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Six-year incidence and systemic associations of retinopathy in a multi-ethnic Asian population without diabetes
  1. Preeti Gupta1,
  2. Ecosse Luc Lamoureux1,2,3,
  3. Charumathi Sabanayagam3,4,
  4. Yih-Chung Tham4,
  5. Gavin Tan1,
  6. Ching-Yu Cheng3,4,
  7. Tien Yin Wong5,
  8. Ning Cheung1
  1. 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  2. 2Ophthalmology, University of Melbourne VCCC, Parkville, Victoria, Australia
  3. 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  4. 4Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
  5. 5Academic Medicine Research Institute, Singapore National Eye Centre, Singapore
  1. Correspondence to Dr Ning Cheung, Singapore National Eye Center Vitreoretinal Division, Singapore, Singapore; cheung.ning{at}


Purpose We described the 6-year incidence and changes of retinopathy, and their associated risk factors in a multi-ethnic Asian population without diabetes.

Methods We included 4374 participants with non-diabetes from a population-based cohort, the Singapore Epidemiology of Eye Disease Study, with gradable retinal photographs at baseline and 6-year follow-up visit. Retinopathy was assessed according to the modified Airlie House classification system.

Results Over the 6-year period, the cumulative rates were 2.5% (106/4279) for retinopathy incidence, 1.0% (1/95) for retinopathy progression and 68.4% (65/95) for retinopathy regression. In multivariable analysis, higher diastolic blood pressure (DBP) (risk ratio (RR)=1.02; 95% CI: 1.00 to 1.04; per 10 mm Hg increase in DBP) and wider retinal arteriolar calibre (RR=1.36; 95% CI: 1.13 to 1.63; per SD increase in central retinal artery equivalent) were associated with higher risk of incident retinopathy, while higher level of high-density lipoprotein (HDL) was associated with lower risk of incident retinopathy (RR=0.56; 95% CI: 0.32 to 0.99; per mmol/L increase in HDL). Compared with Chinese, Malays were more likely to have retinopathy regression (RR=1.63; 95% CI: 1.20 to 2.22), while overweight (RR=0.47; 95% CI: 0.26 to 0.84) and higher glycosylated haemoglobin (HbA1c) level (RR=0.58; 95% CI: 0.37 to 0.93; per per cent increase in HbA1c) were associated with lower likelihood of retinopathy regression.

Conclusion Risk of developing retinopathy in Asians without diabetes is generally low. However, regression of retinopathy over time is common, suggesting that these retinopathy signs may reflect subclinical reversible microvascular dysfunction. Several metabolic risk factors are associated with incidence or regression of retinopathy, suggesting that good metabolic control may still be important in the management of non-diabetic retinopathy.

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  • Contributors PG and NC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. PG, CS, C-YC, TYW, ELL, NC contributed to study concept and design; PG, C-YC, TYW, ELL, NC contributed to acquisition, analysis or interpretation of data. PG and NC contributed to drafting of manuscript. Critical revision of the manuscript for important intellectual content: PG, CS, YCT, GT, TYW, C-YC, ELL, NC. Obtained funding: CS, TYW, C-YC; Statistical analysis: PG, NC; Administrative, technical, or material support: PG; Study Supervision: PG, CS, TYW, C-YC, ELL, NC.

  • Funding Singapore Ministry of Health’s National Medical Research Council (NMRC) under its Talent Development Scheme NMRC/STaR/0003/2008 and Biomedical Research Council (BMRC), Singapore 08/1/35/19/550.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted at the research clinic of the Singapore Eye Research Institute. All protocols followed the principles of the Declaration of Helsinki and received approval by the SingHealth Institutional Review Board (#2015/2279).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data are included in the manuscript. Any additional data can be made available on request.

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