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M. Sanspree, K.M. Daum, S.N. Y. A. Arthur, A.L. Schmidt, D.J. Pillion; Synergistic Effects of Diabetes Mellitus, Hypertension and Obesity as Risk Factors for Glaucoma and Diabetic Retinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3658.
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Purpose:. Residents of the Black Belt (BB) region of Alabama are afflicted with high levels of diabetes mellitus (DM), hypertension and obesity. In an era of scare resources and rising health costs, the identification of individuals most at risk is essential. This study examines the synergistic effects of these risk factors and considers the significance of the identification of individuals most likely to lose vision as a result of glaucoma and/or diabetic retinopathy (DR). Methods: The Rural Alabama Diabetes and Glaucoma Initiative performed comprehensive vision examinations on volunteers from the BB of Alabama and two contiguous counties. This exam included assessment of height, weight, blood pressure (BP), blood sugar, glycosolated hemoglobin (HbA1C), corrected visual acuity (6M), tonometry, slit lamp and fundus evaluation and Humphrey FDT fields testing. Patients were classified DM with HbA1C>=7.0%, hypertensive with BP>=140/90, decreased visual acuity (VA) with VA<=20/40. A positive classification of glaucoma required reproducible field loss, changes of the optic disk and/or IOP>=24 mmHg. DR was assessed with fundus imaging and fundus lens. Patients with a body mass index (BMI) >=25.0 were considered obese. Results. This study evaluated 1597 patients >=35 yrs of age. Of this group, 316 (19.8%), 327 (20.5%) and 38 (2.4%) met criteria for decreased VA, glaucoma and DR, respectively. The presence of one or more risk factors (DM, hypertension, obesity) had no effect on the presence of decreased VA. Three of these risk factors increased the likelihood of glaucoma by 1.6 and the presence of DR by 8.5. Conclusions: The data indicate that the combination of elevated blood pressure, HbA1C and BMI significantly and disproportionably increase the risk of glaucoma and DR. DM, obesity and hypertension were not related to decreased VA.
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