Diabetic Retinopathy: A Review of the Aarhus Approach to Studies on Epidemiology, Computerised Grading, and the Pathophysiology of the Disease

Bek, T.

doi:10.1055/s-2005-861396

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…The department's routine examination programme has been described previously [11][12][13] and includes interviewing patients about the age of onset and the type of pharmacological treatment of diabetes, measurement of best-corrected visual acuity and BP (from 1 December 1999). HbA 1c values were collected from the regional laboratory database (from 1 January 1992), except for those of individuals with known haemolytic disease, dehydration or other conditions known to affect the measurement.…”

Section: Methodsmentioning

confidence: 99%

Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema

Bek

2020

Diabetologia

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Aims/hypothesis The purpose of screening for diabetic retinopathy is to detect either of the two sight-threatening complications: proliferative diabetic retinopathy (PDR) or clinically significant diabetic macular oedema (DME). The aim of the study was to evaluate whether systemic risk factors affect the risk of developing these two complications differently. Methods Survival analysis with death as a competing risk was used to describe the effect of sex, age and time of onset of diabetes, systolic (SBP) and diastolic (DBP) BPs, and the weighted exposure and CV of HbA 1c for the development of PDR and DME from all 2773 patients treated for diabetic retinopathy in a defined population from the Aarhus area, Denmark, between 1 July 1994 and 1 July 2019. Results Increasing HbA 1c above normal increased the risk of developing both PDR and DME (p < 0.04), and values below normal increased the risk of developing PDR (p < 0.013). Increasing DBP increased the risk of developing both PDR and DME (p < 0.0001), whereas increasing SBP increased the risk of developing DME (p < 0.0001), but not PDR (p > 0.08). The risk of developing PDR increased with decreasing age of onset of diabetes (p < 0.0001), whereas the risk of developing DME was maximal for a known onset of diabetes at about 30 years of age and decreased significantly for both lower and higher ages of onset (p < 0.0001). The risk of developing both PDR and DME was lower in women than in men (p < 0.004) and was reduced with lower variability of repeated HbA 1c measurements (p < 0.0001). Conclusions/interpretation Systemic risk factors such as metabolic regulation, arterial BP and the age of onset of diabetes contribute differently to the development of PDR and DME. The overall risk of developing treatment-requiring diabetic retinopathy should be calculated from the risks of reaching each of the two complications separately.

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Section: Methodsmentioning

confidence: 99%

Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema

Bek

2020

Diabetologia

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“…At each examination, the best corrected visual acuity had been measured with visual acuity charts complying with the ETDRS standard (Ferris et al., 1982), followed by 50 or 60 degrees fundus photography in mydriasis centred on respectively the fovea and the optic disk (Bek, 2005). Additionally, the blood pressure, and height and weight for calculation of body mass index (BMI), had been measured since 1999, previous cataract operation (Bek et al., 2022) and heredity to diabetes had been noted since 2003 (Bek, 2022), and HbA1c values had been collected from the central laboratory system since 1992 (Bek, 2020b).…”

Section: Methodsmentioning

confidence: 99%

Individualised screening for diabetic retinopathy with proliferative retinopathy and macular oedema as separate end points

Bek,

Andersen,

Andresen

et al. 2024

Acta Ophthalmologica

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PurposeA number of algorithms have been developed to calculate screening intervals for diabetic retinopathy on the basis of individual risk factors. However, these approaches have not considered proliferative diabetic retinopathy (PDR) and diabetic macular oedema (DME) as separate end points and death as competing risk.MethodsA multi‐state survival model with death as competing risk was used to predict the screening interval for diabetic retinopathy based on information about all 2446 patients from a well‐defined population who had started treatment for either PDR or DME during 25 years. The performance of the model was tested on the existing database and at seven screening sites on patients who had not developed a treatment requiring condition.ResultsTesting on the existing database showed that at a risk level of 2% the algorithm could predict a screening interval with a success rate higher than 90% and a 1.75 times average prolongation of the screening interval without failing to detect the development of verified PDR og DME. The model was limited to a diabetes duration shorter than 40 years and depended on knowledge of relevant risk factors. At the other participating screening sites the algorithm predicted shorter intervals than the screener.ConclusionsAlgorithms for individualised screening for diabetic retinopathy can prolong screening intervals without losing patients who develop a vision threatening condition. The calculation of screening intervals requires access to relevant risk factors and should be developed on large data sets that reflect the population in which the algorithm should be used.

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“…All patients were subjected to measurement of best corrected visual acuity, blood pressure, height and weight for calculating the body mass index (BMI) and fundus photography. Diabetes type was defined on the basis of the time of onset of diabetes, use of insulin and body mass index as described previously (Bek 2005). Additionally, haemoglobin A1c values were collected from the central laboratory system.…”

Section: Patientsmentioning

confidence: 99%

The risk for developing vision‐threatening retinopathy after cataract surgery in diabetic patients depends on the postoperative follow‐up time

Bek

Tilma

Cour

2021

Acta Ophthalmologica

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Purpose: To identify parameters that can predict the postoperative risk for progression of retinopathy to a vision-threatening stage after cataract surgery. This may optimize the timing of surgery and the postoperative follow-up strategy in diabetic patients. Methods: Multi-state survival analysis with death as competing risk was used to investigate how year of onset and age of onset of diabetes, gender, body mass index, HbA1c and blood pressure had affected the risk for developing diabetic macular oedema (DME) and proliferative diabetic retinopathy (PDR) among 2540 right eyes from 2797 diabetic patients operated for cataract on one or both eyes during 25 years until July 1. 2019. Results: Cataract surgery had been performed in 98.8% of patients reaching 90 years of age. The risk for developing both DME and PDR was increased by cataract surgery. The risk was highest during the first postoperative years and increased by preoperative variability in HbA1c. The risk after more than 20 years postoperatively increased by increased cumulative HbA1c pre-operatively. The other studied risk factors contributed differently to the development of the two complications. Conclusions: Decision models for the timing of cataract surgery in diabetic patients should consider that the risk for developing vision-threatening retinopathy depends on follow-up time. Differences in the risk profiles for developing DME and PDR after cataract surgery support that the two complications should be regarded as separate late complications.

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Diabetic Retinopathy: A Review of the Aarhus Approach to Studies on Epidemiology, Computerised Grading, and the Pathophysiology of the Disease

Cited by 8 publications

References 7 publications

Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema

Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema

Individualised screening for diabetic retinopathy with proliferative retinopathy and macular oedema as separate end points

The risk for developing vision‐threatening retinopathy after cataract surgery in diabetic patients depends on the postoperative follow‐up time

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