Showing papers by "Ronald Klein published in 1994"
TL;DR: Although visual loss is still common in this diabetic population, the incidence of blindness may be decreasing, and several modifiable risk factors are associated with loss of vision.
609 citations
TL;DR: These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progress of diabetic Retinopathy during the 10- year study period.
Abstract: Objective: To examine the 10-year incidence and progression of diabetic retinopathy. Design: Population-based incidence study. Participants: Seven hundred sixty-five insulin-taking diabetic persons diagnosed before age 30 years, 251 insulin-taking diabetic persons diagnosed at age 30 years or older, and 282 non-insulin-taking diabetic persons diagnosed at age 30 years or older who participated in baseline, 4-year, and 10-year follow-up examinations. Main Outcome Measures: The 10-year incidence of any retinopathy, progression of retinopathy, and progression to proliferative retinopathy were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study severity scheme. Results: The 10-year incidence of retinopathy (89%, 79%, and 67%), progression of retinopathy (76%, 69%, and 53%), and progression to proliferative retinopathy (30%, 24%, and 10%) were highest in the group diagnosed before age 30 years, intermediate in the insulin-taking group diagnosed at age 30 years or older, and lowest in the non-insulin-taking group, respectively. Increased risk of proliferative retinopathy was associated with more severe retinopathy at baseline. Conclusions: These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progression of diabetic retinopathy during the 10-year study period.
482 citations
Journal Article•
TL;DR: Cross-sectional data indicate age-related differences in refractive status in an adult population and suggest that education is associated with myopia independent of age.
Abstract: PURPOSE: To describe the prevalence of refractive errors in a population of adult Americans. METHODS: From 1988 to 1990, 4926 adults who were 43 to 84 years of age and living in Beaver Dam, Wisconsin at the time of the 1987-1988 census were examined. Refractions were performed according to a modification of the Early Treatment Diabetic Retinopathy Study protocol. Included in this study were 4533 people who had not undergone cataract surgery and who had a best corrected visual acuity better than 20/40 in at least one eye. Myopia was defined as a refractive error less than -0.50 diopters; hyperopia was defined as a refractive error greater than +0.50 diopters. RESULTS: Hyperopia was more frequent than myopia in the study group (age-adjusted of 49.0% and 26.2% in right eyes, respectively, P = 0.0001). The prevalence of hyperopia in the right eye increased with increasing age from 22.1% in those 43 to 54 years of age to 68.5% in those 75 years of age or older. The prevalence of myopia in the right eye decreased from 43.0% in those 43 to 54 years of age to 14.4% in those 75 years of age or older. There was significant relationship between education level and refractive error (age adjusted r = -0.32, P = 0.0001). Neither household income nor occupation was associated with refractive error in our data. CONCLUSION: These cross-sectional data indicate age-related differences in refractive status in an adult population and suggest that education is associated with myopia independent of age.
415 citations
TL;DR: Data from a population-based cohort study are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long- term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the Course of disease.
Abstract: Background: The object was to examine the relationship of hyperglycemia, as measured by glycosylated hemoglobin level, to the incidence and progression of diabetic retinopathy over a 10-year period. Methods: Patients who were younger (n=682) and older (n=834) than 30 years at onset of diabetes participated in baseline (1980-1982) and follow-up (1984-1986 and 1990-1992) examinations of a population-based cohort study. Glycosylated hemoglobin levels were measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. Results: Persons with glycosylated hemoglobin levels in the highest quartile at baseline were more likely to have progression of retinopathy than persons with levels in the lowest quartile (younger-onset group: relative risk [RR], 2.9; 95% confidence interval [CI], 2.3 to 3.5; older-onset group taking insulin: RR, 2.1; 95% CI, 1.6 to 2.8; and older-onset group not taking insulin: RR, 4.3; 95% CI, 3.0 to 6.2) and were more likely to develop proliferative diabetic retinopathy (younger-onset group: RR, 7.1; 95% CI, 4.6 to 11.1; older-onset group taking insulin: RR, 3.1; 95% CI, 1.5 to 6.1; and older-onset group not taking insulin: RR, 13.8; 95% CI, 4.8 to 39.5). These relations were significant ( P Conclusions: These data are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long-term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the course of disease in people with both younger- and older-onset diabetes. (Arch Intern Med. 1994;154:2169-2178)
300 citations
TL;DR: In this article, the relation of older-onset diabetes to open-angle glaucoma was evaluated in a population-based study of age-related eye disease (n = 4926).
281 citations
TL;DR: Sibling correlations were evaluated and segregation analysis was performed on age‐dependent maculopathy scores of the right and left eyes of individuals from 564 families in the Beaver Dam Eye study, finding similar major gene parameter estimates are found for both eyes.
Abstract: Sibling correlations were evaluated and segregation analysis was performed on age-dependent maculopathy scores of the right and left eyes of individuals from 564 families in the Beaver Dam Eye study. There is evidence of significant sibling correlations. The data fit a mixture of two normal distributions, especially after undergoing the Box and Cox power transformation. In each eye, the hypothesis of mendelian transmission of a major effect cannot be rejected under the tau AB free model, but is rejected under the tau's free model. The hypothesis of a random environmental major effect is rejected. Similar major gene parameter estimates are found for both eyes. The results are consistent with a major effect accounting for 62% and 59%, in the right and left eyes, respectively, of the determination of age-related maculopathy scores. A single major gene can account for about 89% and 97% of this variability due to a major effect, or for about 55% and 57% of the total variability, in the right and left eyes, respectively.
259 citations
Journal Article•
242 citations
TL;DR: Results suggest possible benefit to the control of glycemia with respect to death due to vascular disease and diabetes.
Abstract: Background: The purpose of this study was to investigate the association of glycemia with cause-specific mortality in a diabetic population. Methods: The study was a cohort design based in a primary care setting. Participants were all younger-onset diabetic persons (conditions diagnosed when they were younger than 30 years old and taking insulin, N=1210) and a random sample of older-onset diabetic persons (conditions diagnosed when they were 30 years or older, N=1780). Glycosylated hemoglobin levels were obtained at baseline examinations in 1980 to 1982 in which 996 younger-onset and 1370 older-onset persons participated. Median follow-up was 10 years in younger-onset and 8.3 years in older-onset persons; four younger-onset and two older-onset persons were unavailable for follow-up. The main outcome measure was cause-specific mortality as determined from death certificates. Results: In the younger-onset group after controlling for other risk factors in proportional hazards models and considering underlying cause of death, glycosylated hemoglobin was significantly associated with mortality from diabetes (hazard ratio [HR] for a 1% change in glycosylated hemoglobin, 1.25; 95% confidence interval [CI], 1.13 to 1.38) and ischemic heart disease (HR, 1.18; 95% CI, 1.00 to 1.40). In the older-onset group, glycosylated hemoglobin was significantly associated with mortality from diabetes (HR, 1.32; 95% CI, 1.21 to 1.43), ischemic heart disease (HR, 1.10; 95% CI, 1.04 to 1.17), and stroke (HR, 1.17; 95% CI, 1.05 to 1.30), but not cancer (HR, 0.99; 95% CI, 0.88 to 1.10). Results for any mention of specific causes of death were similar. Conclusion: These results suggest possible benefit to the control of glycemia with respect to death due to vascular disease and diabetes. (Arch Intern Med. 1994;154:2473-2479)
235 citations
TL;DR: It is suggested that retinopathy and retinal arteriolar narrowing are common in people with hypertension, and further longitudinal study is necessary to evaluate the public health significance of these retinal lesions regarding possibly increased risk of renal and cardiovascular disease.
Abstract: Objective: To investigate the relationship of various retinal lesions to systemic hypertension in the population-based Beaver Dam Eye Study. Design: In this cross-sectional population-based study, blood pressure was measured using standardized protocols. Using standardized protocols, stereoscopic color fundus photographs were graded in a masked fashion to determine the presence of retinopathy (defined as retinal microaneurysms only, blot hemorrhages only, hemorrhages and/or microaneurysms, cotton-wool spots, hard exudates, intraretinal microvascular abnormalities, venous beading, and retinal new vessels), retinal arteriolar narrowing, and arteriovenous nicking. Participants: Subjects aged 43 through 84 years who lived in Beaver Dam, Wis, between 1987 and 1988 were examined between 1988 and 1990. People with diabetes or retinal vascular occlusions were excluded. Results: Retinopathy was present in 336 subjects (7.8%), arteriolar narrowing in 582 subjects (13.5%), and arteriovenous nicking in 95 subjects (2.2%) in the nondiabetic population. Hypertension was associated with increased frequency of retinopathy, arteriolar narrowing, and arteriovenous nicking. After adjusting for age, hypertension was associated with the presence of retinopathy (in men: relative risk [RR], 1.47; 95% confidence interval [CI], 1.10 to 1.96; in women: RR, 1.69; 95% CI, 1.26 to 2.27), arteriolar narrowing (in men: RR, 1.34; 95% CI, 1.03 to 1.74; in women: RR, 1.37; 95% CI, 1.14 to 1.64), and arteriovenous nicking (in men: RR, 1.87; 95% CI, 0.99 to 3.54; in women: RR, 1.65; 95% CI, 1.00 to 2.73). Retinopathy, arteriolar narrowing, and arteriovenous nicking were more frequent in those subjects whose blood pressure was elevated despite use of antihypertensive medications compared with those subjects whose blood pressure was controlled with antihypertensive medications or those who were normotensive. Conclusions: These data suggest that retinopathy and retinal arteriolar narrowing are common in people with hypertension. Further longitudinal study is necessary to evaluate the public health significance of these retinal lesions regarding possibly increased risk of renal and cardiovascular disease.
188 citations
TL;DR: These data are suggestive of a modest protective effect of estrogen exposure on the lenses of women, and may be possible in studies currently under way in which postmenopausal estrogens are being tested for other (protective) effects.
Abstract: Objective: To evaluate a possible association between estrogen and lens opacities. Design: A prevalence survey of age-related eye disease. Setting: Beaver Dam, Wis. Participants: A total community sample of persons 43 through 84 years of age at the time of a private census were recruited for examination, medical history, and photographs of the lenses of the eyes. Data from women are included in this report. Main Outcome Measures: Photographs were graded by protocol for the presence and severity of age-related lens opacities. Results: Current use of postmenopausal estrogens was associated with a decreased risk of more severe nuclear sclerosis. Younger age at menarche was also associated with a protective effect regarding nuclear sclerosis. Older age at menopause was associated with a decreased risk of cortical opacities. Conclusion: These data are suggestive of a modest protective effect of estrogen exposure on the lenses of women. Further evaluation of this may be possible in studies currently under way in which postmenopausal estrogens are being tested for other (protective) effects.
151 citations
TL;DR: In this paper, the authors investigated the relation between socioeconomic factors and the prevalence of age-related cataract, maculopathy, and visual impairment using a population-based sample of 4926 people 43 to 86 years of age.
TL;DR: Data suggest a possible commonly shared pathogenesis between nuclear sclerotic cataract and age-related maculopathy.
Abstract: Objective: To evaluate the relationship between three types of cataract or cataract surgery and age-related maculopathy. Design: Population-based prevalence study. Participants: A total of 4926 people participating in The Beaver Dam Eye Study from 1988 through 1990. Main Outcome Measures: Grading of photographs for nuclear sclerosis, cortical cataract, and posterior subcapsular cataract and signs of age-related maculopathy was performed using standardized protocols. Results: After adjusting for other risk factors, nuclear sclerosis was associated with increased odds of early age-related maculopathy (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.28 to 3.01) but not of late age-related maculopathy (OR, 1.38; 95% CI, 0.52 to 3.63). Neither cortical nor posterior subcapsular cataracts were related to age-related maculopathy. There were increased odds of early age-related maculopathy in eyes that had undergone cataract surgery. Conclusion: These data suggest a possible commonly shared pathogenesis between nuclear sclerotic cataract and age-related maculopathy.
TL;DR: In this paper, the authors evaluated the impact of combined kidney and pancreas transplantation on the progression of advanced diabetic retinopathy and found no evidence that the normalization of glycemia associated with a combined kidney-pancreas transplanted in patients with advanced proliferative diabetic reginopathy (mostly treated with photocoagulation) accelerated retinogenesis.
TL;DR: The results suggest that pressure phenomena may be related to the development of retinopathy in younger-onset persons, which would have implications for treatments affecting both IOP and blood pressure.
TL;DR: Use of vitamin supplements is longitudinally associated with nuclear and cortical opacities, however, the direction of the association is influenced by the type of opacity and diabetes status.
TL;DR: Self-rated health is a significant predictor of mortality in people with older onset diabetes but not in those with younger onset diabetes when physical health status is controlled.
Abstract: OBJECTIVES. This study examined whether self-rated health is an independent and significant predictor of mortality in people with diabetes, using data collected in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. METHODS. Participants were asked to rate their health in comparison with others their age. A proportional hazards model was used to regress survival time on self-rated health and a number of covariates measuring physical health. RESULTS. People with younger onset diabetes (n = 891) who rated their health relative to their peers as "worse" or "don't know" were no more likely to die than those rating their health as "the same" or "better" when physical health status was controlled. In contrast, those with older onset diabetes (n = 987) who rated their health as "worse" or "don't know" were almost twice as likely to die as those rating their health as "the same" or "better" when physical health status was controlled. CONCLUSIONS. Self-rated health is a significant predictor of mortality in...
TL;DR: Investigating the relations between socioeconomic factors and the incidence of proliferative retinopathy and loss of vision in younger-onset persons with diabetes suggested that education is associated with the development of lost vision, independent of other risk factors.
Journal Article•
TL;DR: Alcohol consumption in moderation (< or = 1 oz/day) does not appear to affect the occurrence of diabetic retinopathy.
TL;DR: The data suggest a previously unsuspected reduction in the adjusted risk for development and progression of retinopathy in African Americans, and this apparently reduced risk is not known.
Abstract: Background: The development and progression of diabetic retinopathy in African Americans with insulin-dependent diabetes mellitus is not known. Methods: Two hundred subjects with insulin-dependent diabetes mellitus with duration of diabetes 16 years or less at first visit were studied; 58 were African Americans and 142 were whites. All had gradable stereoscopic color fundus photographs (seven standard fields) from at least two visits (mean time between first and second visit was 4.1 years). Subjects with hemoglobinopathy or proliferative retinopathy or subjects who had evidence of treatment for proliferative retinopathy at first visit were excluded. Masked grading of photographs was conducted using the modified Airlie House classification scheme. Results: African Americans were older, heavier, had higher systolic blood pressure (all P 1 (HbA 1 ) values ( P =.06) than the whites at first visit. African Americans had a lower rate of two steps or more progression from preexistent retinopathy (19%) than whites (43%). Progression to proliferative retinopathy or treatment was similar by race. Multivariate analysis predicting development or progression of retinopathy, while controlling for length of follow-up, found higher HbA 1 (odds ratio [OR]=2.15), longer duration of insulin-dependent diabetes mellitus (OR=1.69), higher serum creatinine concentration (OR=1.59), and white race (OR=2.62) to be independent risk factors. Conclusions: These data suggest a previously unsuspected reduction in the adjusted risk for development and progression of retinopathy in African Americans. The reason for this apparently reduced risk are not known. (Arch Intern Med. 1994;154:2597-2602)
TL;DR: A recently completed clinical trial demonstrated that early detection and treatment of proliferative retinopathy and clinically significant macular edema with laser photocoagulation could prevent vision loss.
Abstract: Diabetic retinopathy is a leading cause of blindness in the U. S. (1). However, this need not be the case. A recently completed clinical trial sponsored by the National Eye Institute, the Early Treatment Diabetic Retinopathy Study, demonstrated that early detection and treatment of proliferative retinopathy and clinically significant macular edema with laser photocoagulation could prevent vision loss (2,3). Ferris (4) estimated that timely treatment of proliferative retinopathy with panretinal photocoagulation should reduce serious vision loss by 95%. However, data from a number of studies suggest that a significant number of Americans with diabetes may not be receiving recommended eye examinations for the detection of retinopathy (5–7). Delivery of such care has been shown to prev nt vision loss and be cost-effective (8,9).