Clinically Significant Macular Edema and Survival in Type 1 and Type 2 Diabetes

doi:10.1016/j.ajo.2007.11.019

American Journal of Ophthalmology

Volume 145, Issue 4, April 2008, Pages 700-706

https://doi.org/10.1016/j.ajo.2007.11.019 Get rights and content

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.

Section snippets

Study Population

Data are from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR).11, 12 The WESDR is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of persons with type 1 and 2 diabetes mellitus living in 11 counties of Wisconsin. Individuals with diabetes diagnosed at age younger than 30 years were defined as the younger-onset group (n = 996), and those diagnosed at 30 years of age or older were defined as the older-onset group (n =

Results

In the younger-onset group, those who were excluded (n = 42) were older, had longer diabetes duration, and had a higher prevalence of hypertension, nephropathy, and DR. In the older-onset group, individuals excluded (n = 75) from the analysis were older, had a longer diabetes duration, smaller body mass index (BMI), and a higher prevalence of nephropathy and DR.

The prevalence of CSME at baseline was 5.9% and 7.5% for the younger-onset and older-onset groups, respectively. Table 1 shows baseline

Discussion

We report a significant relation of CSME and ischemic heart disease mortality among people with older- but not younger-onset diabetes, independent of glycemic and blood pressure control, nephropathy, and other risk factors. Breakdown of the blood-retinal barrier, secondary to poor glycemic and blood pressure control, may be a risk indicator of similar microvascular disease in the heart and elsewhere.¹⁵ We were unable to show that the association of CSME to mortality was independent of DR

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Original articleClinically Significant Macular Edema and Survival in Type 1 and Type 2 Diabetes

Purpose

Design

Methods

Results

Conclusions

Section snippets

Study Population

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Lancet

Diabetes Res Clin Pract

Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women

Diabetes Care

Association of ocular disease and mortality in a diabetic population

Arch Ophthalmol

Relation of ocular and systemic factors to survival in diabetes

Arch Intern Med

Retinopathy is associated with cardiovascular and all-cause mortality in both diabetic and nondiabetic subjects: the Hoorn Study

Diabetes Care

Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: Early Treatment Diabetic Retinopathy Study Report No. 27

Diabetes Care

Original article
Clinically Significant Macular Edema and Survival in Type 1 and Type 2 Diabetes