Elsevier

Ophthalmology

Volume 114, Issue 7, July 2007, Pages 1332-1340
Ophthalmology

Original Article
Biologic Risk Factors Associated with Diabetic Retinopathy: The Los Angeles Latino Eye Study

https://doi.org/10.1016/j.ophtha.2006.10.023Get rights and content

Objective

To identify biologic risk factors associated with having diabetic retinopathy (DR) in Latinos with type 2 diabetes mellitus (T2DM).

Design

Population-based cross-sectional study.

Participants

Six thousand three hundred fifty-seven Latinos ages ≥40 years from 6 census tracts in Los Angeles, California.

Methods

An in-home interview was administered to all participants in the Los Angeles Latino Eye Study (LALES). All participants diagnosed with T2DM underwent a complete ophthalmologic examination including stereoscopic fundus photography (7 standard Early Treatment Diabetic Retinopathy Study fields). Photographs were graded in a masked manner using a modified Airlie House grading system to assess presence and severity of DR. Univariate and stepwise logistic regression analyses were used to identify independent risk factors.

Main Outcome Measures

Biologic risk factors associated with any DR and proliferative DR (PDR).

Results

Of the 7789 eligible individuals in LALES, 6357 (82%) had a clinical examination. One thousand two hundred sixty-three participants had definite diabetes and 1187 Latinos had T2DM. Of those with T2DM, 46% (544) had DR. Stepwise logistic regression analyses revealed that compared with females, males had a 50% higher risk of having any DR (OR = 1.50; P = 0.006). Factors independently associated with a greater risk of having any DR were longer duration of known diabetes (per year, OR = 1.08, P<0.0001), higher glycosylated hemoglobin levels (per 1%, OR = 1.22, P<0.0001); higher systolic blood pressure (per 20 mmHg, OR = 1.26, P = 0.002); and insulin treatment (OR = 1.60, P = 0.01). Factors independently associated with PDR included longer duration of known diabetes (per year, OR = 1.06, P<0.0001); being on insulin treatment (OR = 3.2, P<0.0001); and a higher systolic blood pressure (per 20 mmHg, OR = 1.44, P = 0.01). The relationship of these variables to the risk of having DR or PDR is not a constant linear function in all cases and varies depending on the variable.

Conclusions

Our study showed that the high risk of DR in adult Latinos is independently associated with both nonmodifiable and modifiable risk factors. These findings suggest that controlling hyperglycemia and hypertension in this ethnic group may reduce the high risk of having DR associated with T2DM.

Section snippets

Design

The LALES was conducted on self-identified Latinos (primarily Mexican American), ages ≥40 years, living in the city of La Puente, California. The University of Southern California’s Institutional Review Board approved the study, and all procedures were in accord with the standards of the Declaration of Helsinki for research involving human subjects. Informed consent was obtained from all study participants. Details of the study design, sampling plan, and baseline data are reported elsewhere.10

Results

Of the 6357 eligible participants who completed a clinical examination, 1263 participants had definite DM; 1187 subjects (94% of those with definite DM) were identified as having T2DM. Almost half (n = 544, 46%) of those with T2DM had DR. Among those who were diagnosed with any DR, 168 (31%) had mild NPDR, 309 (57%) had moderate to severe NPDR, and 67 (12%) had PDR.

Table 1 shows the univariate associations of various risk factors with any DR. Candidate risk factors (those with P<0.10) for the

Discussion

We identified male gender, longer duration of T2DM, elevated glycosylated hemoglobin, higher systolic blood pressure, and treatment with insulin to be independently associated with any DR. In addition, longer duration of T2DM, higher systolic blood pressure, and insulin use were also risk factors for having PDR. We also demonstrated that the relationship of these variables to the risk of having DR or PDR is not a constant linear function in all cases and varies depending on the variable of

References (24)

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    Ophthalmology

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    Manuscript no. 2006-721.

    Supported by the National Eye Institute and National Center on Minority Health and Health Disparities (grant nos. EY 11753, EY 03040), Bethesda, Maryland, and an unrestricted grant from Research to Prevent Blindness, New York, New York.

    The authors have no proprietary or commercial interest in any materials discussed in the article.

    ⁎

    Study Group members are listed in “Appendix.”

    2

    Dr Varma is a Research to Prevent Blindness Sybil B. Harrington Scholar.

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    Copyright © 2007 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.