The incidence of retinopathy was assessed in 188 diabetic and 284 nondiabetic Pima Indian adults six years after an initial examination had shown each to be free of retinopathy. Exminations included direct ophthalmoscopy through dilated pupils. The incidence of retinal lesions was strongly related to the presence of diabetes and, among the diabetic subjects, to insulin treatment, disease duration, plasma glucose concentration, and presence of other complications such as proteinuria, loss of deep tendon reflexes, and increased vibration-sensation threshold. In diabetic subjects not taking insulin, the incidence of exudates in those with systolic blood pressures of at least 145 mm Hg was more than twice that of those with pressures of less than 125 mm Hg. This association persisted when assessed within categories of subjects stratified according to 13 potentially confounding variables, suggesting that control of blood pressure may reduce the incidence of retinal exudates in diabetics not treated with insulin.

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Because of increasing complaints of visual dysfunction, 13 patients with refractory or recently diagnosed ovarian carcinoma were evaluated for possible cisplatin-induced ophthalmologic toxicity. All patients had received high-dose cisplatin (200 mg/m2 in five divided daily doses) over two to four cycles. Eight patients (62%) developed symptoms of blurred vision and three (23%) also developed altered color perception. Retinal toxicity in the form of cone dysfunction was documented by electroretinography and color vision testing in 11 patients. Three patients were studied prospectively. Two patients who developed cone dysfunction had normal ophthalmologic exams before the initiation of chemotherapy or after one cycle of cisplatin, suggesting a causal relationship between cisplatin therapy and subsequent retinal abnormalities. Though visual acuity improved off therapy, color vision abnormalities persisted as long as 16 months beyond therapy.

The occurrence of retinopathy and its relationship to diabetes in 1,640 Pima Indians age 15 and over has been determined. Eighteen per cent of those with two-hour postload plasma glucose levels of equal to or greater than 200 mg./dl. had some evidence of retinopathy. Of those with retinopathy and diabetes, 7 per cent were found to have proliferative or neovascular changes, the remainder having microaneurysms and/or exudates. The frequency of retinopathy increased from 3 per cent among newly diagnosed diabetics to 47 per cent among those with diabetes of 10 or more years duration. No relationship was found with sex, age at diagnosis of diabetes, or age at time of examination when duration of diabetes was taken into account. The occurrence of retinopathy was confined largely to those who fell into the second or hyperglycemic component of the frequency distribution of plasma glucose levels in the population, indicating the significance of the bimodal glucose tolerance frequency distribution.

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