risk factors in Mexican American and Caucasian diabetic subjects does not explain the higher prevalence of Retinopathy complications in the former, although we cannot exclude a more severe effect of glycemia on Retinopathy in Mexican Americans since different measures of glycemia were used in each study.
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epidemiology of proliferative diabetic Retinopathy
Diabetes Care, 1992Co-Authors: Ronald Klein, Barbara E. K. Klein, Scot E. MossAbstract:OBJECTIVE This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative diabetic Retinopathy. In addition, the relation of proliferative Retinopathy to other systemic complications associated with diabetes is reviewed. RESEARCH DESIGN AND METHODS The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at RESULTS The major finding is that proliferative Retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe Retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative Retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative Retinopathy in the younger-onset group. The presence of proliferative diabetic Retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, diabetic nephropathy, and mortality. In the WESDR, a significant number of diabetic people with proliferative Retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation. CONCLUSIONS These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative Retinopathy. They also suggest that once proliferative diabetic Retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative Retinopathy.
Tien Yin Wong - One of the best experts on this subject based on the ideXlab platform.
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traditional and novel risk factors of diabetic Retinopathy and research challenges
Current Medicinal Chemistry, 2013Co-Authors: Gavin S Tan, Kamran M Ikram, Tien Yin WongAbstract:Diabetic Retinopathy affects one-third of people with diabetes and is the most frequent cause of blindness in working aged adults. Although diabetic Retinopathy blindness appears to have fallen in the developed world, the rapidly increasing number of persons with diabetes worldwide has resulted in a continuous increase in the global burden of this disease. The major risk factors for diabetic Retinopathy include duration of diabetes, hyperglycemia, and hypertension, but this is accountable for only a small amount of the variation in the risk of diabetic Retinopathy. Research into new markers for Retinopathy including genetics, blood biomarkers and retinal imaging will further improve our understanding of the risk factors and pathogenesis of diabetic Retinopathy.
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serum apolipoprotein ai and b are stronger biomarkers of diabetic Retinopathy than traditional lipids
Diabetes Care, 2011Co-Authors: Muhammad Bayu Sasongko, Tien Yin Wong, Thanh T Nguyen, Ryo Kawasaki, Alicia J Jenkins, Jonathan E Shaw, Jie Jin WangAbstract:OBJECTIVE To describe and compare the associations of serum lipoproteins and apolipoproteins with diabetic Retinopathy. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 224 diabetic patients (85 type 1 and 139 type 2) from a diabetes clinic. Diabetic Retinopathy was graded from fundus photographs according to the Airlie House Classification system and categorized into mild, moderate, and vision-threatening diabetic Retinopathy (VTDR). Serum traditional lipids (total, LDL, non–HDL, and HDL cholesterol and triglycerides) and apolipoprotein AI (apoAI), apolipoprotein B (apoB), and the apoB-to-apoAI ratio were assessed. RESULTS Diabetic Retinopathy was present in 133 (59.4%) individuals. After adjustment for age, sex, diabetes duration, A1C, systolic blood pressure, and diabetes medications, the HDL cholesterol level was inversely associated with diabetic Retinopathy (odds ratio 0.39 [95% CI 0.16–0.94], highest versus lowest quartile; P trend = 0.017). The ApoAI level was inversely associated with diabetic Retinopathy (per SD increase, 0.76 [95% CI 0.59–0.98]), whereas apoB (per SD increase, 1.31 [1.02–1.68]) and the apoB-to-apoAI ratio (per SD increase, 1.48 [1.13–1.95]) were positively associated with diabetic Retinopathy. Results were similar for mild to moderate diabetic Retinopathy and VTDR. Traditional lipid levels improved the area under the receiver operating curve by 1.8%, whereas apolipoproteins improved the area by 8.2%. CONCLUSIONS ApoAI and apoB and the apoB-to-apoAI ratio were significantly and independently associated with diabetic Retinopathy and diabetic Retinopathy severity and improved the ability to discriminate diabetic Retinopathy by 8%. Serum apolipoprotein levels may therefore be stronger biomarkers of diabetic Retinopathy than traditional lipid measures.
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prevalence and risk factors for diabetic Retinopathy the singapore malay eye study
Ophthalmology, 2008Co-Authors: Tien Yin Wong, Jie Jin Wang, Ning Cheung, Wan Ting Tay, Tin Aung, Seangmei Saw, Su Chi Lim, Shyong E TaiAbstract:Purpose To describe the prevalence and risk factors of diabetic Retinopathy in Asian Malays. Design Population-based cross-sectional study. Participants Persons with diabetes of Malay ethnicity aged 40 to 80 years in Singapore. Methods Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Retinal photographs taken from both eyes were graded for diabetic Retinopathy using the modified Airlie House classification system. Main Outcome Measures Any diabetic Retinopathy, Retinopathy grades, macular edema, or vision-threatening Retinopathy. Results Of the 3261 persons who participated in this study, 757 (23.1%) had diabetes and gradable retinal photographs. In persons with diabetes, the overall prevalence of any Retinopathy was 35.0% (95% confidence interval [CI], 28.2–43.4), the overall prevalence of macular edema was 5.7% (95% CI, 3.2–9.9), and the overall prevalence of vision-threatening Retinopathy was 9.0% (95% CI, 5.8–13.8). Compared with men, women had significantly higher proportions with more severe diabetic Retinopathy, moderate (12% vs. 4%) and severe (3% vs. 0.2%) nonproliferative Retinopathy, proliferative Retinopathy (7% vs. 2%), and vision-threatening Retinopathy (13% vs. 3%). In multiple logistic regression, independent risk factors for any Retinopathy were longer diabetes duration (odds ratio [OR], 1.07; 95% CI, 1.04–1.09, per year increase), higher hemoglobin A1 c (OR, 1.21; 95% CI, 1.10–1.33, per % increase), hypertension (OR, 1.85; 95% CI, 1.04–3.30), and higher pulse pressure (OR, 1.34, 95% CI, 1.19–1.51, per 10-mmHg increase); older age (OR, 0.73; 95% CI, 0.57–0.93, per decade increase) and higher total cholesterol levels (OR, 0.75; 95% CI, 0.63–0.89, per 1-mmol/l increase) were protective of any Retinopathy. Vision-threatening Retinopathy additionally was associated with previous stroke (OR, 3.74; 95% CI, 1.24–11.26), cardiovascular disease (OR, 2.23; 95% CI, 1.08–4.62), and chronic kidney disease (OR, 4.45; 95% CI, 2.18–9.07). Female gender was not an independent risk factor for diabetic Retinopathy after adjusting for metabolic and socioeconomic risk factors. Conclusions One in 10 Malay adults with diabetes in Singapore has vision-threatening diabetic Retinopathy. Risk factors for Retinopathy in this population are largely similar to white populations elsewhere, suggesting that control of these risk factors may reduce both the prevalence and impact of Retinopathy. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
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three year incidence and cumulative prevalence of Retinopathy the atherosclerosis risk in communities study
American Journal of Ophthalmology, 2007Co-Authors: Ronald Klein, Barbara E. K. Klein, Tien Yin Wong, Mary Frances Cotch, F Amirul M Islam, David Couper, Larry D Hubbard, Richey A SharrettAbstract:Purpose To describe the three-year incidence and cumulative prevalence of Retinopathy and its risk factors. Design Population-based, prospective cohort study in four US communities. Methods In the Atherosclerosis Risk in Communities (ARIC) Study, 981 participants had retinal photography of one randomly selected eye at the third examination (1993 to 1995) and three years later at the fourth examination (1996). Photographs were graded on both occasions for Retinopathy signs (for example, microaneurysm, retinal hemorrhage, and/or cotton-wool spots). Incidence was defined as participants without Retinopathy at the third examination who developed Retinopathy at the fourth examination, and cumulative prevalence was defined to include incident Retinopathy as well as participants who had Retinopathy at both the third and fourth examinations. Results The three-year incidence and cumulative prevalence of any Retinopathy in the whole cohort was 3.8% and 7.7%, respectively. In multivariable analysis, incident Retinopathy was related to higher mean arterial blood pressure (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0 to 2.3, per standard deviation increase in risk factor levels), fasting serum glucose (OR 1.6, 95% CI 1.3 to 2.1), serum total cholesterol (OR 1.4, 95% CI 1.0, 2.0), and plasma fibrinogen (OR 1.4, 95% CI 1.1 to 1.9). Among persons without diabetes, the three-year incidence and cumulative prevalence of nondiabetic Retinopathy was 2.9% and 4.3%, respectively. Incident nondiabetic Retinopathy was related to higher mean arterial blood pressure (OR 1.4, 95% CI 0.9 to 2.3) and fasting serum glucose (OR 1.5, 95% CI 1.0 to 2.3). Among persons with diabetes, the three-year incidence and cumulative prevalence of diabetic Retinopathy was 10.1% and 27.2%, respectively. Conclusions Retinopathy signs occur frequently in middle-aged people, even in those without diabetes. Hypertension and hyperglycemia are risk factors for incident Retinopathy.
