Research Articles in Diabetes and Diabetic
Retinopathy
Association of Ocular Disease and Mortality in a Diabetic Population
(From Archive of Ophthalmology 1999;117:1487-1495, Klein R, MD, et al.)
OVERVIEW:
This study examined the association of diabetic retinopathy and other eye conditions with
all-cause and cause-specific mortality in a large population based study: the Wisconsin
Epidemiologic Study of Diabetic Retinopathy (WESDR). Participants were all younger onset
diabetics (less than 30 years of age at diagnosis and using insulin), and a random sample
of older onset diabetics (diagnosed with diabetes at 30 years of age or older). 996
younger onset, and 1370 older onset persons participated, with baseline eye examinations
occurring from 1980 to 1982. Participants were followed for 16 years.
RESULTS:
After controlling for only age and sex, strong and statistically significant associations
were found between most of the ocular conditions studied and mortality in general, and
ischemic heart disease and stroke mortality. Especially the presence of severe retinopathy
or visual impairment at baseline indicated a greatly increased risk of death within 16
years.
In the group of younger onset diabetics, the mean age at diagnosis was 14.6 years, and
at the baseline examination was 29.3 years. The prevalence and severity of retinopathy
were higher than the older onset group. There were 21.5% confirmed deaths in the younger
onset group within 16 years. The following associations were found between ocular
conditions and mortality in this group:
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After controlling for age and sex, the presence of retinopathy at baseline was
associated with death due to ischemic heart disease. The more severe the retinopathy at
baseline, the higher the association with mortality.
-
Visual impairment at baseline was also strongly associated with death due to ischemic
heart disease, regardless of the cause of impairment.
-
There was also a weaker association of any-cause mortality and retinopathy or visual
impairment at baseline.
-
Progression of retinopathy at a 4 year follow-up examination was found to be 44.2%.
Worsening of visual acuity at 4 years by 1/2 occurred in 5.9%, and this was associated
with ischemic heart disease.
In the older onset group, the average age at diagnosis was 54.8 years, and at the
baseline examination 66.6 years. Visual impairment, cataract, and glaucoma were more
frequent in the older onset group. Confirmed mortality within 16 years was 72.7%.
Associations between ocular conditions and mortality in this group include:
-
After controlling for age and sex, retinopathy severity at baseline was associated with
mortality from any cause, and the presence of proliferative retinopathy with stroke
mortality. These associations were not as strong as those in the younger-onset group.
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Visual impairment at baseline was associated with ischemic heart disease and stroke
mortality.
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Cataract, cataract extraction, and glaucoma at baseline were not associated with
mortality, nor was any ocular condition associated with cancer mortality.
-
Progression of retinopathy at the 4 year follow-up, worsening of visual acuity, and
progression to proliferative retinopathy was associated with all-cause mortality, ischemic
heart disease mortality, and ischemic heart disease and stroke mortality, respectively.
COMMENTS:
The WESDR has offered a unique opportunity to examine the relationship of specific ocular
conditions and survival. In both younger and older onset diabetics, visual impairment and
retinopathy are associated with death from vascular causes such as ischemic heart disease
and stroke.
For information about diabetic eye disease in general, and
for an explanation of terminology used below, go to
Diabetic Eye Disease.
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