Brien Holden Vision Institute.

Brien Holden Vision Institute.

In this limited-size, short-term exploratory study, SDM laser was effective in treating chronic CSC. There was no evidence of retinal damage induced by treatment.

Purpose-To investigate changes of vision-related quality of life during a 10-year period in a type 1 diabetes population. Design-Prospective cohort studyParticipants-Individuals who had their diabetes diagnosed before 30 years of age were considered to have type 1 diabetes (N=1,210). Those who participated in both 14-year (1995-96) and 25-year (2005-07) follow-up examinations were included in the current analysis (N=471). Methods-Vision-related quality of life was measured with the National Eye Institute Vision Function Questionnaire (NEI-VFQ-25).Main Outcome Measures-Changes in vision-related quality of life scores. Results-Loss of three lines in the Early Treatment Diabetic Retinopathy Study (ETDRS) chartwas the most important factor related to negative changes in the NEI-VFQ-25 scores in our study after controlling for confounders. Most important changes were observed in subscales such as general vision (−6.46 points); mental health (−10.19 points); role difficulty (−6.06 points); and driving (−10.43 points). Unemployment and the development long-term complications such as nephropathy were also associated with negative changes in some NEI-VFQ-25 subscale scores. On the other hand, changes in diabetic retinopathy status were not related to changes in any subscale after 10 years.

BackgroundThis paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil.MethodsA population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3 300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment.ResultsPresenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3–6.1) and 2.2% (95% CI: 1.6–2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2–9.5) and 3.7% (95% CI: 2.9–4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9–1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2–0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%).ConclusionThe main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.

OBJECTIVE—The purpose of this study was to examine the relationship of glycemic control and exogenous and endogenous insulin levels with all-cause and cause-specific mortality (ischemic heart disease and stroke) in an older-onset diabetic population. RESEARCH DESIGN AND METHODS—The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing, prospective, population-based cohort study of individuals with diabetes first examined in 1980–1982. A stratified sample of all individuals with diabetes diagnosed at 30 years of age or older was labeled “older-onset” (n = 1,370). Those participating in the 1984–1986 examination phase (n = 1,007) were included in the analysis. Endogenous insulin was determined by measurements of plasma C-peptide (in nanomoles per liter), and exogenous insulin was calculated in units per kilogram per day. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1). RESULTS—After 16 years of follow-up, 824 individuals died (all-cause mortality); 358 deaths involved ischemic heart disease and 137 involved stroke. C-peptide and HbA1 were significantly associated with all-cause and ischemic heart disease mortality in our study. The hazard ratio (95% CI) values for all-cause mortality were 1.12 (1.07–1.17) per 1% increase in HbA1, 1.20 (0.85–1.69) per 1 unit · kg−1 · day−1 increase in exogenous insulin, and 1.15 (1.04–1.29) per 1 nmol/l increase in C-peptide and for ischemic heart disease mortality were 1.14 (1.06–1.22), 1.50 (0.92–2.46), and 1.19 (1.02–1.39) for HbA1, exogenous insulin, and C-peptide, respectively, after adjusting for relevant confounders. C-peptide was associated with stroke mortality only among men (1.65 [1.07–2.53]). CONCLUSIONS—Our results show that individuals with higher endogenous insulin levels are at higher risk of all-cause, ischemic heart disease, and stroke mortality.

The adjunctive use of UV-A and B2 therapy did not demonstrate antitrophozoite activity; in vivo UV-A and B2 did not demonstrate efficacy in this model.

Purpose-To investigate the association of clinically significant macular edema (CSME) and longterm survival in individuals with type 1 and type 2 diabetes.Design-Population-based cohort study. Methods-TheWisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated in 1980-82 of individuals with diabetes diagnosed at either < 30 years (younger-onset, n = 996) or 30 years of age (older-onset, n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House Classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria.Results-Prevalence of CSME was 5.9% and 7.5% for the younger-and older -onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause (hazard ratio and 95% confidence interval: 1.41 (0.96-2.07), P = 0.08) or ischemic heart disease mortality (1.14 (0.61-2.12), P = 0.68) in the younger-onset group. In the older onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present: 1.55 (1.25-1.92), P < 0.01 and 1.56 (1.15-2.13), P < 0.01, respectively, when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (1.58 (1.07-2.35), P = 0.02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group.