Abstract
Abstract: :
Purpose: To determine the incidence and progression of diabetic retinopathy and macular edema and associated risk factors in 357 (of 725) African–Americans with type 1 diabetes who participated in 6–year follow–up examinations. Methods: Incidence of any retinopathy, progression of retinopathy, progression to proliferative retinopathy, and macular edema was evaluated from masked grading of seven standard stereoscopic retinal photographs, using the modified Airlie House classification scheme and Early Treatment of Diabetic Retinopathy severity scale. Results: The 6–year incidence of any retinopathy was 73.2%; progression of retinopathy, 58.2%; progression to proliferative retinopathy, 15.5%; and incidence of macular edema, 16.9%. Only 6.2% of patients showed regression of retinopathy. Progression of retinopathy was more likely in patients diagnosed with diabetes after age 13 years and those in the upper two quartiles of glycosylated hemoglobin values measured at baseline. Progression to proliferative retinopathy was higher in those with greater severity of retinopathy, higher glycosylated hemoglobin, and overt proteinuria at baseline. Incidence of macular edema was higher in patients with lower education, higher diastolic blood pressure, and higher glycosylated hemoglobin values at baseline. Conclusions: Results indicate that African–Americans with type 1 diabetes have high 6–year incidence of vision–threatening retinopathy, and that poor glycemic control is a major determinant of disease progression.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: risk factor assessment