Prevalence of diabetes mellitus and arterial hypertension in primary and secondary open-angle glaucomas

• Background: This study was carried out to evaluate the prevalence of diabetes mellitus and arterial hypertension in the open-angle glaucomas. • Methods: The study consisted of 529 patients with primary open-angle glaucoma, including 170 patients with the age-related atrophic type and 22 patients with the highly myopic type; 152 patients with secondary open-angle glaucoma, including 85 patients with pseudoexfoliative glaucoma; 56 patients with the focal type of normal-pressure glaucoma; and 660 nonglaucomatous subjects in the control group. For all study groups, age-matched control groups were formed. • Results: Prevalence of diabetes mellitus and arterial hypertension did not vary significantly (P > 0.25; chi-square test) between the non-highly myopic primary open-angle glaucoma groups and the control groups. In highly myopic primary open-angle glaucoma, pseudoexfoliative glaucoma, and focal normal-pressure glaucoma, diabetes mellitus and arterial hypertension were less common; however, not in all cases was the difference from the control group significant. • Conclusions: The results suggest that diabetes mellitus and arterial hypertension are not more common in patients with primary and secondary open-angle glaucomas than in age-matched nonglaucomatous subjects. In agreement with some previous epidemiologic studies, diabetes mellitus and arterial hypertension may not be positively associated with the primary or secondary open-angle glaucomas. Received: 6 March 1997 Revised version received: 12 May 1997 Accepted: 6 June 1997     

Association of systemic hypertension and diabetes mellitus with cataract extraction. A case-control study

The authors conducted a case-control hospital-based study to assess the prevalence of systemic diseases and drugs in 161 cataract extraction patients and 196 surgical patients matched by age, sex, and race. The data were analyzed using matched multiple logistic regressions. A statistically significant increased risk of cataract extraction was found in patients with systemic hypertension (odds ratio [OR] = 1.49, 95% confidence interval [CI] = 1.06-2.09) and diabetes mellitus (OR = 1.79, 95% CI = 1.23-2.60). Estimation of the combined effect of systemic hypertension and diabetes mellitus resulted in an even higher risk for cataract extraction (OR = 2.66, 95% CI = 1.67-4.23). A positive association of cataract extraction and treatment of systemic hypertension with the diuretic furosemide was also found (OR = 1.95, 95% CI = 1.02-3.74).     

Prevalence of diabetic retinopathy in patients with recently diagnosed diabetes mellitus

Background: The severity of diabetic retinopathy is well known to have a close association with the duration of diabetes mellitus. Patients with recently diagnosed diabetes should have adequate eye examinations to eliminate the possibility of diabetic retinopathy being present because there is no accurate means of determining the duration of the disease. The prevalence of diabetic retinopathy in type 2 diabetic patients with known duration up to one year was investigated in the present study. Methods: A centre for diabetic retinopathy screening was set up in a community in Hong Kong. The screening procedures included history taking, visual acuity measurement, anterior ocular health assessment and retinal examination by fundus photography. Fundus photographs were taken in nine different positions of gaze through natural or dilated pupils. Using the criteria recommended by the American Optometric Association the retinopathy was graded in severity. ‘Recently diagnosed diabetes mellitus’ was defined as having diabetes diagnosed by a physician within the previous year. Results: A total of 12,112 patients having their first visits to the centre were recruited from 2006 to 2009. Among them, 3,510 patients had recently diagnosed diabetes. The mean age of patients was 59.5 years. The prevalence of diabetic retinopathy was 18.2 per cent (639 patients) among the recently diagnosed diabetic patients. Most of the patients had mild non‐proliferative diabetic retinopathy. In these 639 patients, approximately seven per cent had sight‐threatening retinopathy that included significant macular oedema, all of whom required monitoring. The presence of hypertension or smoking was not significantly associated with the prevalence of diabetic retinopathy in recently diagnosed diabetic patients. Conclusions: Screening for diabetic retinopathy is important for newly diagnosed diabetic patients. In Hong Kong, the prevalence of diabetic retinopathy was alarmingly high and some patients had already developed sight‐threatening retinopathy that included macular oedema. Most of them had no symptoms until the retinopathy progressed and they developed macular oedema. A systematic screening program in the community is needed for early detection and to reduce blindness in diabetic patients.     

Ocular factors relevant to keratoepitheliopathy in glaucoma patients with and without diabetes mellitus

PURPOSE: To examine the effect of diabetes mellitus on the keratoepitheliopathy in glaucoma patients with and without diabetes mellitus who were treated with anti-glaucoma eye drops. METHODS: The presence and severity of keratoepitheliopathy was investigated in the eyes of 36 glaucoma patients with diabetes mellitus and 47 nondiabetic patients who had glaucoma. All the patients had used anti-glaucoma eye drops. The ocular factors examined were the status of the lipid layer of the tear fluid assessed by a specular reflection video recording system, the tear volume assessed by the Schirmer test, and the tear film stability assessed by tear break-up time (BUT). RESULTS: The incidence of superficial punctate keratitis (SPK) was 36.1% in the diabetic patients with glaucoma and 27.7% in the nondiabetic patients with glaucoma. Serious cases of SPK were seen only in the diabetic patients with glaucoma. The uniformity of the tear lipid layer, results of the Schirmer test, and the tear BUT in the diabetic patients with glaucoma were similar to those in the nondiabetic patients with glaucoma. CONCLUSION: In glaucoma patients who use anti-glaucoma eye drops, the effects of diabetes mellitus on the keratoepitheliopathy and other ocular factors are not significant. However, we must consider the serious cases of keratoepitheliopathy in these patients.     

Neovascular glaucoma and vitreous hemorrhage following cataract surgery in patients with diabetes mellitus

The potential complications of cataract surgery in the general population are well known. In addition, cataract extraction in the patient with diabetes mellitus is associated with other potential complications common to this disease: neovascular glaucoma and acceleration of proliferative diabetic retinopathy with or without vitreous hemorrhage. We analyzed the records of 154 patients with diabetes mellitus who had undergone standard intracapsular cataract extraction in one eye only with the other eye serving as the unoperated control eye. We were able to determine the status of the diabetic retinopathy before the operation and to note the development of vitreous hemorrhage and rubeosis iridis/neovascular glaucoma after the operation. If either event occurred within six weeks of the surgery, it was considered to be a complication of the cataract extraction. Intracapsular cataract extraction in this diabetic population, without regard of the preoperative status of the retinopathy, was associated with a statistically significant incidence of postoperative rubeosis iridis/neovascular glaucoma (7.8% vs 0%). In patients with preoperative active proliferative diabetic retinopathy, the risk of developing postoperative rubeosis iridis/neovascular glaucoma was even higher (40% vs 0%). There was also a statistically significant incidence of vitreous hemorrhage after surgery in eyes with no diabetic retinopathy or background diabetic retinopathy (6.5% vs 0%). In patients with active proliferative diabetic retinopathy, there was an increased incidence of vitreous hemorrhage after surgery (20% vs 6.5%), but this was not statistically significant due to the small number of patients studied. Possible explanations for these findings are explored and therapeutic and prophylactic measures recommended.     

Prevalence and characteristics of glaucoma among Korean adults

Purpose

The purpose of this study was to investigate the prevalence and characteristics of glaucoma in the population of the rural Korean town, Sangju.

Methods

Residents of Sangju aged greater than 50 years old were included in this study. Participants completed an interview examining their medical and ophthalmic history Information was collected on the participants'' uncorrected and best corrected vision scores, slit lamp examination results, angle width measurements using the Van Herick technique, gonioscopy if the angle width was less than 1 / 4 angle, intraocular pressure (IOP) assessed with the Goldmann applanation tonometry, optic disc examination results, and a visual field test results using frequency-doubling perimetry in cases in which glaucoma was suspected. Glaucoma was diagnosed according to the criteria described by the International Society for Geographic and Epidemiological Ophthalmology.

Results

1,118 residents aged greater than 50 years were examined initially from a population of 2,984 people. Of these, 671 subjects (60%) participated in this study. The prevalence of glaucoma was determined to be 3.4% (95% confidence interval [CI], 2.1-4.8). Open-angle glaucoma with low IOP was determined to be the most common form with a prevalence rate as high as 2.5% (95% CI, 1.8-3.7). Additionally, primary angle closure glaucoma was determined to have a prevalence rate of 0.3% (95% CI, 0.1-0.9). Open-angle glaucoma with low IOP accounted for 94.4% of the open-angle glaucoma cases.

Conclusions

The prevalence of glaucoma among the population of rural Sangju was 3.4%, and open-angle glaucoma with low IOP was the most common form accounting for 94.4% of the total number of cases.     

Relationship between systemic hypertension,perfusion pressure and glaucoma: A comparative study in an adult Indian population

Aims:

To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives.

Design:

Cross-sectional observational study.

Materials and Methods:

A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey''s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2.

Statistical Analysis:

Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect.

Results:

There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP.

Conclusion:

Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.     

Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study

Context:Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India.Aims:To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India.Results:In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 ± 11.7 years (range 21-98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001).Conclusions:Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow-ups.     

高血压合并糖尿病患者白内障超声乳化人工晶体植入术

目的 探讨高血压合并糖尿病白内障超声乳化人工晶体植入术的手术技巧及其临床疗效。方法 42例（42眼）高血压合并糖尿病白内障患者行白内障超声乳化联合人工晶体植入术；对照组为高血压合并糖尿病患者行白内障囊外摘除联合人工晶体植入术。采用临床对照试验方法，比较两组手术后视力、术中术后并发症的发生率。结果 白内障超声乳化组术后视力恢复明显优于囊外摘除组，并发症的发生率均低于对照组。结论 高血压合并糖尿病白内障息者行超声乳化白内障联合人工晶体植入术是安全有效的手术方式。     

Prevalence of open-angle glaucoma in a rural south Indian population

PURPOSE: To determine the prevalence of primary open-angle glaucoma (POAG) and the associated risk factors in a rural population in southern India. METHODS: Subjects aged 40 years or more (n = 3934) underwent a complete ophthalmic examination. Glaucoma was diagnosed according to the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS: Complete data were available for 3924 subjects (response rate, 81.75%). In eyes with normal suprathreshold visual fields, the mean intraocular pressure was 14.29 +/- 3.32 mm Hg (97.5th and 99.5th percentiles, 21 and 25 mm Hg, respectively). The mean vertical cup-to-disc ratio was 0.39 +/- 0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8, respectively). Sixty-four subjects had definite POAG (1.62%, 9.5% CI 1.42-1.82); 30 were men and 34 were women. Subjects with POAG (59.85 +/- 10.43 years) were older (P < 0.001) than the study population (53.78 +/- 10.71 years). In only one (1.5%) person was POAG diagnosed before the study. Two (3.12%) subjects were blind due to POAG; 21 (32.81%) subjects had a presenting IOP >21 mm Hg, and 43 (67.19%) had an IOP <21 mm Hg. The mean central corneal thickness in subjects with POAG (502.82 +/- 35.29 microm) was not different from that of the normal study population (505.93 +/- 31.11 microm). No association was found with diabetes mellitus, systemic hypertension, gender, and myopia. Increasing IOP (per mm Hg) was associated with the disease (OR 1.12; 95% CI, 1.08-1.16). The odds for POAG increased with advancing age after adjustment for gender. CONCLUSIONS: The prevalence of POAG in this population was 1.62%. The prevalence increased with age, and 98.5% were not aware of the disease.     

Macular circulation in patients with diabetes mellitus with and without arterial hypertension

BACKGROUND: Previous fluorescein angiographic studies have shown alterations in the macular microcirculation in patients with diabetes mellitus and arterial hypertension. In both diseases capillary blood velocity was reduced and capillary density decreased. These changes were more pronounced in diabetic patients. We have examined the influence of arterial hypertension in combination with diabetes mellitus. METHODS: 62 patients with diabetes mellitus and arterial hypertension (group 1) were matched with patients with diabetes mellitus but without arterial hypertension (group 2, match criteria: ETDRS stage of retinopathy). In all subjects fluorescein angiograms were performed with a scanning laser ophthalmoscope. Macular capillary blood velocity (CBV), perifoveal intercapillary area (PIA), the coefficient of variation of both parameters, the area of the foveal avascular zone (FAZ), and the arteriovenous passage time (AVP) were assessed by digital image analysis. RESULTS: Systolic and diastolic blood pressures were significantly increased in the patients with arterial hypertension (systolic p=0.0008; diastolic p=0.03). Neither dynamic measures (AVP: 1.64 (0.49) seconds (group 1), 1.72 (0.58) seconds (group 2); CBV: 1.98 (0.39) mm/s (group 1), 2.09 (0.43) mm/s (group 2)) nor morphological measures (PIA: 7985 (3137) microm(2) (group 1), 8338 (3376) microm(2) (group 2); FAZ: 0.319 (0.206) mm(2) (group 1), 0.363 (0.237) mm(2) (group 2)) were significantly different between the two groups of diabetic patients. CONCLUSION: Arterial hypertension did not result in more severe macular capillary dropout than diabetes without hypertension. This might be explained by the fact that most of the patients were being treated with antihypertensive drugs.     

Ciliary circulation in glaucoma complicated by diabetes mellitus

The speed of blood perfusion and the pulsation curve in ciliary arteries was checked by the method of Doppler's pulsating focused ultrasonography in 30 patients aged 46-78 years treated for glaucoma and diabetes. The data obtained were compared with analogical data in nondiabetic patients with glaucoma. It was established that the increase of the intraocular pressure caused a larger and earlier impairment of the regulating mechanism of the ciliary microcirculation in diabetic patients with glaucoma in comparison with the group of glaucomatous patients without diabetes. Particularly high values of pulsation indexes for ciliary arteries were observed in eyes with glaucoma and with diabetic changes rated as the fifth group of diabetic changes.     

The prevalence of diabetes mellitus in the family history of patients with primary glaucoma

The prevalence of diabetes mellitus in the family history of 371 patients with primary glaucoma - closed-angle glaucoma, ocular hypertension and open-angle glaucoma - and 85 age- and sex-matched control subjects was determined. There was a significantly-increased prevalence of familial type 2 diabetes mellitus (non-insulin dependent diabetes mellitus) in patients with closed-angle glaucoma (p = 0.004) and ocular hypertension (p = 0.02). Primary glaucoma was not associated with familial type 1 diabetes mellitus (insulin dependent diabetes mellitus). The implications are discussed.