Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Wong, Tien Yin; Klein, Ronald; Islam, Amirul; Cotch, Mary Frances; Folsom, Aaron R.; Klein, Barbara E.K.; Sharrett, A. Richey; Shea, Steven

doi:10.1016/j.ajo.2005.08.063

Cited by 579 publications

(505 citation statements)

References 41 publications

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“…The overall percentage of retinopathy in our population (28.4%) is similar to that in whites of the MESA (24.8%). In the MESA, the prevalence rates of minimal, mild, moderate, and severe retinopathy among whites were 14.4, 3.9, 3.9, and 2.6%, respectively, 19 whereas in SiMES, the corresponding prevalence rates were, 8.1, 5.4, 5.4, and 9.5%, respectively.…”

Section: Discussionmentioning

confidence: 94%

Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study

Islam

Nguyen

Wang

et al. 2008

Eye

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Purpose To describe the relationship of retinal vascular calibre with diabetes and diabetic retinopathy in an Asian population. Methods A total of 3280 (78.7% response) subjects, aged 40-80 years, of Malay ethnicity residing in Singapore participated in this population-based, cross-sectional study. Retinal vascular calibre was measured and summarized using a validated computer programme from digital retinal photographs. Diabetic retinopathy signs were graded from photographs using the modified Airlie House classification. Results Of the 3004 subjects with data for this analysis, 682 (22.7%) had diabetes, of whom 194 (28.4%) had retinopathy. After multivariable adjustment, retinal arteriolar calibre was significantly wider in persons with diabetes (141 vs 139 lm, Po0.001); venular calibre was not associated with diabetes (P ¼ 0.93). Among participants with diabetes, venular calibre increased from 218.7 lm in those without retinopathy to 231.1 lm in those with moderate and 231.4 lm in those with severe retinopathy (P for trend ¼ o0.001); arteriolar calibre was not associated with diabetic retinopathy. Conclusions This study shows wider retinal arterioles in diabetes and wider venules in those with diabetic retinopathy in an Asian population. These findings confirm earlier data on white population, supporting the concept that a quantitative assessment of retinal vasculature may provide further insights into early diabetic microvascular damage.

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Section: Discussionmentioning

confidence: 94%

Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study

Islam

Nguyen

Wang

et al. 2008

Eye

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“…Previous studies in the UK and USA have reported increased prevalence of both hypertensive and diabetic retinopathy in people of African or African-Caribbean ethnicity compared with Europeans [18][19][20][21][22][23][24]. Several reasons for this have been suggested including differences in BP, duration or onset of diabetes, and glycaemic control.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have also suggested that people of African or African-Caribbean ethnicity are more vulnerable than Europeans to retinopathy [18][19][20][21][22][23][24] and also suffer more microvascular disease in other tissues [25][26][27]. In this study we investigated whether retinal microvascular changes differed between people of European and African-Caribbean ethnicity with type 2 diabetes, and explored the role of blood pressure in these differences.…”

Section: Introductionmentioning

confidence: 97%

Comparison of the retinal microvasculature in European and African-Caribbean people with diabetes

et al. 2009

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Diabetes aggravates the impact of elevated BP (blood pressure) on the microcirculation, and people of African ancestry with diabetes are more susceptible to microvascular damage than Europeans. In the present study, we investigated possible differences in the retinal microcirculation in people of European and African-Caribbean ethnicity with diabetes that might account for this. A total of 51 subjects with Type 2 diabetes (age 40–65 years; 25 male; 29 African-Caribbean) were studied. Clinic and 24 h ambulatory BP, and fasting glucose, insulin and lipids were measured. Digital retinal images were analysed using custom-written semi-automatic software to determine: LDR (length/diameter ratio) and AVR (arteriolar/venular diameter ratio), branching angles, vessel tortuosity and NT (number of terminal vessel branches). Arterioles were narrower in European people with diabetes than in African-Caribbean people with diabetes [mean (S.D.) arteriolar diameter, 76 (7) compared with 82 (11) μm respectively (P=0.03); arteriolar LDR, 28.1 (8.5) compared with 23.7 (7.0) respectively (P=0.046); and AVR, 0.66 (0.21) compared with 0.90 (0.36) respectively (P=0.028)]. Ethnic differences in arteriolar LDR, arteriolar diameter and AVR were not explained by differences in BP, but were attenuated by adjustment for the duration of diabetes. There was no significant relationship between BP and arteriolar narrowing in the group as a whole, although the relationship between arteriolar LDR and systolic BP was stronger in Europeans than African-Caribbeans [β=0.08 (0.07) compared with β=0.03 (0.06); P=0.03]. In conclusion, in the presence of diabetes, a relationship between BP and retinal arteriolar diameter was not evident and implies impaired small artery remodelling in the presence of diabetes. African-Caribbean people with diabetes have wider retinal arterioles and this could contribute to enhanced microvascular damage in this ethnic group.

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“…The Multi-Ethnic Study of Atherosclerosis protocol was used for the evaluation of macular edema (11). These grading protocols were previously used in persons with and without diabetes (12).…”

Section: Retinopathy and Vessel Caliber Assessment Protocolsmentioning

confidence: 99%

Retinopathy and Progression of CKD

Grunwald

Pistilli

Ying

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Retinal abnormalities may be associated with changes in the renal vasculature. This study assessed the association between retinopathy and progression of kidney disease in participants of the Chronic Renal Insufficiency Cohort (CRIC) study.Design, setting, participants, & measurements This was a prospective study in which patients with CKD enrolled in CRIC had nonmydriatic fundus photographs of both eyes. All CRIC participants in six clinical sites in which fundus cameras were deployed were offered participation. Photographs were reviewed at a reading center. The presence and severity of retinopathy and vessel calibers were assessed using standard protocols by graders masked to clinical information. The associations of retinal features with changes in eGFR and the need for RRT (ESRD) were assessed.Results Retinal images and renal progression outcomes were obtained from 1852 of the 2605 participants (71.1%) approached. During follow-up (median 2.3 years), 152 participants (8.2%) developed ESRD. Presence and severity of retinopathy at baseline were strongly associated with the risk of subsequent progression to ESRD and reductions in eGFR in unadjusted analyses. For example, participants with retinopathy were 4.4 times (95% confidence interval [95% CI], 3.12 to 6.31) more likely to develop ESRD than those without retinopathy (P,0.001). However, this association was not statistically significant after adjustment for initial eGFR and 24-hour proteinuria. Venular and arteriolar diameter calibers were not associated with ESRD or eGFR decline. The results showed a nonlinear relationship between mean ratio of arteriole/vein calibers and the risk of progression to ESRD; participants within the fourth arteriole/vein ratio quartile were 3.11 times (95% CI, 1.51 to 6.40) more likely to develop ESRD than those in the first quartile (P,0.001).Conclusions The presence and severity of retinopathy were not associated with ESRD and decline in eGFR after taking into account established risk factors.

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Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Cited by 579 publications

References 41 publications

Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study

Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study

Comparison of the retinal microvasculature in European and African-Caribbean people with diabetes

Retinopathy and Progression of CKD

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