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F. E. Hirai, M. D. Knudtson, B. E. K. Klein, R. Klein; Clinically Significant Macular Edema and Survival: Wisconsin Epidemiologic Study of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):174. doi: https://doi.org/.
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to investigate the association of clinically significant macular edema (CSME) with all cause and cause-specific mortality in a long-term diabetic population.
the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated in 1980-82 of individuals with diabetes diagnosed at either = 30 years of age (older-onset, n=1,370). Stereoscopic color retinal photos were graded for retinopathy using the modified Airlie House Classification scheme and CSME was defined by ETDRS criteria.
the prevalence of CSME was 7.5% and 5.9% for the older- and younger-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,123 older-onset persons died. When adjusting for age and gender CSME was not significantly associated with all-cause (hazard ratio and 95% confidence interval 1.41 (0.96-2.07), p=0.08) or ischemic heart disease mortality (1.14 (0.61-2.12), p=0.68) in the younger-onset group. In the older onset group, there was increasing all-cause and ischemic heart disease mortality when CSME was present: 1.55 (1.25-1.92), p<0.01 and 1.56 (1.15-2.13), p<0.01, respectively, when adjusting for age and gender. After controlling for other risk factors, the association remained significant for all-cause (1.28 (1.02-1.61), p=0.03) but was only marginally significant for ischemic heart disease (1.36 (0.97-1.89), p=0.07). CSME was not significantly associated with stroke mortality by in either group.
CSME appears to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be under care for cardiovascular disease.
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