Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA.
Ophthalmology. 2011 May;118(5):959-63. doi: 10.1016/j.ophtha.2011.01.054. Epub 2011 Mar 24.
Previous studies have identified a higher prevalence of diabetes mellitus (DM) among patient cohorts with nonarteritic anterior ischemic optic neuropathy (NAION). We sought to determine the development of incident NAION among a group of newly diagnosed patients with DM and to estimate the incidence of NAION among the elderly.
Medicare 5% database study.
A total of 25 515 patients with DM and an equal number of age- and gender-matched nondiabetic patients.
Query of Medicare 5% claims files identified patients with a new diagnosis of DM in 1994. A randomly selected control group was created using 1-to-1 propensity score matching. Patients with a diagnosis of giant cell arteritis, preexisting DM, and age 68 years or older or >95 years were excluded. Patients with DM and controls were followed for the development of NAION over the following 4745 days.
Incidence of NAION among patients with and without DM.
In each group, 85% were white, 11% were black, and 4% were other race. Patients were aged 76.4 years, and 40% were male. Mean follow-up was 7.6 years. In the diabetes group, 188 individuals developed NAION (0.7%) compared with 131 individuals (0.5%; P < 0.01) in the control group. In unadjusted Cox regression analysis, having DM was associated with a 43% increased risk (hazard ratio [HR]: 1.431; 95% confidence interval [CI], 1.145-1.789) of developing NAION. After adjusting for other covariates, the risk of developing NAION among individuals with DM was reduced to 40% (HR 1.397; 95% CI, 1.115-1.750). Male gender increased an individual's risk of developing NAION by 32% (HR 1.319; 95% CI, 1.052-1.654). No other covariate was statistically significantly associated with developing NAION. The annual incidence of NAION was 82 per 100 000 persons.
Diabetes mellitus significantly increased the risk of the diagnosis NAION. The incidence of NAION among patients aged more than 67 years may be higher than previously reported.
先前的研究表明，非动脉炎性前部缺血性视神经病变（NAION）患者中糖尿病（DM）的患病率较高。我们旨在确定一组新诊断为 DM 的患者中 NAION 的发病情况，并估计老年人中 NAION 的发病率。
医疗保险 5%数据库研究。
共纳入 25515 例 DM 患者和年龄、性别匹配的非糖尿病患者各 25515 例。
通过查询医疗保险 5%索赔文件，确定 1994 年新诊断为 DM 的患者。采用 1:1 倾向评分匹配方法创建随机对照组。排除患有巨细胞动脉炎、预先存在的 DM 以及年龄≥68 岁或>95 岁的患者。对 DM 患者和对照组患者进行随访，以了解在接下来的 4745 天内是否发生 NAION。
DM 患者和非 DM 患者中 NAION 的发生率。
每组患者中，85%为白人，11%为黑人，4%为其他种族。患者年龄为 76.4 岁，40%为男性。平均随访时间为 7.6 年。在糖尿病组中，有 188 例患者（0.7%）发生 NAION，而对照组中有 131 例（0.5%）（P<0.01）。在未经调整的 Cox 回归分析中，患有 DM 使发生 NAION 的风险增加了 43%（风险比[HR]：1.431；95%置信区间[CI]：1.145-1.789）。在调整其他协变量后，DM 患者发生 NAION 的风险降低至 40%（HR 1.397；95% CI：1.115-1.750）。男性使个体发生 NAION 的风险增加了 32%（HR 1.319；95% CI：1.052-1.654）。没有其他协变量与发生 NAION 有统计学显著相关性。NAION 的年发病率为 82/100000 人。
DM 显著增加了 NAION 的诊断风险。年龄>67 岁的患者中 NAION 的发病率可能高于先前报道。
