Retinopathy in old persons with and without diabetes mellitus: the Age, Gene/Environment Susceptibility–Reykjavik Study (AGES-R).

Kleins Lab // Publications // Mar 01 2012

PubMed ID: 22134840

Author(s): Gunnlaugsdottir E, Halldorsdottir S, Klein R, Eiriksdottir G, Klein BE, Benediktsson R, Harris TB, Launer LJ, Aspelund T, Gudnason V, Cotch MF, Jonasson F. Retinopathy in old persons with and without diabetes mellitus: the Age, Gene/Environment Susceptibility—Reykjavik Study (AGES-R). Diabetologia. 2012 Mar;55(3):671-80. doi: 10.1007/s00125-011-2395-y. Epub 2011 Dec 2. PMID 22134840

Journal: Diabetologia, Volume 55, Issue 3, Mar 2012

AIMS/HYPOTHESIS We aimed to describe the prevalence of retinopathy in an aged cohort of Icelanders with and without diabetes mellitus.

METHODS The study population consisted of 4,994 persons aged ≥ 67 years, who participated in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-R). Type 2 diabetes mellitus was defined as HbA(1c) ≥ 6.5% (>48 mmol/mol). Retinopathy was assessed by grading fundus photographs using the modified Airlie House adaptation of the Early Treatment Diabetic Retinopathy Study protocol. Associations between retinopathy and risk factors were estimated using odds ratios obtained from multivariate analyses.

RESULTS The overall prevalence of retinopathy in AGES-R was 12.4%. Diabetes mellitus was present in 516 persons (10.3%), for 512 of whom gradable fundus photos were available, including 138 persons (27.0%, 95% CI 23.2, 31.0) with any retinopathy. Five persons (1.0%, 95% CI 0.3, 2.3) had proliferative retinopathy. Clinically significant macular oedema was present in five persons (1.0%, 95% CI 0.3, 2.3). Independent risk factors for retinopathy in diabetic patients in a multivariate model included HbA(1c), insulin use and use of oral hypoglycaemic agents, the last two being indicators of longer disease duration. In 4478 participants without diabetes mellitus, gradable fundus photos were available for 4,453 participants, with retinopathy present in 476 (10.7%, 95% CI 9.8, 11.6) and clinically significant macular oedema in three persons. Independent risk factors included increasing age and microalbuminuria.

CONCLUSIONS/INTERPRETATION Over three-quarters (78%) of retinopathy cases were found in persons without diabetes and a strong association between microalbuminuria and non-diabetic retinopathy was found. These results may have implications for patient management of the aged.