Elsevier

Ophthalmology

Volume 116, Issue 3, March 2009, Pages 497-503
Ophthalmology

Original article
The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: The Twenty-five-Year Incidence of Macular Edema in Persons with Type 1 Diabetes

https://doi.org/10.1016/j.ophtha.2008.10.016Get rights and content

Objective

To examine the 25-year cumulative incidence of macular edema (ME) and its relation to various risk factors.

Design

Population-based study.

Participants

A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in baseline examinations (1980–1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations (n = 891) or died before the first follow-up examination (n = 64).

Methods

Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme. Competing risk of death was included in statistical models.

Main Outcome Measures

Incidence of ME and clinically significant ME (CSME).

Results

The 25-year cumulative incidence was 29% for ME and 17% for CSME. Annualized incidences of ME were 2.3%, 2.1%, 2.3%, and 0.9% in the first, second, third, and fourth follow-up periods of the study, respectively. In univariate analyses, the incidence of ME was associated with male sex, more severe diabetic retinopathy, higher glycosylated hemoglobin, proteinuria, higher systolic and diastolic blood pressure, and more pack-years of smoking. Multivariate analyses showed that the incidence of ME was related to higher baseline glycosylated hemoglobin (hazard ratio [HR] per 1% 1.17; 95% confidence interval [CI], 1.10–1.25; P<0.001) and higher systolic blood pressure (HR per 10 mmHg 1.15; 95% CI, 1.04–1.26; P = 0.004) and marginally to proteinuria (HR 1.43; 95% CI, 0.99–2.08; P = 0.06).

Conclusions

These data show that relatively high 25-year cumulative rates of incidence of ME were related to glycemia and blood pressure. The lower risk of incident ME in the last period of the study may reflect recent improvement in care.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The population, who have been described in previous reports,10, 22, 23, 24, 25, 26, 27, 28 consisted of a sample selected from 10,135 diabetic patients who received primary care in an 11-county area in southern Wisconsin from 1979 to 1980. This sample was composed of all persons with “younger-onset” diabetes and a duration-stratified sample of persons with “older-onset” diabetes. The analyses in this report are limited to the group with younger-onset diabetes, all of whom were taking insulin

Characteristics of the Cohort

Characteristics at the baseline examination of those who participated in the 25-year follow-up, those who did not participate because they could not be located or they refused, and those who had died in the 11-year interval between the 14- and 25-year examinations have been presented elsewhere.28 With the exception of less education, there were no significant differences in the characteristics of those who participated compared with those who survived but did not participate. The 120 persons

Discussion

The data reported provide long-term population-based information regarding the 25-year cumulative incidence of ME and its relationship to glycemia, blood pressure, proteinuria, and other factors in persons with type 1 diabetes mellitus. The 25-year incidence of ME (29%) and CSME (17%) were high, and the strongest and most consistent associations were with glycemia and to a lesser extent systolic and diastolic blood pressure and nephropathy as manifest by gross proteinuria. Lower annualized

References (55)

  • R. Klein et al.

    An alternative method of grading diabetic retinopathy

    Ophthalmology

    (1986)
  • B.E. Klein et al.

    Diabetic retinopathy: assessment of severity and progression

    Ophthalmology

    (1984)
  • F.E. Hirai et al.

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

    Am J Ophthalmol

    (2008)
  • K.J. Cruickshanks et al.

    The association of microalbuminuria with diabetic retinopathy: the Wisconsin Epidemiologic Study of Diabetic Retinopathy

    Ophthalmology

    (1993)
  • R. Klein et al.

    Is gross proteinuria a risk factor for the incidence of proliferative diabetic retinopathy?

    Ophthalmology

    (1993)
  • P. Romero et al.

    Diabetic macular edema and its relationship to renal microangiopathy: a sample of type I diabetes mellitus patients in a 15-year follow-up study

    J Diabetes Complications

    (2007)
  • D.G. Yanbaeva et al.

    Systemic effects of smoking

    Chest

    (2007)
  • S.E. Moss et al.

    Cigarette smoking and ten-year progression of diabetic retinopathy

    Ophthalmology

    (1996)
  • R. Klein et al.

    Vision disorders in diabetes

  • J.A. Tielsch

    Prevent Blindness AmericaVision Problems in the U.S: A Report on Blindness and Vision Impairment in Adults Age 40 and Older

  • F.L. Myers et al.

    The natural course of diabetic retinopathy: a clinical study of 321 eyes followed one year or more

  • E.M. Kohner

    The evolution and natural history of diabetic retinopathy

    Int Ophthalmol Clin

    (1978)
  • Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy

    N Engl J Med

    (2000)
  • R. Williams et al.

    Epidemiology of diabetic retinopathy and macular oedema: a systematic review

    Eye

    (2004)
  • B. Miljanovic et al.

    A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes

    Diabetes

    (2004)
  • N. Jaross et al.

    Incidence and progression of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS)Report no. 2

    Clin Experiment Ophthalmol

    (2005)
  • M.C. Leske et al.

    Nine-year incidence of diabetic retinopathy in the Barbados Eye Studies

    Arch Ophthalmol

    (2006)
  • Cited by (0)

    Manuscript no. 2008-826.

    This research is supported by National Institutes of Health grant EY03083 and EY016379 (Ronald Klein, MD, MPH, Barbara E.K. Klein, MD, MPH) and, in part, by the Research to Prevent Blindness (R. Klein and BEK Klein, Senior Scientific Investigator Awards), New York, New York. The National Eye Institute provided funding for the entire study including collection and analyses and of data; RPB provided further additional support for data analyses.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by National Institutes of Health grant EY03083 and EY016379 (Ronald Klein, MD, MPH, Barbara E.K. Klein, MD, MPH) and, in part, by the Research to Prevent Blindness (R. Klein and BEK Klein, Senior Scientific Investigator Awards), New York, New York. The National Eye Institute provided funding for the entire study including collection and analyses and of data; RPB provided further additional support for data analyses.

    View full text