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Ronald Klein

Publications and source records attributed to Ronald Klein.

At least 127 records · Page 7Linked to original sources
PubMed2004

The epidemiology of age-related macular degeneration.

PURPOSE: To review the epidemiology of age-related macular degeneration (AMD). DESIGN: Evidence from epidemiologic data regarding the natural history of AMD and its risk factors are presented. RESULTS: Large, soft drusen associated with pigmentary abnormalities increase the risk of progression to advanced AMD. Large soft drusen may fade over time. Advanced AMD is more likely to be present in whites than blacks, despite the similar prevalence of soft drusen in both groups. Neovascular AMD is more frequent than geographic atrophy in most population-based studies in whites in America, Australia, and the Netherlands than in similar population-based studies in Iceland and Norway. After age and family history, there are few consistent relationships of risk factors to AMD. Of these, the relationship of smoking, hypertension, and cataract surgery to advanced AMD have been most consistent. CONCLUSIONS: Long-term epidemiologic studies have provided information on the distribution and the natural history of AMD and its associated risk factors. It is not known what effect reduction of blood pressure and the cessation of smoking might have on the incidence and progression of AMD.

Disease Progression↗
PubMed2004

Does refractive error influence the association of blood pressure and retinal vessel diameters? The Blue Mountains Eye Study.

PURPOSE: To determine if refractive errors influence the association of blood pressure and retinal vessel diameters. DESIGN: Population-based, cross-sectional study. METHODS: Retinal photographs from the right eyes of participants (n = 3,654, aged 49+ years) in the Blue Mountains Eye Study taken during baseline examinations (1992 to 1994) were digitized. The diameter of all retinal vessels located half to one disk diameter from the disk margin was measured using a computer-assisted imaging program. These measurements were combined to provide the average diameters of retinal arterioles and venules of that eye, and the ratio of their diameters, the arteriole-to-venule ratio (AVR). The association of blood pressure and retinal vessel diameters was analyzed before and after correction for refraction using the Bengtsson formula. RESULTS: Before correction, each 10-mm Hg increase in mean arterial blood pressure was associated with a 3.7-microm (95% confidence interval [CI], 3.2-4.3) decrease in arteriolar diameter and a 0.9-microm (95% CI, 0.3-0.9) decrease in venular diameter. After correction for refraction, each 1-mm Hg increase in mean arterial blood pressure was associated with a 3.7-microm (95% CI, 3.2-4.2) decrease in arteriolar diameter and a 0.8-microm (95% CI, 0.3-0.9) decrease in venular diameter. Refraction was not associated with the AVR and had no effect on the association of blood pressure and AVR. CONCLUSION: Refraction had no appreciable effect on the association of blood pressure and retinal vessel diameters or on the AVR. Correction for refraction is important for quantifying absolute retinal vessel caliber, but may not be particularly important in epidemiologic studies investigating the association of generalized retinal arteriolar narrowing and hypertension.

Aged↗
PubMed2004

The comparability of estimates of retroilluminated lens opacities as judged from film-based and digital imaging.

PURPOSE: Neitz film-based retroillumination cameras, the standard for documenting retroilluminated lens opacities for epidemiologic studies, are no longer produced. A digital imaging system is now available for imaging these opacities. We sought to compare gradings of images from both systems. DESIGN: Comparison of technique. METHODS: One hundred fourteen lenses were imaged with both systems and graded according to protocols. Concordance between the methods was compared using kappa statistics. RESULTS: There was moderate concordance for cortical opacities (kappa = 0.63) and good concordance for posterior subcapsular opacities (kappa = 0.83). Grades from digital images slightly underestimated the frequency and severity of cortical cataract. CONCLUSION: Digital imaging of retroilluminated lens opacities results in similar classification of the severity of opacities. It will be useful for epidemiologic studies of cortical (CC) and posterior subcapsular cataracts (PSC).

Cataract↗
PubMed2004

Relationship between white blood cell count and incident hypertension.

BACKGROUND: Elevated white blood cell (WBC) count is considered to be prospectively associated with cardiovascular disease. However, its relationship to hypertension, independent of smoking and other established cardiovascular risk factors, is not clear, especially among women. METHODS: We used data from a large population-based study in Wisconsin (Beaver Dam Eye study) to examine the prospective association between elevated WBC count and incident hypertension among 2459 hypertension-free women (48.6%) and men (51.4%) after adjusting for, and stratifying by smoking and several other potential confounding factors. RESULTS: In multivariable proportional hazards models, increasing tertiles of WBC count was associated with increased risk ratios (RR) of hypertension in the whole cohort (WBC count tertiles 1-3; RR 1, 1.2, 1.7; P <.01), and separately among women (WBC count tertiles 1-3; RR 1, 1.1, 1.4; P <.05) and men (WBC count tertiles 1-3; RR 1, 1.3, 1.9; P <.01). Results from subsequent analyses stratified by smoking and several other related factors were consistent with this finding. CONCLUSIONS: Elevated WBC count is associated with incident hypertension among women and men independent of smoking and most traditional cardiovascular risk factors in this predominantly white cohort. Further research is required to determine whether this association is true among racial minorities (eg, African Americans), and independent of C-reactive protein, a more specific marker of inflammation.

Adult↗
PubMed2004

Does hormone replacement therapy influence retinal microvascular caliber?

Previous population-based data suggest that retinal arteriolar diameter is wider in women than in men. Estrogen exposures could account for this difference. To evaluate the effects of HRT on small blood vessels, we assessed the relationship between use of hormone replacement therapy (HRT) and retinal microvascular diameter in older women in the Blue Mountains Eye Study baseline population (n = 1993, age >/= 49 years). Information on HRT use was recorded by trained interviewers. A computer-assisted program measured retinal vessel diameters from digitized photographs. Average arteriolar diameter was calculated as the central retinal arteriolar equivalent (CRAE); the lowest quintile of CRAE was considered generalized arteriolar narrowing. Of the 1897 women with complete data, 79 (4%) were premenopausal and 315 (17%), 224 (12%), and 1279 (67%) were current, past, and never HRT users, respectively. Among women aged < 65 years, multivariate-adjusted mean CRAE for the four groups was 196, 198, 201, and 200 microm (P < 0.0001), respectively. Among postmenopausal women >/= 65 years, multivariate-adjusted mean CRAE was 187, 188, 191 microm (P < 0.0001), respectively, for current, past, and never users. Current HRT users were 40% more likely than never users to have generalized arteriolar narrowing (95% confidence interval 1.0-2.1). It appears that the use of HRT in older women may not have any long-term vasodilatory effects on retinal arterioles. These data do not support our hypothesis that exogenous estrogen exposures account for observed wider retinal arteriolar diameters in women.

Aged↗
PubMed2004

Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study: methodology, correlation between eyes, and effect of refractive errors.

OBJECTIVE: Narrowed retinal arterioles may independently predict cardiovascular disease. We describe a computer-assisted method to measure retinal vessel diameters from digitized fundus photographs in a large population, and examine the correlation of retinal vessel diameters between eyes and whether refractive errors affect these measurements. DESIGN AND POPULATION: Population-based, cross-sectional study in Beaver Dam, Wisconsin (n = 4926; age, 43-84 years). METHODS: Retinal photographs were digitized, and all arterioles and venules located in an area 0.5 to 1 disc diameter from the optic disc were measured with the aid of computer software. MAIN OUTCOME MEASURES: Summary of retinal arteriolar and venular diameters, and the ratio of their diameters (arteriole:venule ratio [AVR]). RESULTS: Correlation between right and left eyes was substantial for retinal arteriolar diameters (Pearson correlation coefficient, rho = 0.71) and venular diameters (rho = 0.74), and moderate for the AVR (rho = 0.49). The inverse association of higher blood pressure and smaller retinal arteriolar diameters was similar using data from either one eye or two eyes; arteriolar diameters decreased by 4.1 microm (right eyes), 4.0 microm (left eyes), and 4.0 microm (mean of both eyes) with each 10-mmHg increase in mean arterial blood pressure. A myopic refraction was associated with smaller retinal vessel diameters; arteriolar diameters decreased by 2.8 microm and venular diameters by 3.3 microm with each -1.0-diopter shift towards myopia. However, the pattern and strength of the association of blood pressure and retinal vessel diameters were not altered by variations in refractive errors. CONCLUSIONS: There is good correlation of retinal vessel diameters between eyes. A myopic refraction is associated with smaller retinal vessel diameters. The association of retinal arteriolar diameters and blood pressure seems similar using data from either one eye or two eyes, and is minimally affected by refraction. These data suggest that measurement of retinal vessel diameters from one eye without regard to its refractive status may provide adequate information indicative of a person's retinal vessel caliber if information from two eyes and refraction is unavailable.

Adult↗
PubMed2004

Is medication use associated with the incidence of early age-related maculopathy? Pooled findings from 3 continents.

OBJECTIVE: To investigate whether there is an association between the use of medication and the incidence of early age-related maculopathy (ARM). DESIGN: Pooled data from 3 prospective, population-based cohort studies. PARTICIPANTS: Subjects without early and late ARM at baseline who participated in the follow-up of the Beaver Dam Eye Study (n = 3012), the Rotterdam Study (n = 3434), and the Blue Mountains Eye Study (n = 2203). METHODS: Stereoscopic color fundus photographs of all participants were graded according to a standardized protocol. At baseline, current use of prescription and over-the-counter medication was assessed by interview, and the drug name was confirmed at the research centers. Procedures and definitions were similar at both baseline and follow-up across the 3 study sites. MAIN OUTCOME MEASURES: Incidence of early ARM, defined as the presence at follow-up of either soft distinct drusen with pigmentary changes or soft indistinct or reticular drusen. RESULTS: In the pooled cohort, 53.3% of participants used at least one of the medications selected for this study. Within a mean period of 5.6 years, a total of 683 subjects developed early ARM. Users of antihypertensive medication in general, and beta-blockers in particular, had a borderline statistically significant increased risk of early ARM (odds ratio [OR] for beta-blockers, 1.3; 95% confidence interval [CI], 1.0-1.6) when adjusted for systolic (or diastolic) blood pressure and other confounders. A protective effect of borderline significance was found among women using hormone replacement therapy (OR, 0.6; 95% CI, 0.4-1.0) and in persons using tricyclic antidepressants (OR, 0.4; 95% CI, 0.2-1.0). In contrast with beta-blockers, the direction and magnitude of the association with hormone replacement therapy and tricyclic antidepressants were inconsistent among the 3 study populations. CONCLUSIONS: Pooled data from 3 population-based studies showed no strong associations between medication use and the incidence of early ARM. Of borderline significance were a slightly increased risk among users of beta-blockers and a reduced risk among users of hormone replacement therapy and users of tricyclic antidepressants. Although beta-blocker use could be a proxy for systemic hypertension, these findings warrant further investigations, preferably including information on the dosage and duration of drug exposure.

Adult↗
PubMed2004

Risk factors for incident age-related macular degeneration: pooled findings from 3 continents.

OBJECTIVE: To examine risk factors for incident age-related macular degeneration (AMD) after combining data from 3 population-based cohort studies. DESIGN: Population-based cohort study. POPULATION: A population of 9523 adults (age range, 43-95 years at baseline) living in Australia, The Netherlands, and the United States who participated in a baseline examination and a follow-up examination on average 5 or 6 years later. METHODS: Similar procedures were used at all study sites. Examinations included a standardized questionnaire, pupillary dilation, and stereoscopic color fundus photography. Fundus photographs were graded for lesions associated with AMD using the Wisconsin and International Age-Related Maculopathy Grading Systems. Senior investigators from each site adjudicated all photos graded as late AMD. MAIN OUTCOMES MEASURE: Incidence of late AMD. RESULTS: Among studies, distributions for most risk factors differed, and overall incidence rates were similar. In the Beaver Dam Eye Study, total serum cholesterol was inversely associated with incident neovascular AMD. In the Blue Mountains Eye Study, current smoking (defined as smoking at the time of the baseline examination) was associated with an increased risk of incident geographic atrophy and late AMD; increased total serum cholesterol, having diabetes, and older age at menopause were positively associated with incident geographic atrophy; and an increase in high-density lipoprotein serum cholesterol was inversely related to incident geographic atrophy. In the Rotterdam Study, current smoking was associated with an increased risk of incident geographic atrophy, neovascular AMD, and late AMD; past smoking was associated with an increased risk of incident neovascular AMD and late AMD; and an increased number of years between menarche and menopause was directly related to incident geographic atrophy. After pooling data, the only statistically significant relationships found were between smoking and total serum cholesterol and incident AMD. Current smoking was associated with an increased incidence of geographic atrophy and late AMD (odds ratios [ORs] relative to nonsmokers: 2.83 and 2.35, respectively; ORs relative to past smokers: 2.80 and 1.82, respectively), and total serum cholesterol was associated directly with incident geographic atrophy (OR: 1.08 per 10 mg/dl) and inversely with incident neovascular AMD (OR: 0.94 per 10 mg/dl). CONCLUSIONS: Pooled data support a growing body of evidence indicating that smoking is related to an increased risk of incident AMD. Current smokers were at higher risk of incident AMD than both past smokers and those who never smoked. The relationships found in this study between total serum cholesterol and incident geographic atrophy and neovascular AMD are not readily explained.

Adult↗
PubMed2004

Prevalence of age-related macular degeneration in Latinos: the Los Angeles Latino eye study.

OBJECTIVE: To estimate the age- and gender-specific prevalence of early age-related macular degeneration (AMD; drusen and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy) in Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of self-identified Latinos 40 years and over. Participants underwent a complete ophthalmologic examination, including stereoscopic macular photographs. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Prevalence of early AMD, drusen, geographic atrophy, and exudative AMD. RESULTS: Of the 7789 eligible subjects, 6357 participants (82%) completed an interview and clinical examination, and 5875 (75%) had gradable photographs. Prevalence of advanced AMD increased from 0% in those 40-49 years of age to 8.5% in those 80 or older; that of early AMD from 6.2% to 29.7%, that of retinal pigment abnormalities from 4.1% to 19.3%, that of large drusen (> or =125 microm in diameter) from 8.5% to 45.3%, that of soft drusen from 15.4% to 58.1%, and that of soft indistinct drusen from 3.6% to 30.8%. The prevalence of early AMD and advanced AMD lesions increased with age (P<0.0001). Early AMD was significantly more common in males than in females. Of all participants with early or late AMD, only 57% reported ever visiting an eye care practitioner, and only 21% in the last year. CONCLUSION: Detailed population-based estimates of AMD in Latinos are provided. Despite relatively high rates of early AMD, corresponding rates of advanced AMD are not high. Data on progression of the high rates of early AMD in Latinos require further study.

Adult↗
PubMed2004

The Los Angeles Latino Eye Study: design, methods, and baseline data.

OBJECTIVE: To describe the study design, operational strategies, procedures, and baseline characteristics of the Los Angeles Latino Eye Study (LALES), a population-based assessment of the prevalence of visual impairment, ocular disease, and visual functioning in Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: A detailed interview and eye examination were performed on each eligible participant. The interview included an assessment of demographic, behavioral, and ocular risk factors and health-related and vision-related quality of life. The eye examination included a measurement of visual acuity, intraocular pressure, and visual fields; fundus and optic disc photography; a detailed anterior and posterior segment examination; and measurement of blood pressure, glycosylated hemoglobin levels, and blood glucose levels. MAIN OUTCOME MEASURES: Prevalence of visual impairment, blindness, cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration constitute the study's primary outcome variables. Secondary outcomes include odds ratios for risk factors associated with eye disease, health-related quality of life, and vision-related quality of life. Response rates and baseline characteristics are presented. RESULTS: Of the 7789 individuals eligible for LALES, 6357 (82%) had a clinical examination; an additional 524 completed only an in-home interview. The majority of participants were female (58%), the average (+/- standard deviation) age was 54.9 (+/-10.8) years, and 80.0% were of Mexican origin and 0.4% self-identified as American Indian or Alaskan Native. The age distribution of LALES participants was similar to that of Latinos of Mexican origin in the rest of the United States. CONCLUSION: The LALES has recruited Latinos 40 and older for an ophthalmic epidemiologic study. The LALES cohort will provide information about the prevalence and risk factors of ocular disease in the largest and fastest growing minority in the United States.

Adult↗
PubMed2004

Prevalence and risk indicators of visual impairment and blindness in Latinos: the Los Angeles Latino Eye Study.

OBJECTIVE: To determine the age- and gender-specific prevalence and risk indicators of visual impairment and blindness in urban Latinos 40 years and older. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: Of the 6357 study participants, 6122 underwent a complete ophthalmologic examination at the clinical center, including measurement of best-corrected distance visual acuity (VA) using a standard Early Treatment Diabetic Retinopathy Study protocol. Age- and gender-specific prevalence of visual impairment and blindness were contrasted using Mantel-Haenszel procedures. Sociodemographic and clinical risk indicators of visual impairment were explored using stepwise logistic regression. MAIN OUTCOME MEASURES: Prevalence and odds ratios for risk indicators of visual impairment and blindness. RESULTS: The overall prevalence for visual impairment (best-corrected VA of <==20/40 in the better eye) was 3.0% (n = 182) (range, 0.9% [40-49 years]-27.8% [>/=80 years]). The overall prevalence for blindness (best-corrected VA of <==20/200 in the better eye) was 0.4% (n = 26) (range, 0.2% [40-49 years]-4.2% [>/=80 years]). Visual impairment increased with age (P<0.0001) and was greater in women (P = 0.02). Independent risk indicators (odds ratio [95% confidence interval]) for visual impairment were age 70-79 years (2.8 [1.3-5.8]) or >/=80 years (8.7 [3.9-19.6]), history of ocular disease (3.2 [2.1-4.8]), being unemployed (3.3 [1.7-6.3]), diabetes (2.2 [1.5-3.2]), and being separated/divorced (1.8 [1.0-3.1]) or widowed (2.8 [1.8-4.4]). Participants with >/=12 years of education (0.5 [0.3-0.8]) were less likely to be visually impaired. CONCLUSIONS: Rates of visual impairment and blindness in Latinos are high, especially in older individuals. Better education and employment are likely to decrease the burden of visual impairment in Latinos.

Adult↗
PubMed2004

Prevalence of diabetic retinopathy in adult Latinos: the Los Angeles Latino eye study.

OBJECTIVE: To estimate age- and gender-specific prevalence of diabetic retinopathy (DR) and to determine the association of type, duration, and treatment of diabetes with the prevalence of DR in adult Latinos. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos aged 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of all self-identified Latinos of primarily Mexican ancestry aged 40 years and older residing in 6 census tracts in La Puente, Los Angeles County, California. All participants diagnosed with diabetes underwent a complete ophthalmologic examination, including stereoscopic fundus photography (7 standard Early Treatment Diabetic Retinopathy Study fields). Photographs were graded in a masked manner using a modified Airlie House Grading System to assess presence and severity of DR. MAIN OUTCOME MEASURES: Prevalence of nonproliferative DR, proliferative DR, and macular edema. RESULTS: Of 1263 participants with definite diabetes mellitus, gradable fundus photographs were available in 1217 participants (96%). Of those 1217 participants, 46.9% had DR. Severe nonproliferative DR and proliferative DR were present in 4.4% and 6.1% of diabetics, respectively. Macular edema was observed in 10.4% and clinically significant macular edema was observed in 6.2% of all diabetics. No age- or gender-related differences were present. After adjusting for duration of diabetes, the prevalence of DR was similar in persons with type 1 and type 2 diabetes. CONCLUSIONS: Our data suggest that the prevalence of DR is high among Latinos of primarily Mexican ancestry. The increase in prevalence of DR with longer duration of diabetes emphasizes the public health importance of early diagnosis and management in Latinos. Further data on incidence and progression are required to understand better the natural history of DR in Latinos.

Adult↗
PubMed2004

The relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension: the cardiovascular health study.

BACKGROUND: Microalbuminuria is a risk factor for coronary heart disease (CHD). It occurs most commonly in the settings of diabetes and hypertension. The mechanisms by which it increases CHD risk are uncertain. METHODS: We examined the cross-sectional association of microalbuminuria with a broad range of CHD risk factors in 3 groups of adults aged 65 years or older with and without microalbuminuria: those with (1) no diabetes or hypertension (n = 1,098), (2) hypertension only (n = 1,450), and (3) diabetes with or without hypertension (n = 465). RESULTS: Three factors were related to microalbuminuria in all 3 groups: age, elevated systolic blood pressure, and markers of systemic inflammation. In patients with neither diabetes nor hypertension, increasing C-reactive protein levels were associated with microalbuminuria (odds ratio per 1-mg/L increase, 1.46; 95% confidence interval [CI], 1.15 to 1.84). Among those with diabetes, an increase in white blood cell (WBC) count was associated with microalbuminuria (odds ratio per 1,000-cell/mL increase, 2.57; 95% CI, 1.12 to 5.89). Among those with hypertension, an increase in WBC count (odds ratio per 1,000-cell/mL increase, 1.83; 95% CI, 1.04 to 3.23) and fibrinogen level (odds ratio per 10-mg/dL increase, 1.02; 95% CI, 1.00 to 1.05) were significantly associated with microalbuminuria. In all 3 groups, prevalent CHD was related to an elevated WBC count. In none of the 3 groups was brachial artery reactivity to ischemia, an in vivo marker of endothelial function, related to microalbuminuria. CONCLUSION: Microalbuminuria is associated with age, systolic blood pressure, and markers of inflammation. These associations reflect potential mechanisms by which microalbuminuria is related to CHD risk.

Age Distribution↗
PubMed2004

Relation between intake of vitamins C and E and risk of diabetic retinopathy in the Atherosclerosis Risk in Communities Study.

BACKGROUND: The potential protective effect of vitamins C and E against the development of diabetic retinopathy has not been thoroughly evaluated in epidemiologic studies. OBJECTIVE: The objective was to study the association between prevalent diabetic retinopathy and intake of vitamins C and E in participants of the Atherosclerosis Risk in Communities Study. DESIGN: A total of 1353 subjects with type 2 diabetes diagnosed between 1993 and 1995 or before were included. Nutrient intake was assessed with a food-frequency and supplement questionnaire administered between 1987-1989 and 1993-1995. Prevalent retinopathy (n = 224) was determined in 1993-1995 from graded fundus photographs. RESULTS: No association of retinopathy with intake of vitamin C or E from food alone or from food and supplements combined was observed. The odds ratios and 95% CIs for retinopathy for quartile 4 compared with quartile 1 of vitamins C and E intakes from food and supplements combined were 1.1 (0.7, 1.9) and 1.3 (0.8, 2.2), respectively, after adjustment for diabetes treatment and serum glucose. There was a significant interaction of the observed relations with serum glucose concentration (P < 0.05). Additionally, a decreased odds of retinopathy was found among users (reported use > or =3 y before 1993-1995) of vitamin C or E supplements or multisupplements compared with reported use of no supplements: 0.5 (0.3, 0.8), 0.5 (0.2, 0.8), and 0.4 (0.2, 0.9), respectively. CONCLUSION: No significant overall associations were observed between risk of retinopathy and intake of major dietary antioxidants. The observed association between risk of retinopathy and supplement use may reflect nondietary factors or a possible benefit of supplementation.

Antioxidants↗
PubMed2004

The impact of diabetic retinopathy: perspectives from patient focus groups.

BACKGROUND: Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in visual impairment or blindness. OBJECTIVE: This exploratory qualitative research was conducted to evaluate the symptom experience of DR, its impact on daily activities and health-related quality of life (HRQL), and the applicability of two vision-specific questionnaires. METHODS: Four focus groups (n = 15) were conducted with people with DR to explore their symptom experience and the impact on functioning and HRQL. Adults with type I or II diabetes and mild, moderate or severe non-proliferative DR (NPDR) or proliferative DR (PDR) were recruited. Content analysis and descriptive statistics were used to analyse the data. RESULTS: Participants described a range of symptoms and impact. Difficulty driving, especially at night, and trouble reading were noted with all levels of severity. Participants with PDR and decreased visual acuity have foregone many other important life aspects such as work, reading and sports. For the severely affected, diabetic care activities (e.g. exercising, reading nutritional labels, preparing insulin injections and glucose testing) were difficult to accomplish. Loss of independence, especially mobility and increased fear of accidents, had a profound impact on social activities. For those patients who had not experienced other complications of diabetes, the threat of vision loss was the most devastating. CONCLUSION: The loss of independence and mobility associated with decreased visual functioning and visual loss were major concerns. Moderate, severe NPDR and PDR associated with visual impairment have a significant impact on HRQL, particularly in the areas of independence, mobility, leisure and self-care activities.

Activities of Daily Living↗
PubMed2004

Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study.

Microvascular disease has been linked with renal dysfunction in patients with diabetes. The aim of this study was to examine the association of retinal microvascular abnormalities to renal dysfunction among participants of the Atherosclerosis Risk in Communities Study, a population-based investigation in four U.S. communities. At the third examination (1993 to 1995), retinal photography was performed and the presence of retinal microvascular abnormalities was documented using a standard grading protocol. Renal dysfunction was defined as an increase in serum creatinine of at least 0.4 mg/dl or a death or hospitalization as a result of chronic kidney disease between the second (1990 to 1992) and fourth (1996 to 1998) examinations. Among 10,056 people who were included in the study, 270 (2.7%) developed renal dysfunction. After controlling for age, gender, race, diabetes, BP, and other risk factors, individuals with retinopathy (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.8), microaneurysms (OR, 2.0; 95% CI, 1.3 to 3.1), retinal hemorrhages (OR, 2.6; 95% CI, 1.6 to 4.0), soft exudates (OR, 2.7; 95% CI, 1.6 to 4.8), and arteriovenous nicking (OR, 1.4; 95% CI, 1.0 to 1.9) were more likely to develop renal dysfunction than individuals without these abnormalities. Retinal microvascular abnormalities are associated with renal dysfunction, suggesting that common systemic microvascular processes may underlie the development of microvascular damage in the eye and kidneys.

Arteriosclerosis↗