The Wisconsin Epidemiologic Study of Diabetic Retinopathy: IV. Diabetic Macular Edema

The prevalence of macular edema and its relationship to a number of risk factors were examined in a population-based study in southern Wisconsin. Macular edema was determined from its presence on stereoscopic fundus photographs or from past history as recorded and documented in clinic records and photographs. For participants whose age at diagnosis of diabetes was less than 30 years and who were taking insulin (n = 919), prevalence rates of macular edema varied from 0% in those who had diabetes less than 5 years to 29% in those whose duration of diabetes was 20 or more years. In these persons, macular edema was associated with longer duration of diabetes, presence of proteinuria, diuretic use, male gender and higher glycosylated hemoglobin. For those whose age at diagnosis was 30 years or older (n = 1121), prevalence rates of macular edema varied from 3% in those who had diabetes less than 5 years to 28% in those whose duration of diabetes was 20 or more years. In these persons, presence of macular edema was associated with longer duration of diabetes, higher systolic blood pressure, insulin use, higher glycosylated hemoglobin, and presence of proteinuria.     

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VI. Retinal photocoagulation

The prevalence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study in southern Wisconsin. For participants whose age at diagnosis was less than 30 years and who were taking insulin (996 persons) the prevalence rate of panretinal photocoagulation (13.9%) was higher than that of focal photocoagulation (3.6%). For those whose age at diagnosis was 30 years or older (1370 persons), the prevalence rate for panretinal photocoagulation (3.6%) was slightly higher than that of focal photocoagulation (3.0%). Seventy-two percent of eyes of younger onset and 45% of eyes of older onset persons that had received panretinal photocoagulation treatment were found to have incomplete regression of retinal new vessels, and in approximately half of these eyes severe proliferative retinopathy (Diabetic Retinopathy Study High Risk Characteristics [DRS-HRC]) was present. Among eyes with DRS-HRC, 55% were found to be untreated.     

Alcohol consumption and the prevalence of diabetic retinopathy.

OBJECTIVE: To determine if alcohol consumption is associated with the prevalence of diabetic retinopathy. PARTICIPANTS: This study surveyed a population-based sample (n = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (n = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations completed by 996 and 891 (730 by persons age 21 or older) younger-onset persons, respectively, and 1370 and 987 older-onset persons, respectively. Data analyzed are from the 4-year follow-up examination. Questionnaires concerning consumption were completed at follow-up. MAIN OUTCOME MEASURE: Diabetic retinopathy as determined from stereographic fundus photography. RESULTS: After controlling for known risk factors in the adult younger-onset group, average alcohol consumption, as determined by questionnaire, was inversely associated with prevalence of proliferative diabetic retinopathy (PDR), odds ratio, 0.49; 95% confidence interval, 0.27 to 0.92. The trend was similar for recent consumption, odds ratio, 0.63; confidence interval, 0.37 to 1.09. In the older-onset groups taking or not taking insulin, average or recent alcohol consumption or usage history were not significantly associated with the prevalence of any retinopathy or PDR. CONCLUSIONS: Alcohol consumption does not appear to increase the risk of retinopathy and may have a beneficial effect in younger-onset persons, although further study is needed.     

The association of iris color with eye disease in diabetes

Iris (eye) color was examined for its effect on eye disease in a population-based study of diabetic retinopathy in Wisconsin. Eye color was determined by comparing the iris in a red reflex photograph with standard photographs. In younger-onset diabetic persons (N = 996), macular edema was more prevalent in persons with blue or grey eyes (12%) compared with intermediate (9%) or brown (6%) (P = 0.04). Cataracts were more prevalent in blue or grey eyes (32%) compared with intermediate (22%) or brown (20%) in the younger-onset group (P less than 0.001). In older-onset persons (N = 1370), intraocular pressure (IOP) was higher in persons with brown eyes (17.8 mmHg) compared with blue or grey (17.1 mmHg) or intermediate (16.6 mmHg) (P = 0.012). Eye color was not associated significantly with diabetic retinopathy in either the younger- or older-onset group or with age-related macular degeneration or glaucoma in the older-onset group.     

The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.     

Clinically significant macular edema and survival in type 1 and type 2 diabetes

PURPOSE: To investigate the association of clinically significant macular edema (CSME) and long-term survival in individuals with type 1 and type 2 diabetes. DESIGN: Population-based cohort study. METHODS: The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of individuals with diabetes diagnosed at either younger than 30 years of age (younger-onset group; n = 996) or 30 years of age or older (older-onset group; n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria. RESULTS: Prevalence of CSME was 5.9% and 7.5% for the younger- and older-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.96 to 2.07; P = .08) or ischemic heart disease mortality (HR, 1.14; 95% CI, 0.61 to 2.12; P = .68) in the younger-onset group. In the older-onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present (HR, 1.55; 95% CI, 1.25 to 1.92; P < .01; and HR, 1.56; 95% CI, 1.15 to 2.13; P < .01, respectively), when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (HR, 1.58; 95% CI, 1.07 to 2.35; P = .02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group. CONCLUSIONS: CSME seems to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be receiving care for detection and treatment of cardiovascular disease.     

Diabetic retinopathy in a black population: the Barbados Eye Study.

OBJECTIVE: The distribution of diabetic retinopathy in black populations is largely unknown. The authors present retinopathy data from the predominately black participants of the Barbados Eye Study (BES). DESIGN AND PARTICIPANTS: Prevalence study of 4631 participants based on a random sample of the Barbados population 40 to 84 years of age (84% participation). MAIN OUTCOME MEASURES: Diabetes was defined as self-reported history of physician-diagnosed diabetes or glycosylated hemoglobin greater than 10% (>2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees color stereo fundus photographs of the disc and macula. RESULTS: Diabetes was present in 19.4% of black (n = 4314), 15.2% of mixed (black and white; n = 184), and 7.5% of white/other (n = 133) self-reported racial groups. In the black/mixed population, regardless of diabetes status, the prevalence of retinopathy was 5.9%. In the 636 black and mixed participants with diabetes, the prevalence of retinopathy was 28.5%: 19.8% had minimum changes, 7.7% had moderate changes, and 0.9% had severe retinopathy. Clinically significant macular edema (CSME) was found in 8.6% of those with diabetes. CONCLUSIONS: In the population of African origin, approximately 1 in 17 persons had retinopathy. Among those with diabetes, 28.5% had retinopathy and 8.6% had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the black population.     

Neuroretinal rim area in diabetes mellitus

Neuroretinal rim area (NRA) may indicate the amount of viable optic nerve tissue. Changes in the NRA have been found to occur in people with glaucoma. We sought to determine whether there were effects of retinopathy and intraocular pressure (IOP) on NRA in eyes of people with diabetes. Measurements of optic discs and cups were taken from 35-mm stereoscopic slides taken with a Zeiss fundus camera. The photographs were taken during a population-based study. The difference between disc and cup area was taken to be the NRA. Median photographic NRA from 2085 right eyes was 10.5 mm2. In younger- and older-onset persons, NRA showed a tendency to increase with age and, inconsistently, with the severity of diabetic retinopathy; it decreased with increasing IOP in older-onset persons not taking insulin. The cohort was reevaluated 4 yr later. NRA increased in all groups. Measurements from photographs taken of a nondiabetic comparison group showed no change over the same interval. These data suggest that NRA may be affected by diabetes. This could be due to nerve swelling.     

Automated detection and quantification of venous beading using Fourier analysis.

Venous beading associated with diabetic retinopathy is currently assessed by means of subjective comparison to standard photographs from the modified Airlie House classification scheme. We describe a computerized grading scheme for venous beading. The algorithm, based on Fourier analysis of vessel width measurements, generates a venous beading index (VBI) for digitized colour fundus photographs. Colour photographs of local vessel segments about 1200 microns in length were evaluated by experienced graders. A comparison between the VBI and subjective grading showed good agreement. The mean VBI values across the four levels of clinical grading were significantly different (p = 0.000). Multiple comparison testing indicated that the VBI was able to significantly differentiate between all four categories except the "questionable" (grade 1) category (p < 0.05). We also found that progression of venous beading can be followed with the VBI. The results indicate that further development of automated grading of venous beading is warranted.     

Prevalence of diabetic retinopathy and eye care in a rural area of Spain

objective To study the prevalence of diabetic retinopathy (DR) in a sample of 3544 patients living in a rural area of the province of Valladolid, Spain; as well as to estimate the current eye care to the diabetic population. methods Participants received a comprehensive ocular examination in their local area where they resided and a grading of DR was made using standard protocols. Physicians then provided us with the systemic and demographic data. results The population studied included 175 younger-onset and 3344 older-onset patients, all of whom were under physicians' care, distributed in an 18-county-area far from the urban center. Mean duration of the disease was 7.89 ± 7.7 years (range 0 to 59 years). 73% of participants had not received ophthalmologic care the preceding year and 63.6% had not received a dilated eye examination either. The prevalence of DR was 20.9%; macular edema was found in 5.7% of the patients. Differences in participation were found among counties and these also correlated with differences in prevalence of DR. Prevalence of DR in the younger-onset group was 25.6% and 14.81% in insulin- and non-insulin-dependent patients, respectively. In the older-onset group, it was present in 48.6% and 14.7% of insulin- and non-insulin-dependent patients. Patients with retinopathy were older, with a longer duration of disease, were insulin dependent and had had less eye care. conclusions Deficient screening of ophthalmic disease in diabetic patients should be improved, especially in isolated areas, in order to reduce DR in this group. Insulin-dependent older-onset patients with a longer duration of diabetes had a higher frequency of these complications.     

陕西农村50岁以上人群眼压不对称性与无确诊史青光眼相关研究

目的:通过对陕西省农村50岁以上人群眼压(IOP)不对称性的分布情况及其与无确诊史的调查,分析眼压不对称性与原发性青光眼之间的关系。方法:采用分层整群抽样法于2003-07/12在陕西省洋县、靖边县及富平县对50岁以上人口进行问卷调查,包括询问青光眼确诊史、家族史、发作史和手术史,并进行相关眼科检查,包括视力、眼压、外眼、眼前节、前房深度、眼底等,可疑青光眼者进行进一步检查,包括复查眼压、检查前房角、进行激发试验、检查视野等。双眼眼压之差≥3mmHg定义为眼压不对称性。服用抗青光眼药物者、有诊断史的青光眼患者、接受过白内障手术者及有不可信眼压的受检者不做为调查对象。结果:共调查50岁以上观察对象2125例,其中有1775例完成了青光眼的相关检查,受检率为83.53%。在排除了83例服用抗青光眼药物或有青光眼诊断史、或曾接受过白内障手术及眼压不可信的受检者后,共有1692例符合研究对象纳入标准。调查发现共有23例无青光眼确诊史的患者,患病率为1.36%(95%CI,0.88,2.07)。眼压不对称性共有124例,患病率为7.3%(95%CI,6.2,8.7)。通过Mantel-Haenszel分层分析,显示眼压不对称性的患病率随年龄的增长而显著增加(P=0.012)。双眼中最高眼压>21mmHg的受检者眼压不对称性的患病率(35.7%)明显高于最高眼压≤21mmHg的受检者(7.1%)。应用多因素非条件logistic回归分析显示眼压不对称性与无确诊史的原发性青光眼有显著性关联(OR为3.68;95%CI,1.37,9.86),此联系在双眼中的最高眼压≤21mmHg的受检者中依旧保持(OR为4.74;95%CI,1.16,19.35)。结论:对于那些没有出现高眼压并且还未诊断为青光眼的患者,眼压不对称性与原发性青光眼关联有统计学意义,提示临床上诊断原发性青光眼时,眼压不对称性可作为一个有价值的诊断参考指征。     

Apolipoprotein E gene polymorphisms are not associated with diabetic retinopathy: the atherosclerosis risk in communities study

PURPOSE: Polymorphism of the apolipoprotein E (APOE) gene has been associated with dyslipidemia and cardiovascular disease. This study examines the association of APOE polymorphisms and diabetic retinopathy. DESIGN: Population-based cross-sectional study. METHODS: We studied 1,398 people aged 49 to 73 years with diabetes selected from four United States communities. We performed retinal photography on one randomly selected eye and graded for the presence and severity of diabetic retinopathy using a modification of the Early Treatment Diabetic Retinopathy Study scale. We performed genotyping of common polymorphic APOE alleles using polymerase chain reaction on genomic DNA from venous blood leukocytes. RESULTS: The prevalence of diabetic retinopathy and hard exudates was 15.0% and 5.3% in Caucasians (n = 935), and 24.6% and 9.7% in African-Americans (n = 463), with type 2 diabetes. APOE gene polymorphisms were not associated with diabetic retinopathy in either Caucasians or African-Americans. In African-Americans, the 2/4 genotype (n = 6) was associated with increased prevalence of hard exudates (odds ratio [OR] 4.10, 95% confidence interval [CI] 1.30 to 12.90), as was the 2/3 genotype (n = 9, OR 2.64, 95% CI 1.01 to 6.95). No association between APOE genotypes and hard exudates was found in Caucasians. CONCLUSIONS: These data suggest that APOE gene polymorphisms are not associated with diabetic retinopathy in either Caucasians or African-Americans with type 2 diabetes.     

【In Press】 The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: A community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: Of a total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.     

MMP-2 Rs24386 (C-->T) gene polymorphism and the phenotype of age-related macular degeneration

AIM: To examine the MMP-2 (-1306 C/T) gene polymorphism and the phenotype characterized by soft and hard drusen of early age-related macular degeneration (AMD) and geographic atrophy of late AMD form. METHODS: The study enrolled 850 investigations (290 AMD patients with soft and hard drusen, 34 with geographic atrophy and a random sample of the population n=526). Early AMD was classified according to the International Classification and Grading System. For geographic atrophy diagnosis the Age-Related Eye Disease Study classification was used. The potential association with single nucleotide polymorphisms on MMP-2 Rs243865 was evaluated for all patients, adjusted for age and sex. The genotyping test of MMP-2 Rs243865 (C-->T) was conducted using the real-time polymerase chain reaction method. RESULTS: MMP-2 (-1306 C/T) C/C genotype was more frequently detected in AMD patients with hard drusen than the soft drusen or control group (66.43% vs 53.74%, vs 54.94%, P=0.047). Logistic regression analysis showed that the MMP-2 (-1306) C/C genotype increased the likelihood to develop hard drusen in AMD patients (OR=1.7, 95% CI: 1.06-2.74; P=0.028). No association between MMP-2 (-1306 C/T) gene polymorphism in patients with atrophic AMD and control group was found (54.94%, 37.64%, 7.41% vs 50%, 38.24%, 11.76%; P=0.6). CONCLUSION: The MMP-2 Rs24386 (C-->T) polymorphism is found to be associated with the development of hard drusen in patients with AMD.     

Primary intravitreal triamcinolone acetonide for diabetic massive macular hard exudates

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone acetonide as treatment for massive macular hard exudates in diabetic patients. METHODS: The study was a prospective, noncomparative, interventional case series of 12 eyes (12 patients) with massive hard exudates involving the fovea that had no previous focal laser treatment. A single intravitreal injection of 4 mg of triamcinolone acetonide in 0.1 mL was performed. Visual acuity and evolution of hard exudates and fluorescein leakage were assessed. Potential complications were monitored, including ocular hypertension and endophthalmitis. RESULTS: The follow-up period ranged from 6 to 12 months (mean, 8.25 months). Visual acuity improved significantly at examinations performed 7 days (P = 0.036), 1 month (P = 0.008), 3 months (P = 0.008), and 6 months (P = 0.003) after the injection. Visual acuity improved by at least 2 Snellen lines in 4 patients (33%). However, no eyes with initial visual acuity worse than 20/100 improved to better than 20/100. Foveal hard exudates resolved completely in 6 eyes (50%) and partially in 6 eyes (50%). Fluorescein leakage decreased and a variable proportion of microaneurysms disappeared in all cases. Intraocular pressure elevation occurred in 3 eyes (25%) and was successfully treated by topical medication. No other complications, such as endophthalmitis, were recorded. CONCLUSION: Intravitreal injection of triamcinolone acetonide appears to be beneficial for reducing hard exudates, decreasing fluorescein leakage, and significantly improving visual acuity in patients with diabetic massive hard exudates. Visual improvement may not be important due to profound anatomical impairment caused by hard exudate deposition. Further studies with a larger number of patients are required to assess the long-term efficacy and safety and the need for retreatment.     

Effects of lipid-lowering agents on diabetic retinopathy: a Meta-analysis and systematic review

AIM: To clarify this controversy and to provide evidence for application of lipid lowering agents in treatment of diabetic retinopathy (DR). METHODS: We searched the databases of PubMed, Embase and Cochrane Library Central Register of Controlled Trials (CENTRAL) and abstracts from main annual meetings up to January 1, 2017. Google scholar and ClinicalTrials.gov were also searched for unpublished relevant studies. We included randomized controlled trials (RCTs) that studied lipid-lowering agents in type 1 or type 2 diabetes in this Meta-analysis. The primary endpoint was the progression of DR, and the secondary endpoints included vision loss, development of diabetic macular edema (DME) and aggravation of hard exudates. The pooled odds ratios (OR) with corresponding 95% confidence intervals (95%CIs) were calculated. RESULTS: After systemic and manual literature search by two independent investigators, we included 8 RCTs from 7 published articles with 13 454 participants in this Meta-analysis. The results revealed that lipid-lowering drugs were associated with reduced risk in DR progression [OR=0.77 (95%CI: 0.62, 0.96), P=0.02]. Lipid-lowering agents might have protective effect on DME compared to placebo, although the difference was not statistically significant [OR=0.60 (95%CI: 0.34, 1.08), P=0.09]. However, no significant differences in the worsening of vision acuity [OR=0.96 (95%CI: 0.81,1.14), P=0.64] and hard exudates [OR=0.50 (95%CI:0.15, 1.74), P=0.28] were found between the lipid-lowering drugs and the placebo groups. CONCLUSION: In DR patients, lipid-lowering agents show a protective effect on DR progression and might be associated with reduced risk in the development of DME. However, lipid-lowering agents have no effects on vision loss and hard exudates aggravation. Further clinical trials in larger scale are required to confirm the conclusion of this study and thus justify the use of intensive control lipids with anti-lipid agents at the early stages of DR.     

Patterns of adherence to diabetes vision care guidelines: baseline findings from the Diabetic Retinopathy Awareness Program

OBJECTIVES: (1) To describe baseline patterns of adherence to American Diabetes Association and American Academy of Ophthalmology vision care guidelines for diabetes in the Diabetic Retinopathy Awareness Program, and (2) to evaluate factors associated with nonadherence. This paper describes the baseline characteristics of a population enrolled in a prospective, randomized clinical trial. DESIGN: Cross-sectional study. PARTICIPANTS: Between October 1993 and May 1994, the study identified 2308 persons with diabetes, 18 years of age or older, who were residents of Suffolk County, New York, via a multimedia community-wide recruitment campaign. INTERVENTION AND METHODS: Eligibility for the trial was determined during a 20-minute phone interview, which included questions about vision care practices; diabetes management; and knowledge, attitudes, and beliefs about diabetes, vision, and diabetic retinopathy. This paper describes these patient characteristics at baseline. Eligible patients would be randomized subsequently to a 2-year diabetes educational intervention arm, which included mailed packets and newsletters focused on vision care, or to a control nonintervention arm. MAIN OUTCOME MEASURE: Nonadherence to guidelines at baseline was defined as the absence of a dilated eye examination during the year before recruitment into the study. RESULTS: Of the 2308 persons interviewed, 813 (35%) did not follow the vision care guidelines; two thirds of this group reported no eye examination in the year before the interview, and one third had an undilated examination. Ophthalmologists performed 49% of the examinations in the nonadherent group, versus 86% in the adherent group. In logistic regression analyses, factors related to nonadherence were: younger age (odds ratio [OR] = 0.97), type 2 diabetes with or without insulin use (OR = 1.62 and 1.99, respectively), shorter diabetes duration (OR = 0.97), last eye examination performed by an optometrist (OR = 5.32) or other nonophthalmologist (OR = 4.29), less practical knowledge about diabetes (OR = 1.57), and no prior formal diabetes education (OR = 1.30). CONCLUSIONS: Within this population, more than one third of participants had not been following vision care guidelines. Nonadherence was linked to several potentially modifiable factors; changes in these factors could enhance the early detection of diabetic retinopathy.     

Relation between retinal thickening and clinically visible fundus pathologies in mild nonproliferative diabetic retinopathy

BACKGROUND AND OBJECTIVE: To determine the association of retinal thickening (RT) with clinically observable retinal pathologies in eyes with mild nonproliferative diabetic retinopathy. PATIENTS AND METHODS: Using an objective quantitative imaging method (Retinal Thickness Analyzer), the ratio relative to normal RT (RTI) was measured in 23 eyes with and 35 eyes without clinically observable diabetic fundus pathology. RTI was analyzed in relation to presence of mild diabetic retinal lesions in the +/-0.5 mm vicinity. RESULTS: The percent of eyes with RTI significantly above normal values did not differ significantly between eyes with and without retinopathy (30% vs 34%). Mean RTI was not associated with local presence of microaneurysms (P=0.92), soft exudates (P=0.55), or retinal hemorrhages (P=0.31). Areas without hard exudates had significantly greater mean RTI (1.10) than areas with exudates (0.97, P=0.009). CONCLUSION: In diabetic patients with mild retinopathy, areas with and without clinically observable retinal pathologies had similar retinal thickness. We conclude that clinical strategies for detection of retinal thickening should not be limited to areas with visible fundus pathologies.     

Retinal angiomatous proliferation: association with clinical and angiographic features

AIM: It was the aim of this study to evaluate the frequency of retinal angiomatous proliferation (RAP) and its association with specific clinical and angiographic characteristics in age-related macular degeneration (AMD). METHODS: A consecutive series of 126 newly diagnosed patients with exudative AMD was reviewed retrospectively. All underwent a complete ophthalmic examination, a red-free photograph and fluorescein angiography. Most patients (85/126) underwent indocyanine green choroidal angiography (ICGA). RAP was diagnosed when a connection between the retinal vasculature and the neovascular complex was recognized angiographically. RESULTS: Out of 126 patients with recent neovascular AMD, 17 had RAP (13.5%; 95% CI 8.1-20.7). The study eye of patients with RAP had more frequent hemorrhages (88.2 vs. 59.6%; p = 0.027), hard exudates (82.4 vs. 26.6%; p < 0.001), pigment epithelium detachment (64.7 vs. 23.8%; p = 0.001) and a hot spot in ICGA (70.6 vs. 22.1%; p < 0.001) with respect to the other forms of exudative AMD. Hemorrhages were more frequently superficial, multiple and within the edge of the lesion in the RAP group. Bilateral AMD was more common in the RAP group (70.6 vs. 38.0%; p = 0.011). No statistically significant differences were found regarding sex, age and visual acuity. CONCLUSION: RAP represents a common lesion in patients with neovascular AMD referred to a tertiary care clinic. The recognition of hemorrhages, hard exudates, pigment epithelium detachment or a hot spot in ICGA can assist a correct diagnosis.