糖尿病患者群体中视力丧失的十年发病率。

Ten-year incidence of visual loss in a diabetic population.

作者信息

Moss S E, Klein R, Klein B E

机构信息

Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison.

出版信息

Ophthalmology. 1994 Jun;101(6):1061-70. doi: 10.1016/s0161-6420(94)31217-6.

DOI:10.1016/s0161-6420(94)31217-6

PMID:8008348

Abstract

PURPOSE

The purposes of this study are to estimate the 10-year incidence of blindness and visual loss in a diabetic population, examine risk factors for visual loss, and examine temporal trends in rates of blindness and visual loss.

METHODS

The design is a population-based cohort study, which includes 891 younger-onset persons with diabetes, 485 persons with older-onset diabetes who are taking insulin, and 502 persons with older-onset diabetes who are not taking insulin and who participated in baseline, 4-year, and 10-year examinations. The main outcome measures are incidence of blindness (visual acuity, 20/200 or worse), doubling of the visual angle, and visual impairment (visual acuity, 20/40 or worse).

RESULTS

The 10-year incidences of blindness were 1.8%, 4.0%, and 4.8% in persons in the younger-onset, older-onset taking insulin, and older-onset not taking insulin groups, respectively. Respective 10-year rates of visual impairment were 9.4%, 37.2%, and 23.9%. Rates for doubling of the visual angle were similar. Doubling of the visual angle was more common in women with older-onset diabetes and in persons with younger-onset and older-onset diabetes who were taking insulin and who had higher glycosylated hemoglobin or proteinuria levels. The presence of macular edema or more severe retinopathy was associated with more visual loss in all three groups. Smoking was associated with visual loss in persons with younger-onset diabetes, and systolic blood pressure was associated in persons with older-onset diabetes who were taking insulin. Rates of blindness and doubling of the visual angle decreased in persons with younger-onset diabetes in the second part of the follow-up. In the older-onset groups, only the rate of blindness declined. These decreases could not be explained entirely by treatment or mortality.

CONCLUSIONS

Several modifiable risk factors are associated with loss of vision. Although visual loss is still common in this diabetic population, the incidence of blindness may be decreasing.

摘要

目的

本研究旨在估计糖尿病患者10年失明和视力丧失的发生率，研究视力丧失的危险因素，并探讨失明和视力丧失发生率的时间趋势。

方法

本研究为基于人群的队列研究，纳入了891例早发型糖尿病患者、485例正在使用胰岛素的晚发型糖尿病患者以及502例未使用胰岛素的晚发型糖尿病患者，所有患者均参与了基线、4年及10年的检查。主要观察指标为失明发生率（视力为20/200或更差）、视角翻倍以及视力损害（视力为20/40或更差）。

结果

早发型、晚发型使用胰岛素以及晚发型未使用胰岛素组患者的10年失明发生率分别为1.8%、4.0%和4.8%。相应的10年视力损害发生率分别为9.4%、37.2%和23.9%。视角翻倍的发生率相似。视角翻倍在晚发型糖尿病女性以及早发型和晚发型使用胰岛素且糖化血红蛋白或蛋白尿水平较高的糖尿病患者中更为常见。黄斑水肿或更严重的视网膜病变在所有三组中均与更多的视力丧失相关。吸烟与早发型糖尿病患者的视力丧失相关，收缩压与晚发型使用胰岛素的糖尿病患者的视力丧失相关。在随访的第二阶段，早发型糖尿病患者的失明率和视角翻倍率有所下降。在晚发型组中，仅失明率下降。这些下降不能完全由治疗或死亡率来解释。