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Eye Disorder That Can Cause Blindness is High Among People with Type 1 Diabetes Mellitus

CHICAGO The prevalence of diabetic retinopathy, a disorder of the retina that can cause blindness, associated with type 1 diabetes mellitus is estimated to affect one per 300 adults over the age of 18 years in the United States, according to an article in the April issue of The Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

According to the article, diabetic retinopathy (DR) is the most common eye complication associated with diabetes mellitus (DM). The retina is the light-collecting layer of cells at the back of the eye that converts light into signals, which are sent to the brain via the optic nerve where they are translated into images.

Monique S. Roy, M.D., of the University of Medicine and Dentistry of New Jersey New Jersey Medical School, Newark, and colleagues estimated the prevalence of DR among people with type 1 DM in the United States using data from two large studies and population data from the 2000 U.S. Census. Type 1 diabetes usually develops at a young age (frequently in childhood) and generally requires treatment with insulin.

The researchers found that among 209 million Americans 18 years and older, an estimated 889,000 have type 1 DM diagnosed before age 30. Among people with type 1 DM, the prevalence of diabetic retinopathy was 74.9 percent for blacks, and 82.3 percent for whites. The prevalence of vision-threatening retinopathy was 30 percent for black persons and 32.3 percent for whites. The researchers also found that the prevalence of DR due to type 1 DM diagnosed before age 30 in the general population 18 years and older is estimated at 767,000 persons having DR of any degree of severity (0.37 percent) and 376,000 people having vision-threatening retinopathy (0.18 percent).

Retinopathy due to type 1 DM is an important public health problem in the United States, affecting one per 300 persons 18 and older, and one per 600 persons with advanced, vision-threatening retinopathy, the authors write.

The estimated population prevalences of DR of any level and of VTDR [vision-threatening diabetic retinopathy] are highest in the 40- through 49-year and the 50-year-and-older age groups, most likely because older persons who had the onset of DM prior to age 30 years had a longer average duration of the disease, write the researchers. The prevalence of DR in the general population declines thereafter, reflecting a decreasing prevalence of type 1 DM in older age groups (possibly due to early mortality among persons with type 1 DM).

The authors conclude: The prevalence of DR is expected to increase substantially by 2020, driven by an increasing prevalence of DM over time with the aging of the U.S. population, in combination with anticipated increases in the age-specific prevalence of DM. Because DR is a substantial public health problem, public and private policy efforts directed toward improving primary and secondary prevention programs are warranted.

(Arch Ophthalmol. 2004;122:546-551. Available at www.archophthalmol.com.
Editors Note: This study was supported by grants from the National Eye Institute, Bethesda, Md., and a Lew Wasserman Merit Award from Research to Prevent Blindness, New York, N.Y. (Dr. Roy).

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