Original article
Four-Year Incidence and Progression of Diabetic Retinopathy and Macular Edema: The Los Angeles Latino Eye Study

https://doi.org/10.1016/j.ajo.2009.11.014Get rights and content

Purpose

To estimate the 4-year incidence and progression of diabetic retinopathy, macular edema (ME) and clinically significant macular edema (CSME) among adult Latinos with diabetes mellitus.

Design

A population-based, longitudinal study of 4658 self-identified Latinos (primarily Mexican Americans), residing in Los Angeles, examined at baseline (2000–2003) and at 4 years (2004–2008).

Methods

Participants underwent a standardized ophthalmic examination. Diabetic retinopathy (DR) and CSME were detected by grading of stereoscopic fundus photographs using the modified Airlie House classification scheme. χ2 and trend tests were used to assess differences in incidence when stratifying by age and duration of diabetes.

Results

The 4-year incidence of DR, ME, and CSME was 34.0% (182/535), 5.4% (38/699), and 7.2% (50/699) respectively. Younger persons and those with longer duration of diabetes mellitus had a higher incidence of DR compared to those who were older and had shorter duration of diabetes mellitus. A higher incidence of ME was associated with longer duration of diabetes mellitus (P = .004). Worsening/progression of any DR was found in 38.9% (126/324) and improvement occurred in 14.0% (37/265) of participants. Progression from nonproliferative DR (NPDR) to proliferative DR (PDR) and from NPDR to PDR with high-risk characteristics occurred in 5.3% and 1.9% of participants.

Conclusions

The 4-year incidence and progression of DR and the incidence of ME and CSME among Latinos are high compared to non-Hispanic whites. These findings support the need to identify and modify risk factors associated with these long-term complications.

Section snippets

Study Population and Design

The Los Angeles Latino Eye Study is a population-based cohort study of eye disease in self-identified Latinos aged 40 years and older living in 6 census tracts in the city of La Puente, Los Angeles County, California. The baseline clinical examination was performed from 2000 to 2003, and the 4-year follow-up examination was performed from 2004 to 2008. At baseline, 6357 participants completed an in-home questionnaire and a clinical ophthalmic examination. Details of the study design, methods,

Results

Of the 6357 participants examined at baseline, 6100 living eligible participants were identified for the 4-year follow-up study, and 4658 (76%) completed the follow-up examination. Of these, 904 had definite diabetes at baseline (of which 69 of 904 [7.6%] were newly diagnosed, and 835 of 904 [92.4%] were previously diagnosed), and 775 had gradable fundus photographs in the same eye at baseline and at follow-up; hence this is the cohort used for the analyses in this paper. Compared to those not

Discussion

In LALES, we found that incidence of DR (28% in first eye) and ME (5% in first eye) in Latinos was high compared to incidence previously reported for U.S. non-Hispanic whites. A higher incidence of DR, ME, or CSME was associated with longer duration of diabetes, despite the fact that incidence of these ocular diseases decreased with age. For example, incidence of DR (in the first eye, second eye, or both) at the 4-year follow-up examination was highest among the youngest age groups (40–49 years

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