Cumulative Incidence Of Diabetic Retinopathy Research Articles

Incidence of Diabetic Retinopathy and Its Predictors Among Newly Diagnosed Type 1 and Type 2 Diabetic Patients: A Retrospective Follow-up Study at Tertiary Health-care Setting of Ethiopia.

BackgroundWith an increasing number of diabetes patients in developing countries, the burden of diabetes-related blindness is undoubtedly posing a massive challenge to the sustainable health care system due to the cost of care. Despite this fact, to date, most of the epidemiological research on diabetic retinopathy (DR) in eastern Africa, including Ethiopia, has been limited to survey studies. Thus, we determined the incidence of retinopathy and its predictors among diabetic patients in Jimma University Medical Center, Southwest Ethiopia.MethodsA retrospective follow-up study was conducted on 402 randomly selected diabetic patients of aged ≥15 years. A preliminary reviewed checklist was used to obtain information on the demographics, clinical and physiological attributes. Data were entered using EpiData version 4.6 and analyzed using Stata version 14. All variables at P-values less than 0.2 in bivariable analysis were exported to multivariable analysis. Multivariable accelerated failure time (AFT) regression analyses using Weibull distribution were used to examine the predictors of DR at a 5% level of significance.ResultsThroughout a median follow-up period of 5.9 years, the cumulative incidence of DR was 20.15% (95%CI: 16.50–24.37) and the incidence rate was 36.9 per 1000 person years (PY) (95%CI: 29.7–45.9). Multivariable Weibull AFT regression analyses showed that type two diabetes mellitus (T2DM) (adjusted time ratio (ATR) 0.4095%CI: 0.20–0.78), hypertension (HTN) (ATR 0.54; 95%CI: [0.35, 0.82]), low high density lipoprotein cholesterol (HDL-C) (ATR 0.51; 95%CI: 0.36–0.73), and borderline high total cholesterol (TC) (ATR 0.63; 95%CI: 0.42–0.94) were a predictor of time to DR.ConclusionThe overall incidence of DR among patients with diabetes mellitus was estimated to be 20.15% and is becoming a public health burden in Ethiopia. Our results indicate that T2DM, HTN, low HDL-C and borderline high TC independently predicts an increased incidence/decreased survival time of retinopathy among diabetes patients. The low HDL-C, HTN, and high TC are modifiable risk factors that should be managed along with diabetes.

Diabetic Retinopathy –Incidence And Risk Factors In A Community Setting- A Longitudinal Study

Aim: To evaluate the natural history of diabetic retinopathy (DR) in diabetic patients and to assess long term risk for other chronic diseases associated with DR.Methods: Retrospective, community-based study. Diabetics who underwent their first fundoscopic examination during 2000–2002, and had at least one follow- up examination by the end of 2007 were included. The primary outcome was the development of DR (proliferative diabetic retinopathy (PDR), non PDR (NPDR) or macular edema.Patients were followed for another 9 years for documentation of new diagnosis of related diseases.Results: 516 patients' (1,032 eyes) records were included and were followed first for an average of 4.15 ± 1.27 years. During follow-up, 28 (2.7%) of the total 1,032 eyes examined were diagnosed with PDR. An additional 194 (18.8%) eyes were diagnosed with new NPDR. The cumulative incidence of NPDR was 310/1,032 (30.0%). All the patients who developed PDR had prior NDPR. By the end of the 9 years extended follow up, patients with NPDR had a greater risk for developing chronic renal failure HR = 1.71 (1.14–2.56), ischemic heart disease HR = 1.57 (1.17–2.09), and had an increased mortality rate HR = 1.26 (1.02–1.57)Conclusion: DR is associated with a higher rate of diabetes complications. Patients with DR should be followed more closely.Key pointsDuring a mean follow-up of 4.5 years, the cumulative incidence of diabetic retinopathy in a community cohort was 18.8%.NDPR (non-proliferative diabetic retinopathy) is a predictor of PDR (proliferative diabetic retinopathy).In a real life setting NPDR is a marker of a poorer prognosis.Patients with NDPR should be monitored more closely.

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

ObjectiveThe purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program’s cost-effectiveness. DesignRetrospective chart review. ParticipantsA total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013. MethodsFocused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office. ResultsThe average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%–18.7%). The average savings per tele-ophthalmology examination was $1007. ConclusionsDR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.

The incidence of diabetes mellitus and diabetic retinopathy in a population-based cohort study of people age 50\xa0years and over in Nakuru, Kenya

BackgroundThe epidemic rise of diabetes carries major negative public health and economic consequences particularly for low and middle-income countries. The highest predicted percentage growth in diabetes is in the sub-Saharan Africa (SSA) region where to date there has been no data on the incidence of diabetic retinopathy from population-based cohort studies and minimal data on incident diabetes. The primary aims of this study were to estimate the cumulative six-year incidence of Diabetes Mellitus (DM) and DR (Diabetic Retinopathy), respectively, among people aged ≥50 years in Kenya.MethodsRandom cluster sampling with probability proportionate to size were used to select a representative cross-sectional sample of adults aged ≥50 years in 2007-8 in Nakuru District, Kenya. A six-year follow-up was undertaken in 2013–14. On both occasions a comprehensive ophthalmic examination was performed including LogMAR visual acuity, digital retinal photography and independent grading of images. Data were collected on general health and risk factors. The primary outcomes were the incidence of diabetes mellitus and the incidence of diabetic retinopathy, which were calculated by dividing the number of events identified at 6-year follow-up by the number of people at risk at the beginning of follow-up. Age-adjusted risk ratios of the outcomes (DM and DR respectively) were estimated for each covariate using a Poisson regression model with robust error variance to allow for the clustered design and including inverse-probability weighting.ResultsAt baseline, 4414 participants aged ≥50 years underwent complete examination. Of the 4104 non-diabetic participants, 2059 were followed-up at six-years (50 · 2%). The cumulative incidence of DM was estimated at 61 · 0 per 1000 (95% CI: 50 · 3–73 · 7) in people aged ≥50 years. The cumulative incidence of DR in the sample population was estimated at 15 · 8 per 1000 (95% CI: 9 · 5–26 · 3) among those without DM at baseline, and 224 · 7 per 1000 (116.9–388.2) among participants with known DM at baseline. A multivariable risk factor analysis demonstrated increasing age and higher body mass index to be associated with incident DM. DR incidence was strongly associated with increasing age, and with higher BMI, urban dwelling and higher socioeconomic status.ConclusionsDiabetes Mellitus is a growing public health concern with a major complication of diabetic retinopathy. In a population of 1 · 6 million, of whom 150,000 are ≥50 years, we estimated that 1650 people aged ≥50 develop DM per year, and 450 develop DR. Strengthening of health systems is necessary to reduce incident diabetes and its complications in this and similar settings.

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

ObjectiveThe purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program’s cost-effectiveness. DesignRetrospective chart review. ParticipantsA total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013. MethodsFocused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office. ResultsThe average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%–18.7%). The average savings per tele-ophthalmology examination was $1007. ConclusionsDR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.

Incidence and progression of diabetic retinopathy within a private diabetes mellitus clinic in South Africa

Objective: The study objective was to examine the influence of glycaemic control and ethnic variations on the incidence and progression of diabetic retinopathy (DR).Design, subjects and setting: Eight hundred and ninety-two persons with type 1 diabetes mellitus, and 1 998 persons with type 2 diabetes mellitus, who were enrolled in a private diabetes mellitus management programme in South Africa, participated in the study. Survival analyses were conducted to assess the relationship between the risk factors and the incidence of DR and referable DR, and the progression of DR.Outcome measures: Cumulative incidence of diabetic retinopathy and referable diabetic retinopathyResults: The seven-year cumulative incidence of DR and referable DR was 536 and 50 cases per 1 000 persons with type 1 diabetes mellitus without DR at baseline, and 351 and 47 cases per 1 000 persons with type 2 diabetes mellitus. The seven-year cumulative incidence of referable DR was 332 cases per 1 000 persons with type 1 diabetes mellitus...

Ten-year cumulative incidence of diabetic retinopathy. The Beijing Eye Study 2001/2011.

ObjectiveTo assess the cumulative 10-year incidence of diabetic retinopathy (DR) and its associated factors in a population living in Greater Beijing.MethodsThe population-based longitudinal Beijing Eye Study, which included 4439 subjects (age in 2001: 40+years) in 2001, was repeated in 2011 with 2695 subjects participating (66.4% of the survivors). The study participants underwent a detailed ophthalmic examination. Fundus photographs were examined for the new development of DR.ResultsAfter excluding individuals with DR at baseline (n = 87) or no sufficient fundus photographs in 2011 (n = 6), the study included 2602 subjects with a mean age of 64.6±9.7 years (median: 64.0 years; range: 50 to 93 years). In the 10-year period, 109 subjects (39 men) developed new DR with an incidence of 4.2% (95% confidence interval (CI): 3.45,5.03). In multiple logistic regression analysis, incident DR was significantly associated with higher HbA1c value (P<0.001; Odds Ratio (OR): 1.73; 95% Confidence Interval (CI): 1.35,2.21), longer duration of diabetes mellitus (P<0.001; OR: 1.16; 95% CI: 1.10,1.22), higher serum concentration of creatinine (P = 0.02; OR: 1.01; 95% CI: 1.002,1.022), lower educational level (P = 0.049; OR: 0.74; 95% CI: 0.55,0.99), higher estimated cerebrospinal fluid pressure (P = 0.038; OR: 1.10; 95% CI: 1.01,1.22), and shorter axial length (P<0.001; OR: 0.48; 95% CI: 0.33,0.71).ConclusionsThe cumulative 10-year incidence (mean: 4.2%) of DR in a North Chinese population was significantly associated with a higher HbA1c value, longer known duration of diabetes mellitus, higher estimated CSFP and shorter axial length (P<0.001). Shorter axial length (or hyperopia) and, potentially, higher CSFP may be additional risk factors to be taken into account when counseling and treating patients with diabetes mellitus.

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

The role of statins in the development of microvascular disease in patients with diabetes is unknown. We tested the hypothesis that statin use increases the risk of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot in individuals with diabetes. We identified all patients living in Denmark who were aged 40 years or older and were diagnosed with incident diabetes between Jan 1, 1996, and Dec 31, 2009. We obtained patients' data from the Danish Patient Registry and information on drug use from the Danish Registry of Medicinal Product Statistics. We randomly selected 15,679 individuals from the database who had used statins regularly until their diagnosis of diabetes (statin users) and matched them in a 1:3 ratio with 47,037 individuals who had never used statins before diagnosis (non-statin users). Our primary outcome was to compare the cumulative incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or gangrene of the foot in statin users versus non-statin users. We analysed data with Cox regression models, adjusted for covariates including sex, age at diabetes diagnosis, and method of diabetes diagnosis. To address potential biases between statin users and non-statin users, we made adjustments to our analysis with a propensity score and with other factors. Median follow-up was 2·7 years (range 0-13). During 215,725 person-years of follow-up, 2866 patients developed diabetic retinopathy, 1406 developed diabetic neuropathy, 1248 developed diabetic nephropathy, and 2392 developed gangrene of the foot. Compared with non-statin users, statin users had a lower cumulative incidence of diabetic retinopathy (hazard ratio 0·60, 95% CI 0·54-0·66; p<0·0001), diabetic neuropathy (0·66, 0·57-0·75; p<0·0001), and gangrene of the foot (0·88, 0·80-0·97; p=0·010), but not diabetic nephropathy (0·97, 0·85-1·10; p=0·62). These results were similar after adjusting for the competing risk of death, after matching for a propensity score, after adjusting for visits to a family doctor, and by stratification on covariates. The corresponding multivariable adjusted hazard ratio for risk of diabetes in the total population was 1·17 (95% CI 1·14-1·21; p<0·0001). Use of statins before diagnosis of incident diabetes was not associated with an increased risk of microvascular disease. Whether statins are protective against some forms of microvascular disease-a possibility raised by these data-will need to be addressed in other studies similar to ours, in mendelian randomisation studies, and preferably in randomised controlled trials. Herlev Hospital, Copenhagen University Hospital.

Three Years Follow-Up Incidence of Retinopathy, In Type 1 Diabetic Patients, In a Population-Based Screening Program with Digital Retinal Photographs

Purpose: To determine the incidence of diabetic retinopathy (DR) and risk factors associated with its development in a cohort of patients with type 1 diabetes mellitus (DM 1), after three years of follow up, with annual retinal photograph by teleophthalmological means. Methods: Prospective cohort study of DM 1 patients, medically assisted in the Puerta del Mar Hospital Endocrinology Unit between 2009 and 2010, without DR, or with any degree of retinopathy that requires no treatment. Patients undergo endocrinological study. Control of blood glucose, glycosylated hemoglobin (HbA1c), blood pressure, dyslipidemia, renal dysfunction and smoking were recorded. Annually, three pictures are taken in each eye with a non-mydriatic digital retinal camera and are included in the intranet tool of the Andalusian Integral Diabetes Plan for remote analysis and grading. The cumulative incidence of DR after three years of follow up and the relationship between the recorded risk factors and the onset of DR is analyzed Results: One hundred and forty-three patients were included in the study. The incidence of RD at 3 years followup was 23.1%. Baseline HbA1c showed a clear trend towards significance to the development of the RD (p=0.06). The duration of diabetes and other considered risk factors showed no significant values in the statistical analysis. Conclusions: This study provides the first results of cumulative incidence of DR in a cohort of DM 1 patients, followed-up through the Tele-ophthalmology tool of the Integral Diabetes Plan of Andalusia, which was 23.1%. Only baseline HbA1c showed a trend toward significant association in the development of RD.

Incidence of diabetic retinopathy in Bangladesh: A 15‐year follow‐up study*

The aim of the present study was to estimate the incidence of diabetic retinopathy (DR) among type 2 diabetic (T2D) subjects in Bangladesh. A random sample of 977 patients with T2D was recruited retrospectively in 2008 from newly diagnosed T2D patients who had attended the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) in 1993. Baseline information for the cohort was collected for 1993 from hospital records. The mean time until development of DR in newly diagnosed T2D patients was calculated using survival analysis. Cox's proportional hazards model was used to assess factors affecting the time until development of DR. The cumulative incidence of DR over the 15-year period was 50.6% (95% confidence interval [CI] 47.5%-53.8%). The incidence density (per 100 person-years) of DR was similar in the overall cohort (4.1; 95% CI 3.7-4.5) and in men (4.2; 95% CI 3.7-4.7) and women (4.1; 95% CI 3.6-4.6) separately. The mean time (in years) until development of DR in the cohort was 9.72 (95% CI 9.38-10.06), with similar times in men (9.8; 95% CI 9.3-10.3) and women (9.6; 95% CI 9.5-10.1) analyzed separately. Age, sex, hypertension, lipid profile, HbA1c, and serum creatinine were entered into the hazards model simultaneously. However, only age (hazard ratio [HR] 0.75; 95% CI 0.61-0.92) and HbA1c (HR 0.52; 95% CI 0.33-0.82) had a significant effect on the time until development of DR. Glucose deregulation is the most important factor in the development of DR.

Four Years Incidence of Diabetic Retinopathy and Effective Factors on its Progression in Type II Diabetes

To study the 4 years incidence of diabetic retinopathy in patients with type II diabetes and effective factors on its progression. Among diabetic patients referred to Yazd Diabetes Research Center, 120 patients with type II diabetes without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), postprandial blood sugar, triglyceride, and cholesterol were measured and height, weight, and blood pressure (BP) were recorded. Then patients were followed with eye examination yearly for 4 years. Four-year cumulative incidence of diabetic retinopathy was 47.5% (95% CI: 38.6-56.4). The retinopathy was mild nonproliferative diabetic retinopathy (NPDR) in 43 (35.8%) whereas 10 (8.3%) patients had moderate NPDR, 3 (2.5%) patients had severe NPDR, and only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in the second year, 24.4% in the third year, and 7.4% in the fourth year. Duration of diabetes, FBS, and systolic BP had statistically significant relation with grades of diabetic retinopathy. However, there was no significant association between age, sex, body mass index, triglyceride, cholesterol, method of treatment, smoking, and diastolic BP with grades of diabetic retinopathy. These data provide 4-year cumulative incidence of diabetic retinopathy in defined type 2 diabetic patients. The present study shows that duration of diabetes, hyperglycemia, and systolic BP appear to be the major factors associated with the development of any level of retinopathy in type 2 diabetic patients.

Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial

Laser treatment for diabetic retinopathy is often associated with visual field reduction and other ocular side-effects. Our aim was to assess whether long-term lipid-lowering therapy with fenofibrate could reduce the progression of retinopathy and the need for laser treatment in patients with type 2 diabetes mellitus. The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study was a multinational randomised trial of 9795 patients aged 50-75 years with type 2 diabetes mellitus. Eligible patients were randomly assigned to receive fenofibrate 200 mg/day (n=4895) or matching placebo (n=4900). At each clinic visit, information concerning laser treatment for diabetic retinopathy-a prespecified tertiary endpoint of the main study-was gathered. Adjudication by ophthalmologists masked to treatment allocation defined instances of laser treatment for macular oedema, proliferative retinopathy, or other eye conditions. In a substudy of 1012 patients, standardised retinal photography was done and photographs graded with Early Treatment Diabetic Retinopathy Study (ETDRS) criteria to determine the cumulative incidence of diabetic retinopathy and its component lesions. Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN64783481. Laser treatment was needed more frequently in participants with poorer glycaemic or blood pressure control than in those with good control of these factors, and in those with a greater burden of clinical microvascular disease, but the need for such treatment was not affected by plasma lipid concentrations. The requirement for first laser treatment for all retinopathy was significantly lower in the fenofibrate group than in the placebo group (164 [3.4%] patients on fenofibrate vs 238 [4.9%] on placebo; hazard ratio [HR] 0.69, 95% CI 0.56-0.84; p=0.0002; absolute risk reduction 1.5% [0.7-2.3]). In the ophthalmology substudy, the primary endpoint of 2-step progression of retinopathy grade did not differ significantly between the two groups overall (46 [9.6%] patients on fenofibrate vs 57 [12.3%] on placebo; p=0.19) or in the subset of patients without pre-existing retinopathy (43 [11.4%] vs 43 [11.7%]; p=0.87). By contrast, in patients with pre-existing retinopathy, significantly fewer patients on fenofibrate had a 2-step progression than did those on placebo (three [3.1%] patients vs 14 [14.6%]; p=0.004). An exploratory composite endpoint of 2-step progression of retinopathy grade, macular oedema, or laser treatments was significantly lower in the fenofibrate group than in the placebo group (HR 0.66, 95% CI 0.47-0.94; p=0.022). Treatment with fenofibrate in individuals with type 2 diabetes mellitus reduces the need for laser treatment for diabetic retinopathy, although the mechanism of this effect does not seem to be related to plasma concentrations of lipids.

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

To determine 5-year incidence and progression of diabetic retinopathy in an older Australian population-based cohort. During the period 1992-1994, the Blue Mountains Eye Study examined 3654 residents aged 49+years (82.4% of those eligible), living in two urban postcode areas, west of Sydney, Australia. Participants were subsequently invited to attend 5-year follow-up exams. After excluding 543 (14.8%) who died during the follow-up period, 2334 persons (75.0%) were re-examined during 1997-1999. The examination included a comprehensive questionnaire, blood pressure measurement, standardised refraction, Zeiss stereo retinal photographs, and estimation of fasting blood glucose. Diabetic retinopathy was graded from the retinal photographs, using the modified Early Treatment Diabetic Retinopathy Scale classification (15-step scale). Of participants with diabetes diagnosed at baseline, 150 were re-examined, including 139 with gradable fundus photographs. The cumulative 5-year incidence of diabetic retinopathy was 22.2% before 95% confidence interval (CI) 14.1-32.2%. Retinopathy progression (1+ steps) was documented in 25.9% (95% CI 18.8-34.0%) of participants with retinopathy and gradable photographs at both visits; in 58.3% of these cases, a 2+ -step progression was documented. Progression to proliferative retinopathy occurred in only 4.1% of those with retinopathy at baseline. The only baseline risk factors associated with retinopathy progression, after adjusting for age and gender, were increase in fasting blood glucose, odds ratio (OR) 1.2 (95% CI 1.1-1.4)/mmol/l, and increase in diabetes duration, OR 2.3 (95% CI 1.0-5.3)/10 years. These data provide 5-year cumulative incidence of diabetic retinopathy in a defined older population. Increase in diabetes duration and elevated baseline fasting blood glucose level predicted retinopathy incidence.

Improved visual function in IDDM patients with unchanged cumulative incidence of sight-threatening diabetic retinopathy.

To evaluate trends in visual acuity and the cumulative incidence of diabetic retinopathy in a clinic-based observational follow-up study. All patients visiting Hvidore Hospital in 1984 whose diagnosis of IDDM had been made before 41 years of age and between 1965 and 1979 (n = 356) were followed until 1994 or until their deaths. All patients were Caucasians and resided in Copenhagen. Patients were divided into three prevalence cohorts based on time of diabetes onset: group A, 1965-1969 (n = 113); group B, 1970-1974 (n = 130); and group C, 1975-1979 (n = 113). Fifteen years after diabetes onset, the visual acuity was significantly improved in patients with increasing calendar year of the disease onset. The median (interquartile range) visual acuity was 1.0 (0.8-1.0), 1.0(0.9-1.0), and 1.0 (1.0-1.0) in groups A, B, and C, respectively (P < 0.01 overall; P = 0.28 for group A vs. group B; and P < 0.01 for group A vs. group C) with 60, 66, and 93 having a visual acuity of 1.0 in groups A, B, and C, respectively. The cumulative incidence (+/-SEM), expressed as a percentage and calculated according to the life-table method, of proliferative retinopathy, maculopathy, and laser-treated retinopathy 15 years after onset of diabetes were, respectively, 13+/-3, 11+/-3, and 12+/-3 in group A; 16+/-3, 12+/-3, and 21+/-4 in group B; 11+/-3, 5+/-2, and 12+/-3 in group C, respectively (NS). The development of proliferative retinopathy was associated with the degree of retinopathy and albuminuria at baseline and the mean HbA1c during follow-up. The study revealed an improvement in visual acuity with increasing calendar year of diabetes onset but an unchanged cumulative incidence of diabetic retinopathy.