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T. Y. Wong, N. Cheung, W. T. Tay, M. Sandar, J. J. Wang, T. Aung, S. M. Saw, P. Mitchell, E. S. Tai; The Prevalence and Risk Factors of Diabetic Retinopathy: The Singapore Malay Eye Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1160.
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To describe the prevalence and risk factors of diabetic retinopathy in Asian Malays.
A population-based, cross-sectional study of 3,280 (78.7% response rate) Malay persons aged 40-80 years in Singapore was conducted. Diabetes mellitus was defined as random glucose ≥11.1 mmol/L, use of diabetic medication or self reported diabetes. Retinal photographs taken from both eyes were graded for presence and severity of diabetic retinopathy using the modified Airlie House classification system.
There were 757 persons with diabetes with gradable photographs for analysis. The overall prevalence of any retinopathy was 35.4% and macular edema 5.8%. The prevalence of minimal non-proliferative retinopathy (NPDR) was 12.7%, mild NPDR 6.3%, moderate NPDR 5.9%, and severe NPDR or proliferative retinopathy 10.6%. Vision-threatening retinopathy signs, defined as macular edema, severe NPDR or proliferative retinopathy, were seen in 11.4% of the population. Women had substantially higher proportions with moderate (7.7% vs 3.6%), severe (12.6% vs 7.9%), and vision-threatening (13.6% vs 8.5%) retinopathy than men. In multiple logistic regression, independent risk factors for any retinopathy were younger age (odds ratio [OR] 0.93, 95% confidence intervals [CI], 0.90, 0.96, per year increase), longer diabetes duration (OR 1.04, 95% CI, 1.02, 1.07, per year increase), higher HbA1c (OR 1.26, 95% CI, 1.12, 1.41, per 1% increase), higher pulse pressure (OR 1.03, 95% CI, 1.02, 1.05, per mmHg increase), presence of chronic kidney disease (OR 1.61, 95% CI, 1.01, 2.55), lower body mass index (OR 0.95, 95% CI, 0.90, 0.99, per 1 kg/m2 increase) and lower total cholesterol levels (OR 0.73, 95% CI, 0.60, 0.89, per mmol/L increase)
One in ten adult Malay persons with diabetes in Singapore has vision-threatening diabetic retinopathy. Risk factors for retinopathy in this population are largely similar to white populations elsewhere, suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy.
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