Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

doi:10.1016/j.ajo.2005.08.063

American Journal of Ophthalmology

Volume 141, Issue 3, March 2006, Pages 446-455.e1

https://doi.org/10.1016/j.ajo.2005.08.063 Get rights and content

Purpose

To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites, blacks, hispanics, and chinese.

Design

Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes, participating in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods

Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview, examination, and laboratory investigations.

Results

In this population with diabetes, the prevalence of any retinopathy was 33.2% and macular edema 9.0%. The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1%) and hispanics (37.4% and 10.7%) than in whites (24.8% and 2.7%) and chinese (25.7% and 8.9%) (P = .01 and P = .007, comparing racial/ethnic differences for retinopathy and macular edema, respectively). Significant independent predictors of any retinopathy were longer duration of diabetes, higher fasting serum glucose, use of diabetic oral medication or insulin, and greater waist-hip ratio. Race was not an independent predictor of any retinopathy.

Conclusions

This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites, blacks, hispanics, and chinese participating in the MESA.

Section snippets

Methods

The MESA is a prospective cohort study of men and women 45 to 85 years of age initially free of clinical evidence of cardiovascular disease and living in six United States communities (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St Paul, Minnesota).²⁷ The study objective of MESA was to identify risk factors for subclinical and clinical cardiovascular disease. Selection of study population has been

Results

Participant characteristics comparing those with and without diabetes, as well as participants with diabetes in each of the four racial/ethnic groups, are listed in Table 1. There were significant differences between participants with and without diabetes; participants with diabetes were older and more likely to have less than 8 years of education, hypertension, and higher glucose, BMI, and waist-hip ratios than participants without diabetes. When we compared racial/ethnic groups among

Discussion

Our study provides new data on the prevalence of and risk factors for diabetic retinopathy in four racial/ethnic groups participating in the MESA study, a prospective study of cardiovascular disease in six United States communities (Figure). We found an overall prevalence of retinopathy of 33.2%, CSME of 5.6%, and vision-threatening retinopathy (severe retinopathy or CSME) of 7.9% among participants with diabetes. The rates of diabetic retinopathy in whites in the MESA were lower than that

Tien Yin Wong, MD, PhD, is an Associate Professor in Ophthalmology at the Centre for Eye Research Australia, University of Melbourne, and a Retinal consultant at the Royal Victorian Eye and Ear Hospital. He has a PhD in Epidemiology from the Johns Hopkins University. His clinical and research interest is in retinal vascular diseases, including diabetic and hypertensive retinopathy. He is on the Editorial Board of the British Journal of Ophthalmology and IOVS.

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