title: Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study.
abstract: OBJECTIVE
  To describe the prevalence and risk factors of diabetic retinopathy in Asian Malays.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  Persons with diabetes of Malay ethnicity aged 40 to 80 years in Singapore.
  
  
  METHODS
  Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Retinal photographs taken from both eyes were graded for diabetic retinopathy using the modified Airlie House classification system.
  
  
  METHODS
  Any diabetic retinopathy, retinopathy grades, macular edema, or vision-threatening retinopathy.
  
  
  RESULTS
  Of the 3261 persons who participated in this study, 757 (23.1%) had diabetes and gradable retinal photographs. In persons with diabetes, the overall prevalence of any retinopathy was 35.0% (95% confidence interval [CI], 28.2-43.4), the overall prevalence of macular edema was 5.7% (95% CI, 3.2-9.9), and the overall prevalence of vision-threatening retinopathy was 9.0% (95% CI, 5.8-13.8). Compared with men, women had significantly higher proportions with more severe diabetic retinopathy, moderate (12% vs. 4%) and severe (3% vs. 0.2%) nonproliferative retinopathy, proliferative retinopathy (7% vs. 2%), and vision-threatening retinopathy (13% vs. 3%). In multiple logistic regression, independent risk factors for any retinopathy were longer diabetes duration (odds ratio [OR], 1.07; 95% CI, 1.04-1.09, per year increase), higher hemoglobin A1(c) (OR, 1.21; 95% CI, 1.10-1.33, per % increase), hypertension (OR, 1.85; 95% CI, 1.04-3.30), and higher pulse pressure (OR, 1.34, 95% CI, 1.19-1.51, per 10-mmHg increase); older age (OR, 0.73; 95% CI, 0.57-0.93, per decade increase) and higher total cholesterol levels (OR, 0.75; 95% CI, 0.63-0.89, per 1-mmol/l increase) were protective of any retinopathy. Vision-threatening retinopathy additionally was associated with previous stroke (OR, 3.74; 95% CI, 1.24-11.26), cardiovascular disease (OR, 2.23; 95% CI, 1.08-4.62), and chronic kidney disease (OR, 4.45; 95% CI, 2.18-9.07). Female gender was not an independent risk factor for diabetic retinopathy after adjusting for metabolic and socioeconomic risk factors.
  
  
  CONCLUSIONS
  One in 10 Malay adults with diabetes in Singapore has vision-threatening diabetic retinopathy. Risk factors for retinopathy in this population are largely similar to white populations elsewhere, suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Ning
authors.initials: N
authors.lastname: Cheung
authors.forename: Wan Ting
authors.initials: WT
authors.lastname: Tay
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
authors.forename: Seang Mei
authors.initials: SM
authors.lastname: Saw
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000145:classification / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D015995:Prevalence; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
chemical_list: D001786:Blood Glucose