Objective To evaluate the association of subretinal hyper-reflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar in the Comparison of Age related Macular Degeneration Treatments Trials (CATT) Design Prospective cohort study within a randomized clinical trial. Participants The 1185 participants in CATT. Methods Participants were randomly assigned to ranibizumab or bevacizumab treatment monthly or as-needed. Masked readers graded scar and GA on fundus photography and fluorescein angiography images, SHRM on time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1mm2, or outside the center 1mm2 were obtained on SD-OCT images at 56 (n=76) and 104 (n=66) weeks. VA was measured by certified examiners. Main Outcome Measures SHRM presence, location and size, and associations with VA, scar, and GA. Results Among all CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than eyes with SHRM that resolved (64% vs. 31%; p<0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n=76) and 104 (n=66), mean [SE] VA letter score was 73.5 [2.8], 73.1 [3.4], 65.3 [3.5], and 63.9 [3.7] when SHRM was absent, present outside the central 1mm2, present within the central 1mm2 but not the foveal center, or present at the foveal center (p=0.02). SHRM was present at the foveal center in 43 (30%), within the central 1mm2 in 21 (15%) and outside the central 1mm2 in 19 (13%). When SHRM was present, the median maximum height in microns under the fovea, within the central 1 mm2 including the fovea and anywhere within the scan was 86; 120; and 122, respectively. VA was decreased with greater SHRM height and width (p<0.05). Conclusions SHRM is common in eyes with NVAMD and often persists after anti-VEGF treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM height and width were associated with worse VA. SHRM is an important morphological biomarker in eyes with NVAMD.
Indexes of retinopathy and nephropathy were studied in a large population of diabetics using standardized methods. In each of 973 subjects, more than 100 other variables were also measured: this made It possible to take into account many confounding factors when we examined the relationships of these variables to microangiopathy. The most powerful risk factor for microangiopathy was duration of diabetes, but frequency of both retinopathy and nephropathy was impressively related to the level of plasma glucose at the time of examination. This latter relationship was independent of the effects of other variables. Risk of retinopathy was also related to factors that were probably associated with higher previous plasma glucose levels—need for insulin therapy, history of ketonuria, present level of plasma triglyceride, leanness, and younger age of onset of diabetes. In subjects with a systolic blood pressure of less than 170 mm Hg and who did not have proteinuria, no significant relationship was found between blood pressure and frequency of retinopathy, but, when the systolic pressure was greater than 169 mm Hg, rates of retinopathy were excessive, even In those subjects without proteinuria. Several other factors had no significant relationship to retinopathy or nephropathy: these included age, level of education, smoking, and plasma cholesterol. Rates of severe nephropathy were somewhat greater In men than in women, but this difference was not statistically significant. Rates of retinopathy and of mild proteinuria were similar in men and women. After adjustment for duration of diabetes, the risk of retinopathy was no higher in the 102 subjects with two diabetic parents than in the 254 who had no family history of diabetes.
This is a review of previous and more recent observations on the prevalence and manifestations of diabetes in aboriginal populations of the New World. Rates of diabetes have now been measured or estimated in more than eighty of these groups in the Americas, Greenland, Polynesia, Micronesia and Melanesia. Diabetes was probably uncommon in all these native populations prior to 1940. It is now rife in many of these groups, but still rare in many. Among certain of these populations, rates of diabetes in adults still differ more than tenfold. Among groups of diabetics there are probably significant intertribal differences in the susceptibility to certain manifestations and complications such as retinopathy and coronary disease. There appear to be peculiarities in the insulin secretion patterns of certain of these tribes.The available evidence does not rule out the possibility that genetic factors play an important role in determining inter-tribal differences in prevalence and manifestations. But it is also clear that environmental factors exert powerful effects. Low rates of diabetes have been observed in Athapascan tribes and in some Shoshonean tribes. Diabetes was also rare prior to 1940 in Athapascan and Shoshonean Indians of Oklahoma. But diabetes has recently become common in these Oklahoma tribes. They were formerly lean and are now fat. The status of the many Oklahoma tribes is of particular interest because they represent seven of the eight major linguistic groups of North American Indians, having originated in very diverse parts of the Continent. Rates are now high in all Oklahoma tribes for which evidence is adequate to permit an estimate of prevalence. This includes fifteen tribes drawn from seven different linguistic groups. In seven additional Oklahoma tribes preliminary evidence, although less complete, suggests the probability that rates are also high.Studies of the dramatic emergence of diabetes and its manifestations in these aboriginal groups has considerable potential for gaining a better understanding of the genetic and environmental factors which influence risk and pathophysiology of diabetes and its complications. DIABETES 23:841-55, October, 1974.
Twelve age-matched populations of eleven countries were tested by standardized methods to determine associations between prevalence of hyperglycemia and certain epidemiologic variables, including several nutritional factors. There were great differences among some of these populations in socioeconomic status, diet, adiposity, and race. Environmental and demographic circumstances varied widely and prevalence of diabetes differed as much as ten-fold. There was in general a positive association between prevalence of diabetes and dietary intake of fat and of sugar, and a negative association between prevalence of diabetes and total carbohydrate consumption; but some inconsistencies in these associations suggested that they may have been partly or completely coincidental. Prevalence of diabetes correlated well with serum cholesterol levels, both among and within populations. Thejnost impressive and consistent association in these studies was between prevalence of diabetes and fatness (as estimated by weight in relation to height). Both within and among countries and races, this association was observed to a high degree. Interracial differences in prevalence of diabetes were small when racial groups were matched for adiposity. In a group of 1,645 subjects from the general population of Central America, those with abnormal glucose tolerance had a substantially higher prevalence of electrocardiographic abnormalities than those with normal tolerance.
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