Global prevalence and major risk factors of diabetic retinopathy.

OBJECTIVE: To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS: A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. RESULTS: A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS: There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

Retinal microvascular calibre and risk of incident diabetes: the multi-ethnic study of atherosclerosis.

AIM: To prospectively examine the association of retinal microvascular signs with incident diabetes and impaired fasting glucose (IFG) in a multi-ethnic population-based cohort. METHODS: The multi-ethnic study of atherosclerosis comprised Caucasians, African-Americans, Hispanics and Chinese aged 45-84 years. Retinal vascular calibre and retinopathy were quantified from baseline retinal photographs. Incident diabetes and IFG were ascertained prospectively. RESULTS: After a median follow-up of 3 years, 243 (4.9%) people developed diabetes and 565 (15.0%) developed IFG. After adjusting for known risk factors, participants with wider retinal arteriolar calibre had a higher risk of developing diabetes [HR: 1.60; 95% CI: 1.12-2.29, p=0.011 comparing highest with lowest arteriolar calibre tertile]. In ethnic subgroup analysis, the association between wider retinal arteriolar calibre and incident diabetes was stronger and statistically significant only in Caucasians [HR: 2.78; 95% CI: 1.37-5.62, p=0.005]. Retinal venular calibre and retinopathy signs were not related to risk of diabetes or IFG. CONCLUSION: Wider retinal arteriolar calibre is independently associated with an increased risk of diabetes, supporting a possible role for early arteriolar changes in diabetes development. This effect was largely seen in Caucasians, and not in other ethnic groups, and may reflect ethnic differences in susceptibility to diabetes from microvascular pathways.

Retinal arteriolar narrowing and subsequent development of CKD Stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: Microvascular disease is a major pathogenic factor for chronic kidney disease (CKD) in persons with diabetes, but the role of microvascular disease in the development of CKD in the general population is unclear. The aim of this study is to examine whether microvascular disease precedes the development of CKD stage 3 in participants of the Multi-Ethnic Study of Atherosclerosis (MESA). STUDY DESIGN: Population-based cohort study. SETTING & PARTICIPANTS: MESA is a prospective cohort study of adults aged 45-84 years living in 6 US communities; 4,594 adults with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) when they underwent retinal photography (visit 2: in 2002-2004) were examined. PREDICTOR: Retinal microvascular caliber measured from fundus photographs. OUTCOMES: Incident CKD stage 3 (ie, eGFR <60 mL/min/1.73 m(2)) at 2 subsequent follow-up examinations (visit 3 in 2004-2005, and visit 4 in 2005-2007) and an annual eGFR decrease >1 mL/min/1.73 m(2) computed using the CKD Epidemiology Collaboration (CKD-EPI) equation. RESULTS: After a median follow-up of 4.8 years, there were 232 incident CKD stage 3 cases. Overall, retinal microvascular caliber was not associated with incident CKD stage 3. However, in race-stratified analysis, narrower arterioles in whites was associated with a higher risk of developing CKD stage 3 after adjusting for age, sex, blood pressure, diabetes, and other factors (HR, 1.78; 95% CI, 1.01-3.15; P = 0.04, lowest vs highest arteriolar caliber tertile). This association was seen even in whites without hypertension and diabetes (HR, 2.95; 95% CI, 1.10-7.98; P = 0.03). Retinal arteriolar caliber was not associated with incident CKD stage 3 in African Americans, Chinese, or Hispanics. LIMITATIONS: Analyses were based on a single eGFR measurement, and retinal microvascular caliber and eGFR measurements were not ascertained concurrently. CONCLUSION: Microvascular changes as manifest in the eye may contribute to the development of CKD stage 3 in whites.

Long-term refractive outcomes and stability after excimer laser surgery for myopia.

PURPOSE: To evaluate the long-term refractive outcomes of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for myopia. SETTING: Centre for Eye Research Australia, Melbourne, Australia. DESIGN: Comparative case series. METHODS: Preoperative baseline refractions in eyes having PRK, LASIK, or both at 1 multisurgeon center were analyzed from patient databases. Two- to 13-year follow-up data were analyzed and compared with 1-month postoperative visual outcomes. RESULTS: The study evaluated 389 eyes (229 patients). In the PRK group, the mean preoperative spherical equivalent (SE) was -4.05 diopters (D) ± 1.17 (SD) in eyes with low to moderate myopia and -7.97 ± 2.00 D in eyes with high myopia (P = .009) and in the LASIK group, -3.98 ± 1.27 D and -7.64 ± 1.66 D, respectively (P = .008). At the last visit, the mean SE in the PRK group was -0.64 ± 0.83 D in eyes with low to moderate myopia and -1.06 ± 1.74 D in eyes with high myopia (P = .73) and in the LASIK group, -0.33 ± 0.59 D and -0.63 ± 0.90 D, respectively (P = .68). At the end of the study, 45.9% of eyes with low to moderate myopia and 25.0% with high myopia in the PRK group and 64.8% and 37.3%, respectively, in the LASIK group were within ± 0.50 D of the attempted correction. CONCLUSIONS: Laser refractive surgery effectively treated all levels of myopia. Refractive stability was achieved within 1 year postoperatively, with LASIK showing better stability than PRK for up to 6 to 9 years.

Orbital fibrosis and intraocular recurrence of retinoblastoma following periocular carboplatin.

A 5-month-old infant with bilateral advanced retinoblastoma underwent six cycles of systemic chemotherapy. In an attempt to salvage the second eye, three serial injections of periocular carboplatin were given for persistent vitreous seeding. Following the third injection, the patient developed periocular ecchymosis and magnetic resonance imaging demonstrated abnormal signal characteristics at the site of injection. An orbital biopsy did not demonstrate extraocular tumor extension, but histopathologic examination revealed severe orbital fibrosis and fat necrosis. Following the biopsy, the patient developed an intraocular tumor recurrence at the same location where the carboplatin injections had been given and enucleation was performed to prevent tumor spread. In this case, a child developed orbital scarring and intraocular tumor recurrence at the site of injection following treatment with periocular carboplatin.