0
September 1994, Vol 112, No. 9 >
ARTICLE | September 1994

The Wisconsin Epidemiologic Study of Diabetic Retinopathy: Title and subTitle BreakXIV. Ten-Year Incidence and Progression of Diabetic Retinopathy FREE

Ronald Klein, MD, MPH; Barbara E. K. Klein, MD, MPH; Scot E. Moss, MA; Karen J. Cruickshanks, PhD
Arch Ophthalmol. 1994;112(9):1217-1228. doi:10.1001/archopht.1994.01090210105023
Text Size: A A A
Published online
Article
References
Comments

Objective:  To examine the 10-year incidence and progression of diabetic retinopathy.

Design:  Population-based incidence study.

Participants:  Seven hundred sixty-five insulin-taking diabetic persons diagnosed before age 30 years, 251 insulin-taking diabetic persons diagnosed at age 30 years or older, and 282 non-insulin-taking diabetic persons diagnosed at age 30 years or older who participated in baseline, 4-year, and 10-year follow-up examinations.

Main Outcome Measures:  The 10-year incidence of any retinopathy, progression of retinopathy, and progression to proliferative retinopathy were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study severity scheme.

Results:  The 10-year incidence of retinopathy (89%, 79%, and 67%), progression of retinopathy (76%, 69%, and 53%), and progression to proliferative retinopathy (30%, 24%, and 10%) were highest in the group diagnosed before age 30 years, intermediate in the insulin-taking group diagnosed at age 30 years or older, and lowest in the non-insulin-taking group, respectively. Increased risk of proliferative retinopathy was associated with more severe retinopathy at baseline.

Conclusions:  These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progression of diabetic retinopathy during the 10-year study period.

REFERENCES

1 +
National Society To Prevent Blindness. Vision Problems in the US: Data Analysis, Definitions, Data Sources, Detailed Data Tables, Analysis, Interpretation . New York, NY: National Society To Prevent Blindness; 1980;.
2 +
Klein R, Klein BEK, Moss SE.  Visual impairment in diabetes . Ophthalmology . 1984;;91:1-9.
3 +
Moss SE, Klein R, Klein BEK.  The incidence of vision loss in a diabetic population . Ophthalmology . 1988;;95:1340-1348.
4 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IX: four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1989;;107:237-243.
5 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, X: four-year incidence and progression of diabetic retinopathy when age at diagnosis is 30 years or more . Arch Ophthalmol . 1989;;107:244-249.
6 +
Diabetic Retinopathy Study Research Group.  Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings: DRS Report No. 8 . Ophthalmology . 1981;;88:583-600.
7 +
Early Treatment Diabetic Retinopathy Study Research Group.  Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report Number 1 . Arch Ophthalmol . 1985;;103:1796-1806.
8 +
Yanko L, Goldbourt U, Michaelson IC, Shapiro A, Yaari S.  Prevalence and 15-year incidence of retinopathy and associated characteristics in middle-aged and elderly diabetic men . Br J Ophthalmol . 1983;;67:759-765.
9 +
Goldstein DE, Blinder KJ, Ide CH, et al.  Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus: results of a 12-year longitudinal study . Ophthalmology . 1993;;100:1125-1132.
10 +
Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR.  Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-year follow-up study . Diabetes Care . 1986;;9:443-452.
11 +
Burditt AF, Caird FI, Draper GJ.  The natural history of diabetic retinopathy . Q J Med . 1967;;37:303-317.
12 +
Dwyer MS, Melton LJ III, Ballard DJ, Palumbo PJ, Trautman JC, Chu C-P.  Incidence of diabetic retinopathy and blindness: a population-based study in Rochester, Minnesota . Diabetes Care . 1985;;8:316-322.
13 +
Pirart J.  Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973 . Diabetes Care . 1978;;1:168-188, 252-263.
14 +
Klein R, Klein BEK, Moss SE, DeMets DL, Kaufman I, Voss PS.  Prevalence of diabetes mellitus in southern Wisconsin . Am J Epidemiol . 1984;;119:54-61.
15 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, II: prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1984;;102:520-526.
16 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, Ill: prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years . Arch Ophthalmol . 1984;;102:527-532.
17 +
Diabetic Retinopathy Study Research Group.  Report VII: a modification of the Airlie House classification of diabetic retinopathy . Invest Ophthalmol Vis Sci . 1981;;21:210-226.
18 +
Klein R, Klein BEK, Magli YL, et al.  An alternative method of grading diabetic retinopathy . Ophthalmology . 1986;;93:1183-1187.
19 +
Early Treatment Diabetic Retinopathy Study Research Group.  Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification: ETDRS Report No. 10 . Ophthalmology . 1991;;98:786-806.
20 +
Klein BEK, Davis MD, Segal P, et al.  Diabetic retinopathy: assessment of severity and progression . Ophthalmology . 1984;:91:10-17.
21 +
Early Treatment Diabetic Retinopathy Study Research Group.  Fundus photographic risk factors for progression of diabetic retinopathy: ETDRS Report No. 12 . Ophthalmology . 1991;;98:823-833.
22 +
Kaplan EL. Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
23 +
Mantel N.  Chi-square tests with one degree of freedom: extensions of the Mantel-Haenszel procedure . J Am Stat Assoc . 1963;;58:690-700.
24 +
Klein R, Moss SE, Klein BEK.  Change in glycemia in a four-year interval in insulin-dependent diabetes . Ann Epidemiol . 1992;;2:283-294.
25 +
Hiss RG, Lengyel MC, Hess GE, Bowbeer LA. Diabetes in Communities . Ann Arbor: Michigan Diabetes Research and Training Center and Department of Postgraduate Medicine and Health Professions Education, The University of Michigan Medical School; 1986;:1-100.
26 +
Anderson AR, Christiansen JS, Anderson JK, Kreiner S, Deckert T.  Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study . Diabetologia . 1983;;25:496-501.
27 +
Borch-Johnsen K, Kreiner S.  Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus . BMJ . 1987;;294:1651-1654.
28 +
Winocour PH, Durrington PN, Ishola M, Anderson DC, Cohen H.  Influence of proteinuria on vascular disease, blood pressure, and lipoprotein in insulin-dependent diabetes mellitus . BMJ . 1987;;294:1648-1651.
29 +
Klein R, Klein BEK, Moss SE.  The incidence of gross proteinuria in people with insulin-dependent diabetes mellitus . Arch Intern Med . 1991;;151:1344-1348.
30 +
Kostraba JN, Dorman JS, Orchard TJ, et al.  Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects . Diabetes Care . 1989;;12:686-693.
31 +
Murphy RP, Nanda M, Plotnick L, Enger C, Vitale S, Patz A.  The relationship of puberty to diabetic retinopathy . Arch Ophthalmol . 1990;;108:215-218.
32 +
Frank RN, Hoffman WH, Podgor MJ, et al.  Retinopathy in juvenile-onset type I diabetes of short duration . Diabetes . 1982;;31:874-882.
33 +
Palmberg P, Smith M, Waltman S, et al.  The natural history of retinopathy in insulin-dependent juvenile-onset diabetes . Ophthalmology . 1981;;88:613-618.
34 +
Klein BEK, Moss SE, Klein R.  Is menarche associated with diabetic retinopathy? Diabetes Care . 1990;;13:1034-1038.
35 +
Allen C, Zaccaro DJ, Palta M, Klein R, Duck SC, Dalessio DJ.  Glycemic control in early IDDM . Diabetes Care . 1992;;15:980-987.
36 +
Daneman D, Wolfson DH, Becker DJ, Drash AL.  Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes . J Pediatr . 1981;;99:847-853.
37 +
Blethen SL, Sargeant DL, Whitlow MG, Santiago JV.  Effect of pubertal stage and recent blood glucose control on plasma somatomedin C in children with insulin-dependent diabetes mellitus . Diabetes . 1981;;30:868-872.
38 +
Haffner SM, Klein R, Dunn JF, Moss SE, Klein BEK.  Increased testosterone in type I diabetic subjects with severe retinopathy . Ophthalmology . 1990;;97:1270-1274.
39 +
Merimee TJ, Zapf J, Froesch ER.  Insulin-like growth factors . N Engl J Med . 1983;;309:527-530.
40 +
Division of Diabetes Translation. The Prevention and Treatment of Five Complications of Diabetes: A Guide for Primary Care Practitioners . Atlanta, Ga: Centers for Disease Control; 1991;:41-49.
41 +
Klein R, Moss SE, Klein BEK.  New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation . Diabetes Care . 1987;;10:633-638.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Society To Prevent Blindness. Vision Problems in the US: Data Analysis, Definitions, Data Sources, Detailed Data Tables, Analysis, Interpretation . New York, NY: National Society To Prevent Blindness; 1980;.
2 +
Klein R, Klein BEK, Moss SE.  Visual impairment in diabetes . Ophthalmology . 1984;;91:1-9.
3 +
Moss SE, Klein R, Klein BEK.  The incidence of vision loss in a diabetic population . Ophthalmology . 1988;;95:1340-1348.
4 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IX: four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1989;;107:237-243.
5 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, X: four-year incidence and progression of diabetic retinopathy when age at diagnosis is 30 years or more . Arch Ophthalmol . 1989;;107:244-249.
6 +
Diabetic Retinopathy Study Research Group.  Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings: DRS Report No. 8 . Ophthalmology . 1981;;88:583-600.
7 +
Early Treatment Diabetic Retinopathy Study Research Group.  Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report Number 1 . Arch Ophthalmol . 1985;;103:1796-1806.
8 +
Yanko L, Goldbourt U, Michaelson IC, Shapiro A, Yaari S.  Prevalence and 15-year incidence of retinopathy and associated characteristics in middle-aged and elderly diabetic men . Br J Ophthalmol . 1983;;67:759-765.
9 +
Goldstein DE, Blinder KJ, Ide CH, et al.  Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus: results of a 12-year longitudinal study . Ophthalmology . 1993;;100:1125-1132.
10 +
Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR.  Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-year follow-up study . Diabetes Care . 1986;;9:443-452.
11 +
Burditt AF, Caird FI, Draper GJ.  The natural history of diabetic retinopathy . Q J Med . 1967;;37:303-317.
12 +
Dwyer MS, Melton LJ III, Ballard DJ, Palumbo PJ, Trautman JC, Chu C-P.  Incidence of diabetic retinopathy and blindness: a population-based study in Rochester, Minnesota . Diabetes Care . 1985;;8:316-322.
13 +
Pirart J.  Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973 . Diabetes Care . 1978;;1:168-188, 252-263.
14 +
Klein R, Klein BEK, Moss SE, DeMets DL, Kaufman I, Voss PS.  Prevalence of diabetes mellitus in southern Wisconsin . Am J Epidemiol . 1984;;119:54-61.
15 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, II: prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1984;;102:520-526.
16 +
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy, Ill: prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years . Arch Ophthalmol . 1984;;102:527-532.
17 +
Diabetic Retinopathy Study Research Group.  Report VII: a modification of the Airlie House classification of diabetic retinopathy . Invest Ophthalmol Vis Sci . 1981;;21:210-226.
18 +
Klein R, Klein BEK, Magli YL, et al.  An alternative method of grading diabetic retinopathy . Ophthalmology . 1986;;93:1183-1187.
19 +
Early Treatment Diabetic Retinopathy Study Research Group.  Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification: ETDRS Report No. 10 . Ophthalmology . 1991;;98:786-806.
20 +
Klein BEK, Davis MD, Segal P, et al.  Diabetic retinopathy: assessment of severity and progression . Ophthalmology . 1984;:91:10-17.
21 +
Early Treatment Diabetic Retinopathy Study Research Group.  Fundus photographic risk factors for progression of diabetic retinopathy: ETDRS Report No. 12 . Ophthalmology . 1991;;98:823-833.
22 +
Kaplan EL. Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
23 +
Mantel N.  Chi-square tests with one degree of freedom: extensions of the Mantel-Haenszel procedure . J Am Stat Assoc . 1963;;58:690-700.
24 +
Klein R, Moss SE, Klein BEK.  Change in glycemia in a four-year interval in insulin-dependent diabetes . Ann Epidemiol . 1992;;2:283-294.
25 +
Hiss RG, Lengyel MC, Hess GE, Bowbeer LA. Diabetes in Communities . Ann Arbor: Michigan Diabetes Research and Training Center and Department of Postgraduate Medicine and Health Professions Education, The University of Michigan Medical School; 1986;:1-100.
26 +
Anderson AR, Christiansen JS, Anderson JK, Kreiner S, Deckert T.  Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study . Diabetologia . 1983;;25:496-501.
27 +
Borch-Johnsen K, Kreiner S.  Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus . BMJ . 1987;;294:1651-1654.
28 +
Winocour PH, Durrington PN, Ishola M, Anderson DC, Cohen H.  Influence of proteinuria on vascular disease, blood pressure, and lipoprotein in insulin-dependent diabetes mellitus . BMJ . 1987;;294:1648-1651.
29 +
Klein R, Klein BEK, Moss SE.  The incidence of gross proteinuria in people with insulin-dependent diabetes mellitus . Arch Intern Med . 1991;;151:1344-1348.
30 +
Kostraba JN, Dorman JS, Orchard TJ, et al.  Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects . Diabetes Care . 1989;;12:686-693.
31 +
Murphy RP, Nanda M, Plotnick L, Enger C, Vitale S, Patz A.  The relationship of puberty to diabetic retinopathy . Arch Ophthalmol . 1990;;108:215-218.
32 +
Frank RN, Hoffman WH, Podgor MJ, et al.  Retinopathy in juvenile-onset type I diabetes of short duration . Diabetes . 1982;;31:874-882.
33 +
Palmberg P, Smith M, Waltman S, et al.  The natural history of retinopathy in insulin-dependent juvenile-onset diabetes . Ophthalmology . 1981;;88:613-618.
34 +
Klein BEK, Moss SE, Klein R.  Is menarche associated with diabetic retinopathy? Diabetes Care . 1990;;13:1034-1038.
35 +
Allen C, Zaccaro DJ, Palta M, Klein R, Duck SC, Dalessio DJ.  Glycemic control in early IDDM . Diabetes Care . 1992;;15:980-987.
36 +
Daneman D, Wolfson DH, Becker DJ, Drash AL.  Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes . J Pediatr . 1981;;99:847-853.
37 +
Blethen SL, Sargeant DL, Whitlow MG, Santiago JV.  Effect of pubertal stage and recent blood glucose control on plasma somatomedin C in children with insulin-dependent diabetes mellitus . Diabetes . 1981;;30:868-872.
38 +
Haffner SM, Klein R, Dunn JF, Moss SE, Klein BEK.  Increased testosterone in type I diabetic subjects with severe retinopathy . Ophthalmology . 1990;;97:1270-1274.
39 +
Merimee TJ, Zapf J, Froesch ER.  Insulin-like growth factors . N Engl J Med . 1983;;309:527-530.
40 +
Division of Diabetes Translation. The Prevention and Treatment of Five Complications of Diabetes: A Guide for Primary Care Practitioners . Atlanta, Ga: Centers for Disease Control; 1991;:41-49.
41 +
Klein R, Moss SE, Klein BEK.  New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation . Diabetes Care . 1987;;10:633-638.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems