Has the Frequency of Proliferative Diabetic Retinopathy Declined in the U.S.?
- Ronald Klein, MD, MPH
- From the Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin
- Address correspondence to Ronald Klein, MD, MPH, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 North Walnut St., 405 WARF, Madison, WI 53726-2336. E-mail: kleinr{at}epi.ophth.wisc.edu
Randomized controlled clinical trials provide evidence that intense glucose and blood pressure control result in a reduction in the incidence and progression of retinopathy and visual loss in people with diabetes (1–4). In the Diabetes Control and Complications Trial (DCCT) (1), intensive insulin treatment was found to reduce the risk of retinopathy progression in people with type 1 diabetes by 76% in those without and 54% in those with retinopathy at baseline compared with conventional treatment. In the U.K. Prospective Diabetes Study (UKPDS) (2), after 12 years of follow-up of people newly diagnosed with type 2 diabetes, intensive glycemic control reduced the rate of progression of diabetic retinopathy by 21% and the need for laser photocoagulation by 29% compared with conventional treatment. In the UKPDS (3), tight blood pressure control in hypertensive patients independently resulted in a 34% reduction in the rate of progression of retinopathy, a 35% reduction in retinal photocoagulation, and a 47% reduction in the deterioration of visual acuity by three lines or more compared with conventional blood pressure control. The Appropriate Blood Pressure Control in Diabetes Trial (4) showed that intensive blood pressure control reduced the progression of diabetic retinopathy by 28% in normotensive subjects with type 2 diabetes.
Despite these findings, there are few population-based data demonstrating that application of intensive treatment of blood glucose and blood pressure has resulted in fewer micro- …
