The Wisconsin Epidemiologic Study of Diabetic Retinopathy, a population-based cohort study conducted in an 11-county area in southern Wisconsin, assessed the prevalence and risk of diabetic retinopathy (DR) in individuals who were diagnosed with diabetes before the age of 30, as well as in individuals whose age at diagnosis was 30 or more years. In the former group (n = 996), the prevalence of DR varied from 17% to 97.5% in persons with diabetes for less than five years and 15 or more years, respectively. Proliferative diabetic retinopathy (PDR) varied from 1.2% to 67% in persons with diabetes for less than ten years and 35 or more years, respectively. For persons with diabetes of ten years' duration or less, the Cox regression model relates the severity of DR to longer duration of disease, older age at examination and higher levels of glycosylated hemoglobin. After ten years of diabetes, severity of DR was related to longer duration, high levels of glycosylated hemoglobin, presence of proteinuria, higher diastolic blood pressure and male sex.
In a cross-sectional analysis of this group of patients, 602 persons whose diabetes was diagnosed before age 30 and who were currently taking insulin completed an interview that consisted of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Univariate analyses revealed that the total NEI-VFQ-25 score was lower in persons who:
- were older;
- had a longer duration of diabetes;
- had higher glycosylated hemoglobin;
- were in renal failure;
- had a history of cardiovascular disease, hypertension or amputation of a lower limb;
- had poorer visual acuity, more severe DR, macular edema, glaucoma or cataract;
- had abnormalities in tactile sensation or temperature sensitivity;
- smoked more total pack-years;
- led a more sedentary lifestyle; and
- had poor peak expiratory flow.
In multivariate analyses, lower total VEI-VFQ-25 scores were independently associated with poorer visual acuity, more severe DR, older age, history of loss of tactile sensation, and more total pack-years of cigarettes smoked.
Among individuals diagnosed at age 30 or older (n = 1,370), the prevalence of DR varied from 28.8% in persons who had diabetes for less than five years to 77.8% in persons who had diabetes for 15 or more years. The rate of PDR varied from 2.0% in persons who had diabetes for less than five years to 15.5% in persons living with the disease for 15 or more years. By using the Cox regression model, the severity of DR was found to be related to longer duration of diabetes, younger age at diagnosis, higher glycosylated hemoglobin levels, higher systolic blood pressure, use of insulin, presence of proteinuria and small body mass.
In a 14-year follow-up of 634 insulin-taking type 1 patients who were diagnosed before the age of 30, investigators observed a high rate of DR, with 95.9% of individuals exhibiting some retinopathy by 14 years. Additionally, 85.6% of participating patients had progression (worsening) of DR, 36.8% had progression to PDR, and 13.3% had progression to PDR with high-risk characteristics. Moreover, 26.1% had macular edema, and 17% had clinically significant macular edema. Investigators suggested that better glycemic control at any time during the course of diabetes, as well as control of blood pressure, may be beneficial in reducing the incidence of macular edema and the progression to proliferative disease.
Selected Publications
Klein R, Moss SE, Klein BEK, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus. Arch Ophthalmol 2001;119:733-740.
Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520-526.
Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy III. Prevalence and risk of diabetic retinopathy when age at diagnosis is less 30 or more years. Arch Ophthalmol 1984;102:527-532.
Click on the highlighted citations for summaries of studies
Diabetes Control and Complications Trial Research Group
Early Treatment Diabetic Retinopathy Study Research Group
The Diabetic Retinopathy Study Research Group
Diabetic Retinopathy Vitrectomy Study Research Group
UK Prospective Diabetes Study
This web resource is made possible through an unrestricted educational grant from Eli Lilly and Company.
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