Biomedical subjects

B E Klein

Publications and source records attributed to B E Klein.

At least 235 records · Page 13Linked to original sources

PubMed1989

Relation of ocular and systemic factors to survival in diabetes.

The relationship of survival to systemic and ocular factors in diabetic persons was studied using data collected as part of the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Six years after the baseline examination, 9.5% of 996 insulin-taking people who were younger than age 30 years when their diabetes was diagnosed (younger onset) had died. Of 1370 people whose diabetes was diagnosed after age 30 years (older onset), 35.3% had died. After adjusting for age and sex, longer duration of diabetes, presence of proteinuria, a history of cardiovascular disease, higher blood pressure, diuretic use, a history of smoking, poorer visual acuity, and more severe retinopathy were significantly associated with decreased survival in both groups. Glaucoma was associated with decreased survival in the younger onset group and cataract in the older onset group. These findings suggest that some ocular complications are important risk indicators for death. Their presence in diabetic patients suggests the need for frequent examinations to detect systemic complications and to intervene to minimize their effect.

Adult↗

PubMed1988

Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.

The relationship between hyperglycemia, measured by glycosylated hemoglobin at the initial examination, and the four-year incidence and progression of diabetic retinopathy was examined in a population-based study in Wisconsin. Younger- (n = 891) and older-onset (n = 987) persons participating in baseline and follow-up examinations were included. Glycosylated hemoglobin was measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. In the younger-onset group, comparing the highest with the lowest quartile of glycosylated hemoglobin, the relative risk for developing any diabetic retinopathy was 1.9; for proliferative retinopathy, 21.8; and for progression, 4.0. Among older-onset persons taking insulin, the corresponding relative risks were 1.9, 4.0, and 2.1. Among older-onset persons not taking insulin, relative risks were 4.0 for any retinopathy and 6.2 for progression. A positive relationship between incidence and progression of retinopathy and glycosylated hemoglobin remained after controlling for duration of diabetes, age, sex, and baseline retinopathy. These data suggest a strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy.

Adult↗

PubMed1988

Methodologic considerations in measuring glycosylated hemoglobin in epidemiologic studies.

Multiple linear regression was used to predict an incubated glycosylated hemoglobin value from the unincubated value and blood glucose. Hemoglobin A1 (HbA1) was measured by a disposable microcolumn technique in a large, geographically defined population of diabetic persons in southern Wisconsin. During the study, incubation of blood samples to remove pre-A1c was implemented. Multiple linear regression using data from a group of 788 patients yielded the equation: incubated HbA1 = 0.897 (non-incubated HbA1)-0.00332 (blood glucose) + 0.388. This equation was "validated" by substituting the calculated value of incubated HbA1 for the actual value in a multinomial logistic regression with diabetic retinopathy as the dependent variable. Little change in the model resulted from the substitution. Further validation was obtained from an independent sample of diabetic persons. Calculated values of incubated HbA1 were an average of 0.4% lower than the actual values.

Age Factors↗

PubMed1988

The incidence of vision loss in a diabetic population.

The 4-year incidence of blindness and vision loss was examined in a population-based study of diabetes mellitus. In subjects participating in baseline and 4-year follow-up examinations, the rate of blindness was 1.5, 3.2, and 2.7% in younger onset persons, older onset persons taking insulin, and older onset persons not taking insulin, respectively. The rate of blindness increased with increasing age, increasing diabetic retinopathy severity, and lower baseline visual acuity in all three groups. Blindness increased with increasing duration of diabetes in younger onset persons and older onset persons taking insulin. The incidence of vision loss, as measured by a doubling of the visual angle, was associated with older age, more severe retinopathy, and presence of macular edema in the three groups. It was also associated with duration of diabetes, presence of proteinuria, and higher glycosylated hemoglobin in younger onset and older onset persons taking insulin.

Adolescent↗

PubMed1988

Proteinuria in diabetes.

In a population-based study in southern Wisconsin, 1370 diabetic persons diagnosed after 29 years of age were examined using standard protocols to determine the prevalence of proteinuria and associated risk variables. Proteinuria (greater than or equal to 0.30 g/L) was present in 18.0% of persons taking insulin and 12.2% of the persons not taking insulin. Proliferative retinopathy and proteinuria were associated with each other. Proteinuria was also associated with increasing duration of diabetes, high systolic blood pressure, use of digoxin, and being male, but not with a history of cigarette smoking or metabolic control as measured by glycosylated hemoglobin.

Adult↗

PubMed1987

Accommodative ability in younger-onset diabetes.

The relationships among accommodative ability, younger-onset diabetes, and other factors are examined in this report. The study population consists of younger-onset diabetic persons less than 45 years of age who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. In 656 of 859 such persons, near point of accommodation was measured twice for each eye using the best correction for distance visual acuity and a Prince rule. Mean amplitude of accommodation in the diabetic population decreased with age and was less than that of a nondiabetic group and of previously published reports. Other factors associated with decreased accommodation in the diabetic population in a multiple linear regression analysis include sex, with the female population being more susceptible; absence of myopia; a longer duration of diabetes; higher glycosylated hemoglobin level; higher blood glucose level; increasing severity of diabetic retinopathy; and higher systolic blood pressure.

Accommodation, Ocular↗

PubMed1987

Optic disc cupping as clinically estimated from photographs.

Cup-to-disc ratios of 204 right eyes were evaluated by two clinicians and by a trained grader using a standardized grading scheme. Mean measurements by the grader were greater than estimates made by either clinician. The measurement scheme used by the trained grader has a high degree of reliability and validity. The standard protocol provides an objective assessment of optic disc cupping and could be easily adapted for office use.

Diabetic Retinopathy↗

PubMed1987

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VII. Diabetic nonproliferative retinal lesions.

The prevalences of hard exudates, soft exudates, intraretinal microvascular abnormalities (IRMAs), and venous beading and their relationships to demographic and other characteristics were examined in a population-based study in southern Wisconsin. For participants whose age at diagnosis was less than 30 years and who were taking insulin (N = 996), hard exudates were found in 24.2%, soft exudates in 15.3%, IRMAs in 16.5%, and venous beading in 7.0% of the population. For participants whose age at diagnosis was 30 years or older and who were taking insulin (N = 674), hard exudates were found in 28.3%, soft exudates in 15.5%, IRMAs in 8.8%, and venous beading in 3.2%. For older-onset persons not taking insulin (N = 696), hard exudates were found in 9.4%, soft exudates in 5.4%, IRMAs in 2.6%, and venous beading in 0.9% of the population. The severities of the lesions were found to be consistently associated with longer duration of diabetes in younger-onset persons and the presence of proteinuria in older-onset persons.

Cross-Sectional Studies↗

PubMed1987

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VI. Retinal photocoagulation.

The prevalence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study in southern Wisconsin. For participants whose age at diagnosis was less than 30 years and who were taking insulin (996 persons) the prevalence rate of panretinal photocoagulation (13.9%) was higher than that of focal photocoagulation (3.6%). For those whose age at diagnosis was 30 years or older (1370 persons), the prevalence rate for panretinal photocoagulation (3.6%) was slightly higher than that of focal photocoagulation (3.0%). Seventy-two percent of eyes of younger onset and 45% of eyes of older onset persons that had received panretinal photocoagulation treatment were found to have incomplete regression of retinal new vessels, and in approximately half of these eyes severe proliferative retinopathy (Diabetic Retinopathy Study High Risk Characteristics [DRS-HRC]) was present. Among eyes with DRS-HRC, 55% were found to be untreated.

Adult↗

PubMed1987

The association of iris color with eye disease in diabetes.

Iris (eye) color was examined for its effect on eye disease in a population-based study of diabetic retinopathy in Wisconsin. Eye color was determined by comparing the iris in a red reflex photograph with standard photographs. In younger-onset diabetic persons (N = 996), macular edema was more prevalent in persons with blue or grey eyes (12%) compared with intermediate (9%) or brown (6%) (P = 0.04). Cataracts were more prevalent in blue or grey eyes (32%) compared with intermediate (22%) or brown (20%) in the younger-onset group (P less than 0.001). In older-onset persons (N = 1370), intraocular pressure (IOP) was higher in persons with brown eyes (17.8 mmHg) compared with blue or grey (17.1 mmHg) or intermediate (16.6 mmHg) (P = 0.012). Eye color was not associated significantly with diabetic retinopathy in either the younger- or older-onset group or with age-related macular degeneration or glaucoma in the older-onset group.

Adult↗

PubMed1987

Glycosylated hemoglobin in a population-based study of diabetes.

Glycosylated hemoglobin was measured in persons who participated in a population-based study of diabetic retinopathy in southern Wisconsin. There were 996 persons who were diagnosed prior to 30 years of age and who were taking insulin (younger onset), and 1,370 persons who were diagnosed at 30 years of age or older (older onset) who were examined from 1980-1982. Glycosylated hemoglobin was measured using a microcolumn technique. Mean glycosylated hemoglobin was highest in younger onset persons (10.9%), and lowest in older onset persons not taking insulin (9.0%). Only a small percentage of values for the diabetic persons fell within the range of values found in a nondiabetic comparison group. Mean glycosylated hemoglobin was found to be associated with retinopathy status but not with proteinuria.

Adolescent↗

PubMed1986

The incidence of acute hospital-treated eye injuries.

Little information is available on the incidence and severity of eye injuries despite the disfigurement and vision loss they cause. From a population-based study in Dane County, Wisconsin, the incidence of acute hospital-treated eye injuries was 423/100,000 residents in 1979. The most common causes of eye injuries were assaults, work-related events, sports and recreational activities, motor vehicle crashes, and falls. Consumer products were involved in almost 70% (9/13) of severe eye injuries classified as severe. Injuries from fireworks were not found at all in this population. Implementing known strategies for eye injury prevention would substantially reduce their incidence. These include requiring certified eye protectors at workplaces and in sports activities whenever possible rather than making their use voluntary. For the preponderance of eye injuries, however, modifying potentially hazardous consumer products, including the interior of passenger cars, will be necessary.

Acute Disease↗

PubMed1986

An alternative method of grading diabetic retinopathy.

The purpose of this report is to present a system for grading the severity of diabetic retinopathy that is a rapid, relatively inexpensive, and standardized alternative to the more detailed Early Treatment Diabetic Retinopathy Study (ETDRS) system; present data on its reproducibility; and compare it to the detailed ETDRS grading system. The alternative system was used to grade fundus photographs obtained during a large prevalence study, the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). The alternative method involved grading seven stereoscopic standard fields as a whole, and assigning a level of severity for the eye according to the greatest degree of retinopathy using a modified Airlie House Classification scheme. Using an eight-level classification system of increasing severity of retinopathy, there was 78.3% exact agreement between the alternative and ETDRS systems. A grader regraded all 503 disagreements, and was in exact agreement 49.3% of the time with the alternative system, 35.7% of the time with the detailed system, and 15.0% with neither the alternative or detailed systems. Interobserver agreement for the alternative system was 78.5%; intraobserver agreement over a 9 month to 1 year period was 90.0% for grader 1 and 84.0% for grader 2. The alternative system of grading, when used by experienced graders, is a reproducible method for objectively determining retinopathy status in epidemiologic studies.

Diabetic Retinopathy↗

PubMed1986

The validity of a survey question to study diabetic retinopathy.

This report presents the results of a comparison between information obtained from response to the question "Have you been told that the diabetes has affected the back of your eyes, that is, the retina?" and the determination of the severity of retinopathy by grading of stereoscopic fundus photographs. Both "younger onset" (n = 996) and "older onset" (n = 1,370) persons who participated in a large population-based study of diabetic persons in southern Wisconsin from 1980-1982 were included. For the younger onset persons, 31.1% responded positively, while 70.7% were found to have retinopathy. The sensitivity of the questionnaire response varied from 17.8% for persons with mild nonproliferative retinopathy to 81.9% for persons with proliferative retinopathy. The specificity was 97.3%. For the older onset persons, 14.9% responded positively, while 54.2% were found to have retinopathy. The sensitivity of the question varied from 9.9% for persons with mild nonproliferative retinopathy to 68.7% for persons with proliferative retinopathy. The specificity was 93.3%. The question used in this survey provides a highly specific measure of prevalence; it is most sensitive for proliferative retinopathy.

Adult↗

PubMed1985

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. A comparison of retinopathy in younger and older onset diabetic persons.

In a population-based survey of diabetic persons, retinopathy was detected by stereoscopic color fundus photography in 70% of persons under 30 years of age at diagnosis and taking insulin (Group YO), in 62% of persons 30 years of age or older at diagnosis and taking insulin (Group OO-I) and in 36% of persons 30 years of age or older at diagnosis not taking insulin (Group OO-N). The mean duration of known diabetes was 14.6 years in Group YO, 11.0 years in Group OO-I and 6.9 years in Group OO-N. After 20 years of diabetes, proliferative retinopathy was present in about 50% of Group YO, about 25% of Group OO-I and about 5% of Group OO-N. After 15 years of diabetes, macular edema was present in about 18% of Group YO, about 20% of Group OO-I and about 12% of Group OO-N. When present, macular edema tended to be associated with more hard exudate in Group OO-N.

Adult↗

PubMed1985

Prevalence of cataracts in a population-based study of persons with diabetes mellitus.

Persons with diabetes mellitus have been found to be at increased risk of developing cataracts when compared with nondiabetic persons. This report describes the study of characteristics which may be related to this problem in a population-based sample of diabetic persons. Prevalence of surgical aphakia and cataract increased with increasing age in both younger and older onset diabetic persons. Females had higher rates than males. In multivariate analyses, for younger onset persons, longer duration of diabetes, older age at examination, increased severity of retinopathy, diuretic usage and higher glycosylated hemoglobin levels were significantly associated with greater prevalence of cataract. In older onset persons, age at examination, increased severity of retinopathy, diuretic usage, lower intraocular pressure, smoking and lower diastolic blood pressure were significantly associated with greater prevalence of cataract. Longitudinal data concerning the relationship of some of these characteristics to subsequent development or progression of cataract are necessary before considering the possibility of preventive trials in this condition.

Adolescent↗

PubMed1985

Diabetic retinopathy as detected using ophthalmoscopy, a nonmydriatic camera and a standard fundus camera.

The study was performed to evaluate whether the severity of diabetic retinopathy as assessed by three alternative methods was concordant with the severity of retinopathy as determined from 30 degrees stereoscopic photographs. The three methods were direct ophthalmoscopy through an undilated pupil, nonstereoscopic 45 degrees retinal photography through a pharmacologically undilated pupil and nonstereoscopic 45 degrees photography through a dilated pupil. A single 45 degrees photograph centered between the disc and fovea was taken and direct ophthalmoscopy was performed on 99 persons prior to pharmacological dilation of the pupil. After dilation, another 45 degrees photograph was taken of the same field, as well as 30 degrees stereoscopic color photographs of DRS fields 1, 2 and 4 (modified). Corresponding photographic fields were graded by masked, trained graders for the severity of retinopathy and for the presence of specified diabetic lesions using the Modified Airlie House Classification scheme. For three levels of severity of retinopathy (none, nonproliferative or proliferative) exact agreement between direct ophthalmoscopy and grading of retinopathy from stereoscopic photographs taken with the standard 30 degrees camera was 54.3% (n = 94). For four levels of severity of retinopathy (none, microaneurysms only, all other nonproliferative retinopathy and proliferative retinopathy), exact agreement between gradings of retinopathy of the 45 degrees photographs taken through undilated pupils and 30 degrees photographs taken through dilated pupils was 82.5% (n = 63); and for 45 degrees photographs and 30 degrees photographs taken through dilated pupils it was 86.5% (n = 74). These data suggest that 45 degrees nonstereoscopic fundus photographs, when graded according to a standard classification scheme, provide reasonably reliable photographic representation of the severity of retinopathy when broad overall categories are used.

Adolescent↗

PubMed1985

Quantitation of optic disc cupping.

In population-based studies and in clinical practice a reliable, objective measure of optic disc cupping is needed. This measure is of special importance when following patients with diagnosed or suspected glaucoma. We have developed a new system using stereoscopic fundus photographs for quantitating optic disc cupping from these photographs. Measurements of the cup are based on cup contour. For this system, measurements of longest and shortest cup and longest and shortest disc diameters by two observers were highly correlated, with correlation coefficients of 0.88, 0.88, 0.77, and 0.82, respectively. Mean cup to disc ratios for long and short disc diameters were within 0.04 (n = 330) between the two observers. The measurements show a high degree of inter- and intra-observer reliability, and are inexpensive in time and materials to perform. This method is well suited to population-based studies.

Diabetes Mellitus↗