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P. S. Silva, J. K. Sun, Z. A. Haddad, J. G. Santiago, L. P. Aiello; Differences in Ophthalmic Outcomes Over 3 Years in 12,372 Patients With Type 1 or Type 2 Diabetes Mellitus (DM). Invest. Ophthalmol. Vis. Sci. 2009;50(13):4432.
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To determine the effects of DM type on ophthalmic outcomes among all diabetic patients examined over a 3 year period at an academic retina practice specializing in diabetes eye care.
A retrospective review of the customized electronic medical record (EMR) was performed that was inclusive of all patients evaluated at both the Beetham Eye Institute and the endocrinology service of the Joslin Diabetes Center from 1/1/06 to 10/31/08. Standardized forms were used to collect patient demographics, visual acuity (VA) outcomes, anterior segment exam, diabetic retinopathy (DR) and macular edema (DME) severity, and procedures.
A total of 17,310 patient records were reviewed including 12,372 (71%) with DM. This group was 82% White, 49% female (49%) and had median age 58 yrs (Q1, Q3: 44, 69), DM duration 15 yrs (8, 26), age at DM diagnosis 39 yrs (17, 52) and followup of 375 days (182, 503). Retinopathy was present in 58%, PDR in 18% and DME in 17%. There were 5,057 (41%) patients with type 1 (T1DM), 6,988 (56%) with type 2 (T2DM) and unspecified DM type in 327 (3%). T1DM were younger and had longer median follow-up (393 vs 367 days) and DM duration (25 vs 14 yrs) than T2DM. After multivariate modeling adjusting for differences in gender, age, DM duration and length of followup, T1DM had higher rates of any DR (66% vs 54%, p<0.001) or proliferative DR (25 vs 12%, p<0.001) compared to T2DM. In contrast,T2DM had higher rates of any DME (22 vs 19%, p<0.001) or clinically significant DME (6 vs 3%, p<0.001) and increased prevalence of cataracts (77 vs 53%, p<0.001), cataract extraction (6.8 vs 4.0%, p = 0.003), DME treatments (8.9 vs 7.0%, p<0.001) and PRP (7.3 vs 6.9%, p=0.004). Median BCVA in the better seeing eye of all patients was 20/20 (20/25, 20/16) and remained unchanged during the study period regardless of DM type. However, mean BCVA was 2.5 letters better in T1DM than T2DM (p<0.001). The onset of rubeosis was more commonly associated with ≥10 letter VA loss (8.1 vs 1.3%, p<0.001) and was more common in T1DM (4.3 vs 4.0%, p=0.02). VA loss following onset of rubeosis was 3.2-fold higher in T1DM (23.5 vs 7.3%).
Ocular outcomes of a large, well-characterized cohort of diabetic patients from an academic retina practice specializing in diabetes eye care were excellent with median VA of 20/20 throughout followup. T1DM patients maintained slightly better BCVA than T2DM but developed more DR and PDR and had >3-fold higher risk of developing rubeosis. In contrast, T2DM patients developed more DME, had more PRP and ME treatment, and were more likely to develop significant cataracts requiring subsequent cataract surgery.
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