Retinal vascular abnormalities in persons with type 1 diabetes: The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVIII

doi:10.1016/S0161-6420(03)00863-7

Ophthalmology

Volume 110, Issue 11, November 2003, Pages 2118-2125

https://doi.org/10.1016/S0161-6420(03)00863-7 Get rights and content

Abstract

Purpose

To describe the distribution of retinal vascular characteristics and their correlates in people with type 1 diabetes.

Design

Population-based study with baseline cross-sectional findings.

Participants

Nine hundred ninety-six persons who were diagnosed with diabetes before 30 years of age and who were taking insulin in an 11-county area in south-central Wisconsin participated in the baseline examination from 1980 to 1982. In addition, 225 persons without diabetes participated.

Methods

Retinal photographs of 7 standard fields were taken; lightbox grading was performed to determine arteriovenous (A/V) nicking and focal retinal arteriolar narrowing. Computer-assisted grading was performed from a digitized image of field 1 to determine central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and the arteriole-to-venule ratio (AVR).

Main outcome measures

Frequency and distribution of A/V nicking, CRAE, CRVE, AVR, and focal retinal arteriolar narrowing.

Results

In multivariate analyses, retinopathy severity, mean arterial blood pressure, presence of gross proteinuria, glycosylated hemoglobin, and history of cardiovascular disease were associated with CRAE. Retinopathy severity, age, mean arterial blood pressure, duration of diabetes, glycosylated hemoglobin level, and body mass index were associated with CRVE. With the exception of glycosylated hemoglobin, similar factors were associated with AVR. Age (odds ratio [OR] per 10 years, 2.43 and 2.02) and retinopathy severity (OR per level, 1.14 and 1.21) were associated with focal retinal arteriolar narrowing and A/V nicking, respectively. In persons ≥18 years of age, smoking was associated with CRAE, CRVE, and A/V nicking (OR, 2.67), but not with AVR or focal arteriolar narrowing.

Conclusions

This study documented the frequency and distribution of retinal vascular characteristics and their relationships to various factors in persons with type 1 diabetes.

Section snippets

Study population

The population has been described in detail in previous reports.11, 12, 13 It consisted of a sample selected from 10,135 diabetic patients who received primary care in an 11-county area in southern Wisconsin from 1979 to 1980. The full sample was composed of younger-onset and older-onset persons. These analyses are limited to the group of younger-onset persons, all of whom were taking insulin and had been diagnosed before 30 years of age (n = 1210). There were 996 persons in this group who

Results

The mean age of the diabetic group was 29 years, and the mean duration of diabetes was 15 years. Hypertension and gross proteinuria were each present in 22% of the diabetic cohort. Retinopathy was present in 72% of the cohort, 23% of whom had proliferative retinopathy. Focal retinal arteriolar narrowing was present in 14%, and A/V nicking was present in 8%. The mean CRAE was 217 μm, the mean CRVE was 245 μm, and the mean AVR was 0.88.

Discussion

The data reported herein are unique in describing information regarding the distributions of microvascular disease (generalized and focal retinal arteriolar narrowing, venular dilation, and A/V nicking) and their associations with systemic and ocular factors in a population-based cohort composed of all known patients with type 1 diabetes diagnosed before 30 years of age who were receiving treatment in a defined geographic area during a specified period. Quantifying the retinal arterioles and

Acknowledgements

We are grateful to the 452 Wisconsin physicians and their staff who participated in and supported this study.

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Manuscript no. 220874.

Supported by the National Institutes of Health, Bethesda, Maryland (grant no. EY03083-19) and the National Heart, Lung, and Blood Institute, Bethesda, Maryland (grant no. HL59259-03).

View full text

Retinal vascular abnormalities in persons with type 1 diabetes: The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVIII☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Study population

Results

Discussion

Acknowledgements

Lancet

Ophthalmology

J Clin Epidemiol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Diameters of the retinal vessels in diabetic and normal subjects

Diabetes

Vessel measurements in diabetic fundi

Proc R Soc Med

Oxygenation and vasodilation in relation to diabetic and other proliferative retinopathies

Ophthalmic Surg

Fundus photography of width and intensity profiles of the blood column and the light reflex in retinal vessels

Acta Ophthalmol (Copenh)

Laser Doppler velocimetry study of retinal circulation in diabetes mellitus

Arch Ophthalmol

Retinal vasodilation and hyperglycaemia in diabetic children and adolescents

Acta Ophthalmol Scand

Retinal arteriolar narrowing and risk of coronary heart disease in men and womenthe Atherosclerosis Risk in Communities Study

JAMA

Prevalence of diabetes mellitus in southern Wisconsin

Am J Epidemiol

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years

Arch Ophthalmol

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years

Arch Ophthalmol

The hypertensive detection and follow-up program

Prev Med