Identification of independent risk factors for the development of diabetic retinopathy requiring treatment.
BACKGROUND
Diabetic retinopathy is screened by fundus photography and screening intervals are defined according to general rules to ensure that vision threatening complications are detected even if the progression of the disease is fast. The resulting superfluous examinations of patients with slow disease progression can be reduced by a more exact decision model that allows an adjustment of the screening interval to each patient's individual risk profile. This requires an identification of independent risk factors for reaching treatment end points for diabetic retinopathy.


METHODS
Clinical data from 5365 patients who had undergone 23 324 examinations at the Department of Ophthalmology, Århus University Hospital between Jan 1st 1994 and Dec 31st 2007 were used to identify independent risk factors for progression of treatment requiring retinopathy.


RESULTS
The risk of reaching a treatment end point was in both diabetes types independently affected by retinopathy grade and HbA1c. Furthermore, in type 1 diabetic patients the risk of reaching a treatment end point was independently affected by disease duration and by a recommended control interval of less than 3 months, in spite of correction for retinopathy grade and other studied confounders, whereas in type 2 diabetes this risk was affected by increasing age of diagnosis of the disease.


CONCLUSIONS
Only a subset of known risk factors for development and progression of diabetic retinopathy should be used to construct a decision model for optimizing screening intervals for diabetic retinopathy.
Mehlsen
Jesper
J
Department of Ophthalmology, Aarhus University Hospital, Denmark. jespermehlsen@mac.com
Erlandsen
Mogens
M
Poulsen
Per L
PL
Bek
Toke
T
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D003661:Decision Support Techniques; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D005451:Fluorescein Angiography; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human