Showing papers by "Ronald Klein published in 1983"

Is cigarette smoking associated with diabetic retinopathy

Abstract: The relationship between cigarette smoking and diabetic retinopathy is examined in this report. All participants were examined between September 1980 and July 1981 as part of a population-based study in southwestern Wisconsin. Exposure data on cigarette smoking at the time of examination were derived from a set of questions about present or past smoking history, duration of smoking, and number of cigarettes smoked per day. Retinopathy status was determined according to the modified Airlie House classification. The rate of diabetic retinopathy varied from 21% in those who had diabetes for 0-4.9 years to 97% in those who had diabetes for 15 or more years, for persons diagnosed before 30 years of age, and from 28% to 78% for comparable durations in those diagnosed at 30 years or older. There was no association between smoking history and duration of diabetes. In participants diagnosed before age 30, the relative risk for the presence of retinopathy in smokers compared with those who had never smoked was 1.06 (95% confidence limits (CL) 0.97-1.18); in participants diagnosed at 30 years or older it was 0.89 (95% CL 0.75-1.06). There was no relationship between the risk or severity of retinopathy and number of cigarettes smoked daily, or the number of pack-years smoked while diabetic. These data suggest that there is no excess risk of retinopathy in smokers or ex-smokers when contrasted with those who never smoked.

An Approach to the Prevention of Blindness in Diabetes

Abstract: Diabetic eye disease is the leading cause of new cases of legal blindness in American adults under the age of 65 yr. Diabetic persons are at risk for visual loss due to diabetic retinopathy, glaucoma, and cataracts. Better understanding of the natural histories of these complications and recent advances in treatment have provided a rationale for developing an approach to prevent visual loss. This approach requires that diabetic patients who are at high risk for visual loss, and not under the care of ophthalmologists, be systematically screened, referred, and treated.

Management of eye disease in the insulin-dependent diabetic patient.

Abstract: SUMMARY Severe retinopathy and blindness are rare in children with IDDM. However, many of the pathologic changes that will lead to severe retinopathy start in childhood or adolescence. Available data suggest an association between poor glucose control and severity of retinopathy. Further data are needed to confirm the role of “tight” control of blood sugar and blood pressure, or the use of medical therapy such as aldose reductase inhibitors or aspirin, in preventing the incidence or the progression of retinopathy. Patients with IDDM should receive regular ophthalmologic examinations, since timely panretinal photocoagulation treatment may prevent visual loss. This is especially important since diabetic individuals may be unaware of potential loss of vision because vision is usually unimpaired in the earlier stages of diabetic retinopathy. Even patients with new blood vessel growth may be unaware of the threat to vision until a serious hemorrhage into the vitreous occurs. At this point, it may be more difficult to obtain successful results from treatment.