6 year Incidence and progression of diabetic retinopathy: the Singapore Malay Eye Study

Abstract

Purpose : To determine 6-year incidence and progression of diabetic retinopathy and its risk factors in a population based cohort in Singapore.

Methods : We conducted a prospective, population-based cohort study of Asian Malay persons 40-80 years at baseline in 2004-2006(n=3,280 response rate 78.9%), with a 6-year follow-up in 2010-2012(n=1,900 response rate 72.1%). Those with diabetes had their retinal photographs from baseline and follow-up graded for DR using the modified Airlie House classification system and the modified Early Treatment Diabetic Retinopathy Scale classification(15-step scale). Incidence of DR was defined as severity level of 15 or greater at the follow-up visit in those free of DR at baseline. Progression of DR was defined as an increase in the severity level at least one step on the 15 step scale at the follow-up visit in those who had no DR or nonproliferative DR at baseline.

Results : 522 subjects with diabetes and gradable photos at baseline participated in the 6 year followup study. Of the 387 without DR at baseline, 17.3% (95% CI 13.9 to 21.4; n=67) developed any DR at followup. At baseline 135 (25.9%) had any DR present of which 31.1% (95% CI 23.9 to 39.4; n=42) had a 1-step increase in severity level. Overall 20.9% (95%CI 17.6 to 24.6%) of participants seen at the followup study had progression of DR; in 78.9% of these cases, a 2+ -step progression was documented. Progression to proliferative retinopathy occurred in only 2.6% (95%CI 1.5 to 4.4%) of those with retinopathy at baseline. 12.3% (95%CI 9.7 to 15.5%) of those with baseline DR, regressed at least one step.
Baseline risk factors associated with progression of DR, after adjusting for age and gender, were higher serum blood glucose(OR 1.12; 95% CI 1.07-1.17)/mmol, higher glycated hemoglobin(OR 1.54; 95% CI 1.38-1.73), longer diabetes duration(OR 1.05; 95% CI 1.02-1.08)/year, and lower body mass index(OR 0.95; 95% CI 0.90-0.99). Baseline C-reactive protein, serum creatinine, chronic kidney diseases and peripheral neuropathy were not associated with progression. In a multivariate model, adjusting for age, gender and metabolic risk factors, only glycated hemoglobin remained significant(OR 1.51; 95% CI 1.34-1.71).

Conclusions : These data provide 6-year cumulative incidence and progression of diabetic retinopathy in an Urban Asian Malay population. Higher baseline glycated hemoglobin levels predicted retinopathy progression.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.