Relationship between fasting glucose and retinopathy for diagnosis of diabetes: results from a population-based study in urban and rural China.

PURPOSE: The purpose of this study was to assess the relationship between the fasting plasma glucose cutoff of 7 mmol/L and the presence of retinopathy in a population in China. METHODS: The Beijing Eye Study 2006 is a population-based study, which included 3,251 subjects aged >or= 45 years. By using fundus photographs, retinopathy was assessed according to the Early Treatment of Diabetic Retinopathy Study. RESULTS: The correlation between fasting plasma glucose concentration and retinopathy suggested a continuous relation instead of a uniform glycemic threshold for prevalent retinopathy. For the diabetes plasma glucose concentration cutoffs of 7.0 mmol/L, 5.6 mmol/L, and 7.8 mmol/L to differentiate between subjects with or without retinopathy, the sensitivities were 18.8%, 44.0%, and 15.4%, respectively, and the specificities were 94.3%, 73.8%, and 96.6%, respectively. After excluding subjects with known diabetes and/or subjects on antidiabetic treatment, the sensitivities of diabetes plasma glucose concentration cutoffs of 7.0 mmol/L, 5.6 mmol/L, and 7.8 mmol/L to differentiate between subjects with or without retinopathy were 7.9%, 34.2%, and 6.3%, respectively, and the specificities were 96.5%, 77.1%, and 98.1%, respectively. CONCLUSION: Confirming a recent study from Australian and North American populations, the results suggest that also for the Chinese population, a uniform glycemic threshold for prevalent retinopathy does not exist.

Posterior vitreous contraction after cerebral sinus thrombosis.

The authors describe a 34-year-old woman who presented with headaches and marked papilledema after she had been taking oral hormonal therapy for the treatment of dysfunctional uterine bleeding. Neurological examination led to the diagnosis of a cerebral venous sinus thrombosis. After thrombolytic treatment, the headaches vanished and the papilledema in the right eye disappeared. Visual acuity increased to 20/25 in the right eye and 20/32 in the left eye. However, the marked papilledema in the left eye had resulted in a pronounced contraction of the posterior vitreous at the optic nerve head associated with a secondary folding of the macula and subretinal pigmentary irregularities in the foveal region.

Body height and ocular diseases. The Beijing Eye Study.

BACKGROUND: To determine whether body height is associated with ocular diseases. METHODS: The population-based Beijing Eye Study 2006 included 3,251 (73.2%) subjects out of 4,439 subjects invited to be examined. Ocular and general parameters were examined for associations with body height. RESULTS: Out of the 3,251 subjects included in the study, measurements of body height were available for 3,214 subjects (98.9%). In univariate analysis, short body height was significantly associated with a higher frequency of angle-closure glaucoma (P = 0.04), trachoma (P < 0.001), and pterygium (P = 0.02), a higher degree of cortical cataract (P < 0.001), and a higher frequency of arterial hypertension (P < 0.001). A multivariate analysis, including all confounding parameters which were significantly associated with body height in univariate analysis (i.e., age, gender, rural versus urban region, level of education) revealed that body height by itself was no longer significantly associated with the presence of any of the diseases tested. CONCLUSIONS: Angle-closure glaucoma, trachoma, pterygium, cortical cataract and arterial hypertension are present more often in adult Chinese with a short body stature. These associations are due to confounding factors such as age, level of education, and anterior chamber depth, which by themselves are associated with the ocular diseases mentioned.

Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006.

BACKGROUND: To evaluate the prevalence and associated factors of diabetic retinopathy in adult Chinese with diabetes mellitus. METHODS: The Beijing Eye Study 2006 is a population-based cross-sectional study that included 3,251 (73.2%) subjects (aged 45+ years) out of 4,439 subjects originally participating in the Beijing Eye Study 2001. Diabetes defined as fasting glucose concentrations > or = 7.0 mmol/L or self-reported diagnosis of diabetes was detected in 381/3,251 (12.9%) subjects. Diabetic retinopathy was defined by the presence of at least one microaneurysm in the diabetic subjects according to the Early Treatment of Diabetic Retinopathy Study (ETDRS). RESULTS: Gradable fundus photographs were available for 362 (95.0%) subjects. Diabetic retinopathy was detected in 101 subjects (27.9%). Most of the diabetic retinopathy was of the mild type (74/101; 73%). Severe non-proliferative or proliferative diabetic retinopathy was present in 16 (16%) subjects, and clinically significant macular edema in four (4%) subjects. Presence of diabetic retinopathy was significantly associated with rural region (Odds ratio (OR): 3.52), duration of diabetes mellitus (OR: 1.08), fasting plasma glucose concentration (OR: 1.14), type of diabetes treatment (OR: 2.09), and marginally significantly, with hyperopic refractive error (OR: 1.13; P = 0.08). The stage of diabetic retinopathy was associated with rural region (P < 0.001), known duration of diabetes (P = 0.001), type of diabetes treatment (P = 0.001), concentrations of high-density lipoproteins (P = 0.004), and fasting glucose concentrations (P = 0.002). CONCLUSIONS: Prevalence of diabetic retinopathy among adult diabetic Chinese was about 27.9%. The stage of retinopathy was mild in 75% of the subjects with diabetic retinopathy. Associated factors were diabetes duration, diabetic treatment type, low metabolic control, rural region, and marginally hyperopia.

Retinopathy and mortality. The Beijing Eye Study.

BACKGROUND: To assess the association between a retinopathy as defined by the Early Treatment of Diabetic Retinopathy Study (ETDRS) criteria, and mortality in a population-based setting. METHODS: At baseline in 2001, the Beijing Eye Study examined 4,391 subjects for retinopathy lesions, with a detected frequency of 285/4391 (6.5%) subjects. Using fundus photographs, the retinopathy was graded according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) criteria. The mean age was 56.05 +/- 10.51 years (range, 40-101 years). In 2006, all study participants were re-invited for a follow-up examination. RESULTS: Out of the 4,391 subjects, 3,224 subjects (73.4%) returned for follow-up examination, while 140 subjects (3.2%) were dead and 1,027 subjects (23.4%) did not agree to be re-examined or had moved away. Mortality rate was significantly higher (P = 0.002; odds ratio [OR]: 2.20; 95% confidence intervals [CI]: 1.32, 3.67) in the 285 subjects with retinopathy (18/285 or 6.3 +/- 1.4%; 95%CI: 3.6%, 9.0%) than in the 4,106 participants without retinopathy (122/4,106 or 3.0 +/- 0.3% 95%CI: 2.4%, 3.6%). In binary logistic regression analysis, mortality was significantly associated with age (P < 0.001; OR: 1.10; 95%CI: 1.08, 1.12), gender (P = 0.006; OR: 0.61; 95%CI: 0.43, 0.86), rural versus urban region (P < 0.001; OR: 5.65; 95%CI: 3.81, 8.40), and presence of retinopathy (P = 0.005; OR: 2.13; 95%CI: 1.25, 3.62). CONCLUSIONS: In addition to higher age, male gender, and living in a rural region, a retinopathy as defined by ETDRS criteria is a risk factor for an increased mortality in adult Chinese.

[The experimental study of captopril and valsartan on the preventing and treatment of diabetic retinopathy in diabetic mice].

OBJECTIVE: To evaluate the action of Angiotensin II (AngII) on the occurrence and development of diabetic retinopathy and the effect of captopril and valsartan on preventing and treating diabetic retinopathy. METHODS: Male C57BL/KsJ db/+ mice were obtained at 3 weeks of age and maintained on diets enriched animal fat for 4 weeks. After exposure to high-fat diet for 4 weeks, mice were injected intraperitoneally with streptozotocin (STZ) 100 mg/kg body weight. After 2 weeks, nonfasting plasma glucose concentration was measured by nipping the distal part of the tail. Mice whose plasma glucose concentrations were higher than 11.1 mmol/L were selected for the study as model groups. Starting from day 2, captopril 12.5 mg/kg or valsartan 40 mg/kg was given to treatment group via the oral route After treatment for 4, 8, 12 weeks, respectively, eyeballs of mice from each group were enucleated, embedded in paraffin to make tissue sections for immunohistochemistry analysis. The instrument for computer image-analysis was used to analyze the expression of AngII and VEGF in ganglion cell layer. The analyzed indices were mean gray scale value and area density value. RESULTS: With increased duration of diabetes, the mean gray scale values of AngII and VEGF decreased significantly. At the same time, area density values of AngII and VEGF increased significantly. The area density values of VEGF in captopril treated-group was significantly lower than that in valsartan-treated group for the same duration. Moreover, the area density values of VEGF at 4 weeks was significantly lower than that at 8 weeks or 12 weeks. The area density value in captopril treated-group had a significant negative correlation with diabetes duration. AngII had significant positive correlation with VEGF. CONCLUSION: AngII possibly participated directly and/or indirectly in the occurrence and development of diabetic retinopathy via the upregulation the expression of VEGF. Early treatment with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin 1 type receptor (AT1R) antagonists could improve diabetic retinopathy to some degree and protect the retinas. The effect of treatment with ACEi was better than that with AT1R antagonists in short term situation.