This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

II. Prevalence and Risk of Diabetic Retinopathy When Age at Diagnosis Is Less Than 30 Years

Ronald Klein, MD; Barbara E. K. Klein, MD; Scot E. Moss, MA; Matthew D. Davis, MD; David L. DeMets, PhD

Arch Ophthalmol. 1984;102(4):520-526.

Abstract
• In a population-based study in southern Wisconsin, 996 insulin-taking, younger-onset diabetic persons were examined using standard protocols to determine the prevalence and severity of diabetic retinopathy and associated risk variables. The prevalence of diabetic retinopathy varied from 17% to 97.5% in persons with diabetes for less than five years and 15 or more years, respectively. Proliferative retinopathy varied from 1.2% to 67% in persons with diabetes for less than ten years and 35 or more years, respectively. For persons with diabetes of 10 years' duration or less, the Cox regression model relates the severity of retinopathy to longer duration, older age at examination, and higher levels of glycosylated hemoglobin. After ten years of diabetes, severity of retinopathy was related to longer duration, high levels of glycosylated hemoglobin, presence of proteinuria. higher diastolic BP, and male sex.

Author Affiliations
From the Departments of Ophthalmology (Drs R. Klein, B. Klein, and Davis and Mr Moss) and Statistics (Dr DeMets), University of Wisconsin Medical School, Madison.

Footnotes
Accepted for publication Sept 1, 1983.

Reprint requests to Department of Ophthalmology, Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (Dr Klein).

This work was supported by grant EY03083 (Dr R. Klein) from the National Eye Institute. Determinations of glycosylated hemoglobin levels were performed in the Core Laboratory of the Clinical Nutrition Center with support from US Public Health Service, National Institutes of Health grant P30 AM AG 26659 (Earl Shrago, MD).

The authors are grateful to the 452 Wisconsin physicians and their staffs who participated in and supported this study: Frederick Goetz, MD, Don Detmer, MD, Frank Larson, MD, Robin Ewart, MD, Edward Ehrlich, MD, Sigurd Sivertson, MD, Anastosios Tsiatis, PhD, Charles Palit, PhD, and Jean Espenshade, RN, provided consultation and criticism at different stages of the project; Moneen M. Meuer was project coordinator; Stacy Meuer performed data management; Steven D. Kessler, OD, and Karen A. Hasenfuss examined participants; Bob E. Harrison, Michael W. Neider, Dan Mattson, and Marlene Wahlstrom, RN, assisted with fundus photography; Rose Brothers, Magnus Harding, Cheryl Hiner, Yvonne Magli, Mary Peckham, and Anita Temple performed detailed grading of the fundus photographs; Anik Ganguly, BE, Dennis Cudia, PhD, and Larry Hubbard, MA, did programming and gave data management advice; Sue Anderson, MA, and Alasdair MacCormick, PhD, provided statistical consultation; Kathy Kaap, MFA, Bernadette Bull, Jenny Phillips, Sue Thomas, Mae Wildt, and Lorraine Boyle provided secretarial assistance; Jeanne M. Parus, MS, Terry Spennetta, and Dr Shrago, provided laboratory support; Ed Krill, JD, provided legal advice; William Davis, MA, and Reggie Gauger provided administrative support; local hospitals and churches provided supportive services for the mobile examining van; the State of Wisconsin Division of Health donated the van, and Otto Adams drove the van.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevention and treatment of microvascular disease in childhood type 1 diabetes
Marcovecchio et al.
Br Med Bull 2010;0:ldp053v1-ldp053.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2010
American Diabetes Association
Diabetes Care 2010;33:S11-S61.
FULL TEXT  

Common Sequence Variation in the VEGFA Gene Predicts Risk of Diabetic Retinopathy
Abhary et al.
IOVS 2009;50:5552-5558.
ABSTRACT | FULL TEXT  

The Relation of Markers of Inflammation and Endothelial Dysfunction to the Prevalence and Progression of Diabetic Retinopathy: Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Ophthalmol 2009;127:1175-1182.
ABSTRACT | FULL TEXT  

A Systematic Meta-Analysis of Genetic Association Studies for Diabetic Retinopathy
Abhary et al.
Diabetes 2009;58:2137-2147.
ABSTRACT | FULL TEXT  

Metabolic Memory in Diabetes Is True Long-term Memory
Frank
Arch Ophthalmol 2009;127:330-331.
FULL TEXT  

Standards of Medical Care in Diabetes--2009
American Diabetes Association
Diabetes Care 2009;32:S13-S61.
FULL TEXT  

Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting
Cade
ptjournal 2008;88:1322-1335.
ABSTRACT | FULL TEXT  

Heritability of the Severity of Diabetic Retinopathy: The FIND-Eye Study
Arar et al.
IOVS 2008;49:3839-3845.
ABSTRACT | FULL TEXT  

Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study
Gallego et al.
BMJ 2008;337:a918-a918.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2008
American Diabetes Association
Diabetes Care 2008;31:S12-S54.
FULL TEXT  

Coronary Artery Bypass Grafting Versus Coronary Implantation of Sirolimus-Eluting Stents in Patients with Diabetic Retinopathy
Ohno et al.
Ann. Thorac. Surg. 2007;84:1474-1478.
ABSTRACT | FULL TEXT  

Association between Glycosylated Hemoglobin Level and Cardiovascular and All-Cause Mortality in Type 1 Diabetes
Shankar et al.
Am J Epidemiol 2007;166:393-402.
ABSTRACT | FULL TEXT  

Clinical Factors Associated With Resistance to Microvascular Complications in Diabetic Patients of Extreme Disease Duration: The 50-year Medalist Study
Keenan et al.
Diabetes Care 2007;30:1995-1997.
FULL TEXT  

The 100 Most Frequently Cited Articles in Ophthalmology Journals
Ohba et al.
Arch Ophthalmol 2007;125:952-960.
ABSTRACT | FULL TEXT  

Depression is a Risk Factor for Poor Glycemic Control and Retinopathy in African-Americans With Type 1 Diabetes
Roy et al.
Psychosom. Med. 2007;69:537-542.
ABSTRACT | FULL TEXT  

Genome-Wide Linkage Analyses to Identify Loci for Diabetic Retinopathy
Looker et al.
Diabetes 2007;56:1160-1166.
ABSTRACT | FULL TEXT  

A 74-Year-Old Woman With Diabetes
Abrahamson
JAMA 2007;297:196-204.
ABSTRACT | FULL TEXT  

The North Jutland County Diabetic Retinopathy Study: population characteristics
Knudsen et al.
Br J Ophthalmol 2006;90:1404-1409.
ABSTRACT | FULL TEXT  

Lower-than-Expected Prevalence and Severity of Retinopathy in an Incident Cohort followed during the First 4-14 Years of Type 1 Diabetes: The Wisconsin Diabetes Registry Study
LeCaire et al.
Am J Epidemiol 2006;164:143-150.
ABSTRACT | FULL TEXT  

The Epidemiology of Eye Disease: From Glycemia to Genetics The Friedenwald Lecture
Klein and Klein
IOVS 2006;47:1747-1753.
FULL TEXT  

Scanning laser entoptic perimetry for the detection of visual defects associated with diabetic retinopathy
El-Bradey et al.
Br J Ophthalmol 2006;90:17-19.
ABSTRACT | FULL TEXT  

Vascular Targeting of Ocular Neovascularization with a Vascular Endothelial Growth Factor121/Gelonin Chimeric Protein
Akiyama et al.
Mol. Pharmacol. 2005;68:1543-1550.
ABSTRACT | FULL TEXT  

Detecting ocular-visual function changes in diabetes
Westall
Br J Ophthalmol 2005;89:1392-1393.
FULL TEXT  

Laser Photocoagulation and, to a Lesser Extent, Photodynamic Therapy Target and Enhance Adenovirus Vector-Mediated Gene Transfer in the Rat Retina
Anzai et al.
IOVS 2005;46:3883-3891.
ABSTRACT | FULL TEXT  

Ruboxistaurin, a Protein Kinase C {beta} Inhibitor, as an Emerging Treatment for Diabetes Microvascular Complications
Joy et al.
The Annals of Pharmacotherapy 2005;39:1693-1699.
ABSTRACT | FULL TEXT  

Increased JNK Phosphorylation and Oxidative Stress in Response to Increased Glucose Flux through Increased GLUT1 Expression in Rat Retinal Endothelial Cells
Zhou et al.
IOVS 2005;46:3403-3410.
ABSTRACT | FULL TEXT  

Discordant Trends in Microvascular Complications in Adolescents With Type 1 Diabetes From 1990 to 2002
Mohsin et al.
Diabetes Care 2005;28:1974-1980.
ABSTRACT | FULL TEXT  

Screening for Retinopathy in the Pediatric Patient With Type 1 Diabetes Mellitus
Lueder et al.
Pediatrics 2005;116:270-273.
ABSTRACT | FULL TEXT  

The DIabetic REtinopathy Candesartan Trials (DIRECT) Programme: baseline characteristics
The DIRECT Programme Study Group
Journal of Renin-Angiotensin-Aldosterone System 2005;6:25-32.
ABSTRACT  

Electrocardiographic Abnormalities in Individuals With Long-Duration Type 1 Diabetes
Klein et al.
Diabetes Care 2005;28:145-147.
FULL TEXT  

Care of Children and Adolescents With Type 1 Diabetes: A statement of the American Diabetes Association
Silverstein et al.
Diabetes Care 2005;28:186-212.
FULL TEXT  

Diabetic Retinopathy
Fong et al.
Diabetes Care 2004;27:2540-2553.
FULL TEXT  

Cardiovascular Disease, Mortality, and Retinal Microvascular Characteristics in Type 1 Diabetes: Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Intern Med 2004;164:1917-1924.
ABSTRACT | FULL TEXT  

Insulin Resistance and Proliferative Retinopathy: A Cross-Sectional, Case-Control Study in 115 Patients with Type 2 Diabetes
Parvanova et al.
J. Clin. Endocrinol. Metab. 2004;89:4371-4376.
ABSTRACT | FULL TEXT  

The Prevalence of Diabetic Retinopathy Among Adult Type 1 Diabetic Persons in the United States
Roy et al.
Arch Ophthalmol 2004;122:546-551.
ABSTRACT | FULL TEXT  

The Prevalence of Diabetic Retinopathy Among Adults in the United States
Arch Ophthalmol 2004;122:552-563.
 

Angiopoietin-2 Causes Pericyte Dropout in the Normal Retina: Evidence for Involvement in Diabetic Retinopathy
Hammes et al.
Diabetes 2004;53:1104-1110.
ABSTRACT | FULL TEXT  

Reduction of Diabetic Macular Edema by Oral Administration of the Kinase Inhibitor PKC412
Campochiaro
IOVS 2004;45:922-931.
ABSTRACT | FULL TEXT  

View 1: Should this patient receive laser treatment?
Dowler
Br J Ophthalmol 2004;88:433-435.
FULL TEXT  

Diabetic Retinopathy
Frank
NEJM 2004;350:48-58.
FULL TEXT  

The Relation of Retinal Vessel Caliber to the Incidence and Progression of Diabetic Retinopathy: XIX: The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Ophthalmol 2004;122:76-83.
ABSTRACT | FULL TEXT  

The Impact of Diabetic Retinopathy on Participation in Daily Living
Lamoureux et al.
Arch Ophthalmol 2004;122:84-88.
ABSTRACT | FULL TEXT  

Retinal Vessel Diameters and the Incidence of Gross Proteinuria and Renal Insufficiency in People With Type 1 Diabetes
Wong et al.
Diabetes 2004;53:179-184.
ABSTRACT | FULL TEXT  

Retinopathy in Diabetes
Fong et al.
Diabetes Care 2004;27:s84-87.
FULL TEXT  

Effects of Aldose Reductase Inhibitors and Galactose Withdrawal on Fluorescein Angiographic Lesions in Galactose-Fed Dogs
Cusick et al.
Arch Ophthalmol 2003;121:1745-1751.
ABSTRACT | FULL TEXT  

Retinal Vascular Changes and 20-Year Incidence of Lower Extremity Amputations in a Cohort With Diabetes
Moss et al.
Arch Intern Med 2003;163:2505-2510.
ABSTRACT | FULL TEXT  

Sustained Effect of Intensive Treatment of Type 1 Diabetes Mellitus on Development and Progression of Diabetic Nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study
Writing Team for the Diabetes Control and Complica
JAMA 2003;290:2159-2167.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy: Contemporary prevalence in a well-controlled population
Brown et al.
Diabetes Care 2003;26:2637-2642.
ABSTRACT | FULL TEXT  

Effects of Duration and Age at Onset of Type 1 Diabetes on Preclinical Manifestations of Nephropathy
Drummond et al.
Diabetes 2003;52:1818-1824.
ABSTRACT | FULL TEXT  

Dual blockade with candesartan cilexetil and lisinopril in hypertensive patients with diabetes mellitus: rationale and design
Andersen et al.
Journal of Renin-Angiotensin-Aldosterone System 2003;4:96-99.
ABSTRACT  

Screening for diabetic retinopathy
Squirrell and Talbot
JRSM 2003;96:273-276.
FULL TEXT  

Increased Serum IGF-I During Pregnancy Is Associated With Progression of Diabetic Retinopathy
Lauszus et al.
Diabetes 2003;52:852-856.
ABSTRACT | FULL TEXT  

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes: Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS)
Henricsson et al.
Diabetes Care 2003;26:349-354.
ABSTRACT | FULL TEXT  

Topical Nepafenac Inhibits Ocular Neovascularization
Takahashi et al.
IOVS 2003;44:409-415.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy
Fong et al.
Diabetes Care 2003;26:226-229.
FULL TEXT  

Diabetic Retinopathy
Fong et al.
Diabetes Care 2003;26:s99-102.
FULL TEXT  

Inaugural Article: Soft and hard classification by reproducing kernel Hilbert space methods
Wahba
Proc. Natl. Acad. Sci. USA 2002;99:16524-16530.
ABSTRACT | FULL TEXT  

Blood pressure and cardiac autonomic function in relation to risk factors and treatment perspectives in Type 1 diabetes
Poulsen
Journal of Renin-Angiotensin-Aldosterone System 2002;3:222-242.
ABSTRACT  

The DIabetic Retinopathy Candesartan Trials (DIRECT) Programme, rationale and study design
The DIRECT Programme Study Group and Chaturvedi
Journal of Renin-Angiotensin-Aldosterone System 2002;3:255-261.
ABSTRACT  

Encapsulated Cell-Based Delivery of CNTF Reduces Photoreceptor Degeneration in Animal Models of Retinitis Pigmentosa
Tao et al.
IOVS 2002;43:3292-3298.
ABSTRACT | FULL TEXT  

Blockade of Nitric-Oxide Synthase Reduces Choroidal Neovascularization
Ando et al.
Mol. Pharmacol. 2002;62:539-544.
ABSTRACT | FULL TEXT  

Regression of Ocular Neovascularization in Response to Increased Expression of Pigment Epithelium-Derived Factor
Mori et al.
IOVS 2002;43:2428-2434.
ABSTRACT | FULL TEXT  

Quantitative Assessment of the Integrity of the Blood-Retinal Barrier in Mice
Derevjanik et al.
IOVS 2002;43:2462-2467.
ABSTRACT | FULL TEXT  

Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy
Lopes de Faria et al.
Br J Ophthalmol 2002;86:725-728.
ABSTRACT | FULL TEXT  

Neurotrophic Factor Receptors in Epiretinal Membranes After Human Diabetic Retinopathy
Harada et al.
Diabetes Care 2002;25:1060-1065.
ABSTRACT | FULL TEXT  

Review: Overview of diabetic eye disease
Leese and Ellis
British Journal of Diabetes & Vascular Disease 2002;2:14-17.
ABSTRACT  

Peak Expiratory Flow Rate: Relationship to Risk Variables and Mortality: The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Diabetes Care 2001;24:1967-1971.
ABSTRACT | FULL TEXT  

Retinal perfusion pressure and pulse pressure: clinical parameters predicting progression to sight-threatening diabetic retinopathy
Patel et al.
British Journal of Diabetes & Vascular Disease 2001;1:80-87.
ABSTRACT  

Is the pulse rate useful in assessing risk of diabetic retinopathy and macular oedema? The Wisconsin Epidemiological Study of Diabetic Retinopathy
Wong et al.
Br J Ophthalmol 2001;85:925-927.
ABSTRACT | FULL TEXT  

The NEI-VFQ-25 in People With Long-term Type 1 Diabetes Mellitus: The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Ophthalmol 2001;119:733-740.
ABSTRACT | FULL TEXT  

Understanding the Value of Diabetic Retinopathy Screening
Fong et al.
Arch Ophthalmol 2001;119:758-760.
FULL TEXT  

Maternally Inherited Diabetes and Deafness: A Multicenter Study
Guillausseau et al.
ANN INTERN MED 2001;134:721-728.
ABSTRACT | FULL TEXT  

How Many Steps of Progression of Diabetic Retinopathy Are Meaningful?: The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Ophthalmol 2001;119:547-553.
ABSTRACT | FULL TEXT  

Screening for Diabetic Retinopathy
Palmberg
Diabetes Care 2001;24:419-420.
FULL TEXT  

Markers of Insulin Resistance Are Strong Risk Factors for Retinopathy Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study
Chaturvedi et al.
Diabetes Care 2001;24:284-289.
ABSTRACT | FULL TEXT  

Erythrocyte Sodium-Lithium Countertransport and Proliferative Diabetic Retinopathy
Lopes de Faria et al.
IOVS 2000;41:1482-1485.
ABSTRACT | FULL TEXT  

The Risk of Cardiovascular Disease Mortality Associated With Microalbuminuria and Gross Proteinuria in Persons With Older-Onset Diabetes Mellitus
Valmadrid et al.
Arch Intern Med 2000;160:1093-1100.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy in African Americans With Type 1 Diabetes: The New Jersey 725: I. Methodology, Population, Frequency of Retinopathy, and Visual Impairment
Roy
Arch Ophthalmol 2000;118:97-104.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy in African Americans With Type 1 Diabetes: The New Jersey 725: II. Risk Factors
Roy
Arch Ophthalmol 2000;118:105-119.
ABSTRACT | FULL TEXT  

Identification of androgen receptor protein and 5alpha -reductase mRNA in human ocular tissues
Rocha et al.
Br J Ophthalmol 2000;84:76-84.
ABSTRACT | FULL TEXT  

Association of Ocular Disease and Mortality in a Diabetic Population
Klein et al.
Arch Ophthalmol 1999;117:1487-1495.
ABSTRACT | FULL TEXT  

Risk Factors for Hospitalization in People With Diabetes
Moss et al.
Arch Intern Med 1999;159:2053-2057.
ABSTRACT | FULL TEXT  

Treatment of Diabetic Retinopathy
Ferris et al.
NEJM 1999;341:667-678.
FULL TEXT  

Alcohol Intake and the Risk of Coronary Heart Disease Mortality in Persons With Older-Onset Diabetes Mellitus
Valmadrid et al.
JAMA 1999;282:239-246.
ABSTRACT | FULL TEXT  

Factors Associated With Implementation of Preventive Care Measures in Patients With Diabetes Mellitus
Streja and Rabkin
Arch Intern Med 1999;159:294-302.
ABSTRACT | FULL TEXT  

Seeing Beyond Retinopathy in Diabetes: Electrophysiological and Psychophysical Abnormalities and Alterations in Vision
Ewing et al.
Endocr. Rev. 1998;19:462-476.
ABSTRACT | FULL TEXT  

Diabetic retinopathy in Down's syndrome
Fulcher et al.
Br J Ophthalmol 1998;82:407-409.
ABSTRACT | FULL TEXT  

United Kingdom Prospective Diabetes Study, 30: Diabetic Retinopathy at Diagnosis of Non-Insulin-Dependent Diabetes Mellitus and Associated Risk Factors
Kohner et al.
Arch Ophthalmol 1998;116:297-303.
ABSTRACT | FULL TEXT  

Incidence of self reported glaucoma in people with diabetes mellitus
Klein et al.
Br J Ophthalmol 1997;81:743-747.
ABSTRACT | FULL TEXT  

Disentangling the influence of insulin dependent diabetes mellitus on refraction
SMITH
Br J Ophthalmol 1997;81:337-338.
FULL TEXT  

Is Obesity Related to Microvascular and Macrovascular Complications in Diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Intern Med 1997;157:650-656.
ABSTRACT  

Incidence of Retinopathy and Associated Risk Factors From Time of Diagnosis of Insulin-Dependent Diabetes
Klein et al.
Arch Ophthalmol 1997;115:351-356.
ABSTRACT  

Prevalence of diabetic retinopathy in patients with diabetes mellitus diagnosed after the age of 70 years
Cahill et al.
Br J Ophthalmol 1997;81:218-222.
ABSTRACT | FULL TEXT  

Interval Between Onset of Mild Nonproliferative and Proliferative Retinopathy in Type I Diabetes
Vitale et al.
Arch Ophthalmol 1997;115:194-198.
ABSTRACT  

Lifetime Benefits and Costs of Intensive Therapy as Practiced in the Diabetes Control and Complications Trial
The Diabetes Control and Complications Trial Resea
JAMA 1996;276:1409-1415.
ABSTRACT  

Long-term Incidence of Lower-Extremity Amputations in a Diabetic Population
Moss et al.
Arch Fam Med 1996;5:391-398.
ABSTRACT  

Discrete Event Simulation to Evaluate Screening for Diabetic Eye Disease
Davies and Canning
SIMULATION 1996;66:209-216.
ABSTRACT  

The Incidence of Hypertension in Insulin-Dependent Diabetes
Klein et al.
Arch Intern Med 1996;156:622-627.
ABSTRACT