title: Association of ocular disease and mortality in a diabetic population.
abstract: OBJECTIVE
  To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population.
  
  
  METHODS
  Geographically defined population-based cohort study.
  
  
  METHODS
  An 11-county area in Wisconsin.
  
  
  METHODS
  Participants were all younger-onset diabetic persons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabetic persons (diagnosed as having diabetes at > or =30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years.
  
  
  METHODS
  All-cause and cause-specific mortality as determined from death certificates.
  
  
  RESULTS
  In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality.
  
  
  CONCLUSIONS
  Presence of more severe retinopathy or visual impairment in diabetic patients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison 53705-2397, USA. kleinr@epi.ophth.wisc.edu
authors.forename: R
authors.initials: R
authors.lastname: Klein
authors.forename: B E
authors.initials: BE
authors.lastname: Klein
authors.forename: S E
authors.initials: SE
authors.lastname: Moss
authors.forename: K J
authors.initials: KJ
authors.lastname: Cruickshanks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002386:Cataract / Q000150:complications; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality*; D003930:Diabetic Retinopathy / Q000150:complications; D005128:Eye Diseases / Q000150:complications*; D005260:Female; D005901:Glaucoma / Q000150:complications; D006801:Humans; D008269:Macular Edema / Q000150:complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D014786:Vision Disorders / Q000150:complications; D014922:Wisconsin / Q000453:epidemiology