Research Articles in Diabetes and Diabetic
Retinopathy
Diabetic Retinopathy in African Americans with Type I Diabetes: The
New Jersey 725, Part I
(From Archives of Ophthalmology 2000;118:97-104, Roy, Monique S MD. Diabetic
Retinopathy in African Americans with Type I Diabetes: The New Jersey 725, Part I.
Methodology, population, frequency of retinopathy, and visual impairment.)
OVERVIEW:
This purpose of this study is to determine the frequency and severity of diabetic
retinopathy, as well as associated visual impairment, among African Americans with type I
diabetes mellitus. A total of 725 African Americans with type I diabetes were enrolled in
the study. The New Jersey Department of Health database was used as a source of patients
with diabetes. African Americans with type I diabetes, treated and diagnosed with insulin
before the age of 30 were considered eligible.
RESULTS:
After being identified as an eligible patient for this study, a clinical evaluation was
performed including ocular examination, fundus photography, and blood pressure
measurements. Severity of diabetic retinopathy was determined based on grading of the
worse eye. A detailed medical and socioeconomic history was taken.
There was a wide range of ages in this study: from 3 to 80 years, with a duration of
diabetes ranging from 0.1 to 62 years. Overall, nearly 2/3 of the patients, or 64%, had
some retinopathy at the time of examination. 18.9% had proliferative diabetic
retinopathy. The frequency and severity of diabetic retinopathy were significantly
associated with age at examination and with the duration of diabetes:
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Age 15 - 19: 6.3% had moderate or worse retinopathy.
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Age 20 - 29: 22.8% had moderate or worse retinopathy.
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Age 30 - 44: 48.9% had moderate or worse retinopathy.
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Age 45 and older: 68.9% had moderate or worse retinopathy.
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93% or those 45 and older had some evidence of retinopathy.
Proliferative retinopathy was found in 11.4% of those aged 20 to 29, and in 59% in
those 45 years and older.
Visual impairment (20/40 or worse in the affected eye) and legal blindness (20/200 or
worse) was associated with advancing age and with longer duration of diabetes. Overall,
diabetic retinopathy was either partly or fully responsible for 62% of the cases of visual
impairment, and 90.0% of legal blindness.:
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Of all patients, 7.9% had minimal to moderate impairment of visual acuity, and 3.1% were
legally blind.
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Visual impairment was lowest in those under 18 years at 7.6%, and highest in those 45
and older at 32.8%.
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Legal blindness was first seen in 2.1% of those 25 to 34 years of age, and increased to
14.8% of those 45 and older.
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Among patients with 30 or more years of diabetes, 31.6% had some visual impairment, and
13.2% were legally blind.
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Other causes of visual impairment included glaucoma, cataract, other retinal diseases,
and refractive error.
Compared with men, women had a significantly higher frequency of visual impairment,
even after adjusting for age and duration of diabetes. Women were also found to have a
higher frequency of visual impairment in the better eye than men due at least partly to
diabetic retinopathy.
There was found to be no significant association between visual impairment and
socioeconomic status, income, or marital status.
COMMENTS:
This study reveals an alarmingly high rate of diabetic retinopathy, proliferative
retinopathy, and visual impairment in Type I diabetics. Increasing age and duration of
diabetes were found to significantly increase the risk of retinopathy, its severity, and
visual loss.
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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