Association of Elevated Serum Lipid Levels With Retinal Hard Exudate in Diabetic Retinopathy

Chew, Emily Y.; Klein, Michael L.; Ferris, Frederick L.; Remaley, Nancy A.; Murphy, Robert P.; Chantry, Kathryn H.; Hoogwerf, Byron J.; Miller, Dayton T.

doi:10.1001/archopht.1996.01100140281004

Cited by 644 publications

(448 citation statements)

References 15 publications

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“…Predictors of future progression include microaneurysm count [18], and such features of the insulin-resistance syndrome as waist-to-hip ratio and serum triglyceride [19]. Serum triglyceride and cholesterol concentrations were associated with faster development of hard exudates and moderate visual loss in a subanalysis of the ETDRS [20]. Moderate alcohol consumption [21] and smoking [22] do not appear to influence the course of DR.…”

Section: Prevalence and Risk Factorsmentioning

confidence: 96%

Diabetic retinopathy

2002

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Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

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Section: Prevalence and Risk Factorsmentioning

confidence: 96%

Diabetic retinopathy

2002

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“…25 Stronger evidence for a role of serum lipids in exudative maculopathy is suggested in prospective studies. In the Early Treatment Diabetic Retinopathy Study (ETDRS), 26 a subgroup of 2709 of the original 3711 patients had serum lipids measured. Higher baseline total and LDL cholesterol levels increased the risk of retinal exudation by two-fold at baseline.…”

Section: Are Serum Lipids Associated With Increased Risk Of Maculopathy?mentioning

confidence: 99%

The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy?

Chowdhury

Hopkins

Dodson

et al. 2002

Eye

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The treatment for diabetic maculopathy is laser photocoagulation of the pigment epithelium. With the advent of systemic lipid lowering therapy over the last decade, there may be potential for medical therapy also. There is some anecdotal evidence of the effect of lipid lowering agents (particularly statins) in reducing exudate, and a number of studies have shown that lipid lowering therapy may reduce macular exudates, but numbers in these trials are small. A randomised controlled trial is now required to investigate whether the use of systemic lipid lowering therapy is of benefit in patients with exudative maculopathy, even in the absence of dyslipidaemia.

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“…Cholesterol concentrations are also associated with the development of hard exudates. 19 Our study helps link these findings by defining an association between cholesterol and clinically relevant macular disease that requires laser photocoagulation or ongoing care by an ophthalmologist. Studies examining the effect of cholesterol lowering on the development of maculopathy are required.…”

Section: Discussionmentioning

confidence: 88%

Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

Leese

2004

Eye

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Purpose The aim of this study was to determine whether there were any differences in the risk factors for developing proliferative diabetic retinopathy or maculopathy in patients with type-I diabetes. Method In all, 1632 patients aged 35 years or younger at diagnosis and treated with insulin, attending six hospital diabetes clinics in Scotland and included on the Royal College of Physicians of Edinburgh Diabetes Register were followed up for a median of 4.0 (2.5-5.5 years: interquartile range). All patients were screened at least annually for diabetic retinopathy using direct ophthalmoscopy, and positive findings were confirmed using slit lamp by an ophthalmologist. Results Duration of diabetes and HbA1c were the important risk factors for developing proliferative retinopathy, while duration of diabetes, systolic blood pressure, and HbA1c were the important factors for maculopathy. The adjusted relative incidence for proliferative retinopathy with a HbA1c in the highest quartile was 26.7, while for maculopathy it was only 2.29. Carstairs deprivation score was not associated with either retinal pathology. There was a plateau effect for systolic blood pressure of 140 mmHg and for duration of diabetes of 16 years for developing either maculopathy or proliferative retinopathy.Conclusion Duration of diabetes is a strong predictor for maculopathy and proliferative disease, but is relatively more important for proliferative disease. Raised systolic blood pressure is relatively more important for predicting maculopathy, while raised HbA1c is relatively more important for developing proliferative retinopathy.

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Association of Elevated Serum Lipid Levels With Retinal Hard Exudate in Diabetic Retinopathy

Cited by 644 publications

References 15 publications

Diabetic retinopathy

Diabetic retinopathy

The role of serum lipids in exudative diabetic maculopathy: is there a place for lipid lowering therapy?

Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

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