title: Clinically significant macular edema and survival in type 1 and type 2 diabetes.
abstract: OBJECTIVE
  To investigate the association of clinically significant macular edema (CSME) and long-term survival in individuals with type 1 and type 2 diabetes.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of individuals with diabetes diagnosed at either younger than 30 years of age (younger-onset group; n = 996) or 30 years of age or older (older-onset group; n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria.
  
  
  RESULTS
  Prevalence of CSME was 5.9% and 7.5% for the younger- and older-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.96 to 2.07; P = .08) or ischemic heart disease mortality (HR, 1.14; 95% CI, 0.61 to 2.12; P = .68) in the younger-onset group. In the older-onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present (HR, 1.55; 95% CI, 1.25 to 1.92; P < .01; and HR, 1.56; 95% CI, 1.15 to 2.13; P < .01, respectively), when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (HR, 1.58; 95% CI, 1.07 to 2.35; P = .02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group.
  
  
  CONCLUSIONS
  CSME seems to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be receiving care for detection and treatment of cardiovascular disease.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Madison, Wisconsin 53726, USA.
authors.forename: Flavio E
authors.initials: FE
authors.lastname: Hirai
authors.forename: Michael D
authors.initials: MD
authors.lastname: Knudtson
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008269:Macular Edema / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014922:Wisconsin / Q000453:epidemiology