Elsevier

Ophthalmology

Volume 105, Issue 6, 1 June 1998, Pages 998-1003
Ophthalmology

The 14-year incidence of visual loss in a diabetic population1☆,

https://doi.org/10.1016/S0161-6420(98)96025-0Get rights and content

Abstract

Objective

The purpose of the study was to estimate the 14-year incidence of visual loss in a diabetic population and to examine its relationship to potential risk factors.

Participants

A population-based sample of younger onset diabetic persons diagnosed younger than 30 years of age and taking insulin (n = 880) were examined at baseline, 4 years, 10 years, and 14 years.

Intervention

Visual acuity (VA) as measured by the Early Treatment Diabetic Retinopathy Study protocol was performed.

Main outcome measures

Visual impairment (VI), defined as a VA of 20/40 or worse in the better eye; blindness, defined as a VA of 20/200 or worse in the better eye; and doubling of the visual angle were measured.

Results

Cumulative 14-year incidences of VI, doubling of the visual angle, and blindness were 12.7%, 14.2%, and 2.4%, respectively. In univariate analyses, loss of vision as measured by doubling of the visual angle is associated with older age, longer duration of diabetes, higher glycosylated hemoglobin, higher systolic and diastolic blood pressure, presence of proteinuria, more pack-years smoked, presence of macular edema, and more severe retinopathy. In logistic regression analyses, incidence of doubling of the visual angle is associated independently with retinopathy (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03, 1.11 for each level), glycosylated hemoglobin (OR, 1.46; 95% CI, 1.28, 1.66 for each 1%), proteinuria (OR, 2.32; 95% CI, 1.39, 3.88 for presence), and age (OR, 1.45; 95% CI, 1.20, 1.75 for 10 years). In addition, a change in glycosylated hemoglobin from baseline to the 4-year examination is associated with loss of vision (OR, 1.15; 95% CI, 1.02, 1.30 for a 1% increase).

Conclusions

Loss of vision continues to be significant in persons with diabetes. These results suggest that prevention of retinopathy through control of glycemia will have a beneficial effect on visual outcome.

Section snippets

Methods

Case identification methods and descriptions of the population have appeared in previous reports.7, 8, 9, 10, 11, 12 Briefly, the study area consisted of 11 counties in southern Wisconsin. From July 1, 1979 to June 30, 1980, 10,135 persons with diabetes were identified in the practices of 452 of 457 primary care physicians in the area. A two-part sample of 2990 of these persons was invited to participate in the baseline examination from 1980 to 1982. The first part consisted of the entire

Results

Of the 996 persons with younger onset diabetes who participated in the baseline examination, 891 (89.5%), 765 (76.8%), and 634 (63.7%) participated in the 4-, 10-, and 14-year examinations, respectively. Reasons for nonparticipation in the 4and 10-year examinations and characteristics of participants and nonparticipants have been described.8, 9

Of persons who participated in earlier examinations but who did not participate in the 14-year examination, 56 had died, 4 could not be located, 44

Discussion

There is a need for reliable estimates of vision loss due to diabetes. Such estimates are important for planning clinical trials by providing baseline levels for determining sample sizes, for planning public health programs to reduce the impact of diabetic complications, and for evaluating the results of the programs. It also is important that the estimates be representative of the general diabetic population. Many estimates are based on small sample sizes, limited follow-up, self-reports of

References (27)

  • F.L Ferris

    How effective are treatments for diabetic retinopathy?

    JAMA

    (1993)

  • Screening guidelines for diabetic retinopathy

    Ann Intern Med

    (1992)

  • The National Eye Health Education Program: From Vision Research to Eye Health Education: Planning the Partnership

    (1990)

    • Cited by (0)

    ☆

    Supported by National Institutes of Health grant EYO 3083 (RK, BEKK) and, in part, by the Research to Prevent Blindness (RK, Senior Scientific Investigator Award).

    1

    The authors have no proprietary interests in any materials mentioned in this study.

    View full text
    Copyright © 1998 American Academy of Ophthalmology, Inc. Published by Elsevier Inc. All rights reserved.