Biomedical subjects

B E Klein

Publications and source records attributed to B E Klein.

At least 145 records · Page 8Linked to original sources

PubMed1995

The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity.

PURPOSE: To investigate the relationship of age-related maculopathy, cataract, and glaucoma to visual acuity in the population-based Beaver Dam Eye Study. METHODS: A cross-sectional, population-based study was performed in people 43 through 86 years of age residing in Beaver Dam, Wisconsin, who were identified between 1987 and 1988 and examined (n = 4926) between 1988 and 1990. Of those who participated, 99.4% were white. Visual acuity was measured (n = 4886) using a modification of the Early Treatment Diabetic Retinopathy Study protocol. Stereoscopic color fundus photographs and slit lamp and retroillumination photographs of the lens were graded in a masked fashion using standardized protocols to determine the presence of age-related maculopathy and central cataract. RESULTS: Fifty-seven percent of those who were legally blind had late age-related maculopathy in both eyes. The frequency of visual acuity of 20/200 or worse was not significantly different in eyes with exudative macular degeneration (48%) than in eyes with pure geographic atrophy (42%). While controlling for other factors (age, central cataract, and glaucoma) in participants with both gradable age-related maculopathy and visual acuity measurable in at least one eye (n = 4716), investigators found that each of the early age-related maculopathy lesions was associated with a decrease in visual acuity of approximately two letters or fewer when compared to eyes without these lesions. Late age-related maculopathy was associated with a decrease of approximately seven lines of letters read correctly. CONCLUSION: These data demonstrate that exudative macular degeneration and pure geographic atrophy are the most important causes of legal blindness in this population and that early age-related maculopathy, central cataract, and glaucoma had a small effect on visual acuity.

Adult↗

PubMed1995

Evidence for a major gene for cortical cataract.

PURPOSE: To examine the possible presence of a major gene determining susceptibility to cortical cataract. METHODS: The percentage of the lens area involved with cortical opacity, summed over both eyes, was evaluated in 1275 individuals from the Beaver Dam Eye Study. After adjusting for the effects of age and sex, these measures of cortical cataract were subjected to sibling correlational analysis, commingling analysis, and segregation analysis. The Box and Cox power transformation was applied to the data for the commingling and segregation analyses. Using regressive models, four modes of transmission were examined, and under each mode three hypotheses and a general model were fitted by maximum likelihood and compared. RESULTS: Sister-sister and brother-brother correlations of the adjusted measures of cortical cataract are significant and similar; the brother-sister correlation is not significantly different either from these correlations or from zero. Two commingled distributions give the best fit to the data, especially after power transformation. Under each of four modes of transmission, the hypothesis that best fits the data is one in which there are only two distributions (and, hence, dominance under mendelian transmission), the power transformation parameter is fixed at the estimate obtained from commingling analysis, and there is residual sibling correlation. The data thus suggest the existence of a major effect for cortical cataract. Random environmental influences can be rejected as a cause of this major effect. Our analysis indicates the existence of a significant effect of sex on the residual variance. Allowing for this, the data suggest transmission of a single major gene, though this may not be the sole cause of the commingled distributions. CONCLUSIONS: Assuming a common variance for the two sexes, a single major gene can account for 58% of the variability of age- and sex-adjusted measures of cortical cataract. With the variance sex dependent, a major gene can account for 75% and 45% of the total variability among males and females, respectively.

Adult↗

PubMed1995

Serum carotenoids and tocopherols and severity of nuclear and cortical opacities.

PURPOSE: To determine whether higher levels of individual carotenoids and tocopherols in the serum are related to less severe nuclear and cortical opacities within the general population. METHODS: Levels of individual carotenoids and tocopherols in the serum were determined in 400 randomly selected persons aged 50 to 84 years participating in the Nutritional Factors in Eye Disease Study of Beaver Dam, Wisconsin. Severity of nuclear and cortical opacities was assessed from lens slit lamp and retroillumination photographs taken at the same time. Relationships between serum levels of nutrients and prevalence of these opacities were evaluated using logistic regression analysis accounting for known possible confounders. RESULTS: Higher levels of individual or total carotenoids or alpha-tocopherol in the serum were not associated with less severe nuclear or cortical opacities overall. However, associations differed between men and women and within specific population subgroups. A significant trend for lower odds for either type of opacity with increasing levels of beta-carotene in the serum was observed in men. For nuclear sclerosis, this protective association with beta-carotene was found in younger but not older men. Higher levels of three other carotenoids (alpha-carotene, beta-cryptoxanthin, and lutein) in serum were significantly related to lower odds for nuclear sclerosis only in men who smoked. In contrast to these inverse associations observed in some subgroups, higher levels of some carotenoids and alpha-tocopherol often were directly associated with nuclear sclerosis, particularly in women. CONCLUSIONS: Higher levels of carotenoids and tocopherols are not consistently associated with less severe opacities in the general population.

Aged↗

PubMed1994

The association of glycemia and cause-specific mortality in a diabetic population.

BACKGROUND: The purpose of this study was to investigate the association of glycemia with cause-specific mortality in a diabetic population. METHODS: The study was a cohort design based in a primary care setting. Participants were all younger-onset diabetic persons (conditions diagnosed when they were younger than 30 years old and taking insulin, N = 1210) and a random sample of older-onset diabetic persons (conditions diagnosed when they were 30 years or older, N = 1780). Glycosylated hemoglobin levels were obtained at baseline examinations in 1980 to 1982 in which 996 younger-onset and 1370 older-onset persons participated. Median follow-up was 10 years in younger-onset and 8.3 years in older-onset persons; four younger-onset and two older-onset persons were unavailable for follow-up. The main outcome measure was cause-specific mortality as determined from death certificates. RESULTS: In the younger-onset group after controlling for other risk factors in proportional hazards models and considering underlying cause of death, glycosylated hemoglobin was significantly associated with mortality from diabetes (hazard ratio [HR] for a 1% change in glycosylated hemoglobin, 1.25; 95% confidence interval [CI], 1.13 to 1.38) and ischemic heart disease (HR, 1.18; 95% CI, 1.00 to 1.40). In the older-onset group, glycosylated hemoglobin was significantly associated with mortality from diabetes (HR, 1.32; 95% CI, 1.21 to 1.43), ischemic heart disease (HR, 1.10; 95% CI, 1.04 to 1.17), and stroke (HR, 1.17; 95% CI, 1.05 to 1.30), but not cancer (HR, 0.99; 95% CI, 0.88 to 1.10). Results for any mention of specific causes of death were similar. CONCLUSION: These results suggest possible benefit to the control of glycemia with respect to death due to vascular disease and diabetes.

Adolescent↗

PubMed1994

Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy.

BACKGROUND: The object was to examine the relationship of hyperglycemia, as measured by glycosylated hemoglobin level, to the incidence and progression of diabetic retinopathy over a 10-year period. METHODS: Patients who were younger (n = 682) and older (n = 834) than 30 years at onset of diabetes participated in baseline (1980-1982) and follow-up (1984-1986 and 1990-1992) examinations of a population-based cohort study. Glycosylated hemoglobin levels were measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. RESULTS: Persons with glycosylated hemoglobin levels in the highest quartile at baseline were more likely to have progression of retinopathy than persons with levels in the lowest quartile (younger-onset group: relative risk [RR], 2.9; 95% confidence interval [CI], 2.3 to 3.5; older-onset group taking insulin: RR, 2.1; 95% CI, 1.6 to 2.8; and older-onset group not taking insulin: RR, 4.3; 95% CI, 3.0 to 6.2) and were more likely to develop proliferative diabetic retinopathy (younger-onset group: RR, 7.1; 95% CI, 4.6 to 11.1; older-onset group taking insulin: RR, 3.1; 95% CI, 1.5 to 6.1; and older-onset group not taking insulin: RR, 13.8; 95% CI, 4.8 to 39.5). These relations were significant (P < .005) in all groups examined, even after controlling for other risk variables. CONCLUSIONS: These data are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long-term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the course of disease in people with both younger- and older-onset diabetes.

Adult↗

PubMed1994

Is there evidence of an estrogen effect on age-related lens opacities? The Beaver Dam Eye Study.

OBJECTIVE: To evaluate a possible association between estrogen and lens opacities. DESIGN: A prevalence survey of age-related eye disease. SETTING: Beaver Dam, Wis. PARTICIPANTS: A total community sample of persons 43 through 84 years of age at the time of a private census were recruited for examination, medical history, and photographs of the lenses of the eyes. Data from women are included in this report. MAIN OUTCOME MEASURES: Photographs were graded by protocol for the presence and severity of age-related lens opacities. RESULTS: Current use of postmenopausal estrogens was associated with a decreased risk of more severe nuclear sclerosis. Younger age at menarche was also associated with a protective effect regarding nuclear sclerosis. Older age at menopause was associated with a decreased risk of cortical opacities. CONCLUSION: These data are suggestive of a modest protective effect of estrogen exposure on the lenses of women. Further evaluation of this may be possible in studies currently under way in which postmenopausal estrogens are being tested for other (protective) effects.

Adult↗

PubMed1994

Hypertension and retinopathy, arteriolar narrowing, and arteriovenous nicking in a population.

OBJECTIVE: To investigate the relationship of various retinal lesions to systemic hypertension in the population-based Beaver Dam Eye Study. DESIGN: In this cross-sectional population-based study, blood pressure was measured using standardized protocols. Using standardized protocols, stereoscopic color fundus photographs were graded in a masked fashion to determine the presence of retinopathy (defined as retinal microaneurysms only, blot hemorrhages only, hemorrhages and/or microaneurysms, cotton-wool spots, hard exudates, intraretinal microvascular abnormalities, venous beading, and retinal new vessels), retinal arteriolar narrowing, and arteriovenous nicking. PARTICIPANTS: Subjects aged 43 through 84 years who lived in Beaver Dam, Wis, between 1987 and 1988 were examined between 1988 and 1990. People with diabetes or retinal vascular occlusions were excluded. RESULTS: Retinopathy was present in 336 subjects (7.8%), arteriolar narrowing in 582 subjects (13.5%), and arteriovenous nicking in 95 subjects (2.2%) in the nondiabetic population. Hypertension was associated with increased frequency of retinopathy, arteriolar narrowing, and arteriovenous nicking. After adjusting for age, hypertension was associated with the presence of retinopathy (in men: relative risk [RR], 1.47; 95% confidence interval [CI], 1.10 to 1.96; in women: RR, 1.69; 95% CI, 1.26 to 2.27), arteriolar narrowing (in men: RR, 1.34; 95% CI, 1.03 to 1.74; in women: RR, 1.37; 95% CI, 1.14 to 1.64), and arteriovenous nicking (in men: RR, 1.87; 95% CI, 0.99 to 3.54; in women: RR, 1.65; 95% CI, 1.00 to 2.73). Retinopathy, arteriolar narrowing, and arteriovenous nicking were more frequent in those subjects whose blood pressure was elevated despite use of antihypertensive medications compared with those subjects whose blood pressure was controlled with antihypertensive medications or those who were normotensive. CONCLUSIONS: These data suggest that retinopathy and retinal arteriolar narrowing are common in people with hypertension. Further longitudinal study is necessary to evaluate the public health significance of these retinal lesions regarding possibly increased risk of renal and cardiovascular disease.

Adult↗

PubMed1994

Is age-related maculopathy associated with cataracts?

OBJECTIVE: To evaluate the relationship between three types of cataract or cataract surgery and age-related maculopathy. DESIGN: Population-based prevalence study. PARTICIPANTS: A total of 4926 people participating in The Beaver Dam Eye Study from 1988 through 1990. MAIN OUTCOME MEASURES: Grading of photographs for nuclear sclerosis, cortical cataract, and posterior subcapsular cataract and signs of age-related maculopathy was performed using standardized protocols. RESULTS: After adjusting for other risk factors, nuclear sclerosis was associated with increased odds of early age-related maculopathy (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.28 to 3.01) but not of late age-related maculopathy (OR, 1.38; 95% CI, 0.52 to 3.63). Neither cortical nor posterior subcapsular cataracts were related to age-related maculopathy. There were increased odds of early age-related maculopathy in eyes that had undergone cataract surgery. CONCLUSION: These data suggest a possible commonly shared pathogenesis between nuclear sclerotic cataract and age-related maculopathy.

Adult↗

PubMed1994

The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy.

OBJECTIVE: To examine the 10-year incidence and progression of diabetic retinopathy. DESIGN: Population-based incidence study. PARTICIPANTS: Seven hundred sixty-five insulin-taking diabetic persons diagnosed before age 30 years, 251 insulin-taking diabetic persons diagnosed at age 30 years or older, and 282 non-insulin-taking diabetic persons diagnosed at age 30 years or older who participated in baseline, 4-year, and 10-year follow-up examinations. MAIN OUTCOME MEASURES: The 10-year incidence of any retinopathy, progression of retinopathy, and progression to proliferative retinopathy were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study severity scheme. RESULTS: The 10-year incidence of retinopathy (89%, 79%, and 67%), progression of retinopathy (76%, 69%, and 53%), and progression to proliferative retinopathy (30%, 24%, and 10%) were highest in the group diagnosed before age 30 years, intermediate in the insulin-taking group diagnosed at age 30 years or older, and lowest in the non-insulin-taking group, respectively. Increased risk of proliferative retinopathy was associated with more severe retinopathy at baseline. CONCLUSIONS: These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progression of diabetic retinopathy during the 10-year study period.

Adolescent↗

PubMed1994

Sibling correlations and segregation analysis of age-related maculopathy: the Beaver Dam Eye Study.

Sibling correlations were evaluated and segregation analysis was performed on age-dependent maculopathy scores of the right and left eyes of individuals from 564 families in the Beaver Dam Eye study. There is evidence of significant sibling correlations. The data fit a mixture of two normal distributions, especially after undergoing the Box and Cox power transformation. In each eye, the hypothesis of mendelian transmission of a major effect cannot be rejected under the tau AB free model, but is rejected under the tau's free model. The hypothesis of a random environmental major effect is rejected. Similar major gene parameter estimates are found for both eyes. The results are consistent with a major effect accounting for 62% and 59%, in the right and left eyes, respectively, of the determination of age-related maculopathy scores. A single major gene can account for about 89% and 97% of this variability due to a major effect, or for about 55% and 57% of the total variability, in the right and left eyes, respectively.

Adult↗

PubMed1994

The relation of socioeconomic factors to age-related cataract, maculopathy, and impaired vision. The Beaver Dam Eye Study.

PURPOSE: To investigate the relations between socioeconomic factors and the prevalence of age-related cataract, maculopathy, and visual impairment. METHODS: A population-based sample of 4926 people 43 to 86 years of age was examined from 1988 to 1990. Education, income, employment status, marital status, nuclear sclerosis, cortical, and posterior subcapsular cataract, age-related maculopathy, and impaired vision were all ascertained using standard protocols. RESULTS: While controlling for age, sex, diabetes status, multivitamin use, alcohol consumption, and cigarette smoking, less education was significantly associated with nuclear and cortical cataract, and lower income was significantly associated with cortical and posterior subcapsular cataract and impaired vision. There was a "U-shaped" relation between income and cataract surgery. Neither income nor education was related to age-related maculopathy. There was no relation of marital status to cataract status or age-related maculopathy. CONCLUSION: These data suggest that education and income are associated with cataract, cataract surgery, and impaired vision. These relations were not explained by other risk factors measured in the study.

Adult↗

PubMed1994

The association of alcohol consumption with the incidence and progression of diabetic retinopathy.

PURPOSE: To investigate the association of alcohol consumption with the incidence and progression of diabetic retinopathy. METHODS: The population consisted of a cohort of adult younger-onset (diagnosis received before 30 years of age and taking insulin, n = 439) and older-onset (diagnosis received after 30 years of age, n = 478) persons with diabetes examined from 1984 to 1986 and again from 1990 to 1992. The outcomes were incidence of retinopathy, progression, and progression to proliferative retinopathy. Retinopathy was determined by grading of stereoscopic color fundus photographs. Alcohol consumption was determined by questionnaire and summarized as average or recent consumption. The proportion of heavier drinkers was small, 6% of younger-onset and 4% of older-onset persons. RESULTS: In the younger-onset group, progression of retinopathy occurred in 62%, 51%, 61%, and 71% of nondrinkers, light, moderate, and heavier drinkers, respectively, based on average intake (P = 0.28). Based on recent intake, 55%, 46%, 63%, and 69% of nondrinkers, light, moderate, and heavier drinkers, respectively, progressed (P = 0.10). A similar trend is seen for incidence of retinopathy, but the sample sizes are small. No association is seen with progression to proliferative diabetic retinopathy. After controlling for age, sex, and glycemia in a logistic regression model, alcohol intake is not associated with progression of retinopathy. In the older-onset group, alcohol intake is not related to the incidence or progression of retinopathy. CONCLUSION: Alcohol consumption in moderation (< or = 1 oz/day) does not appear to affect the occurrence of diabetic retinopathy.

Adult↗

PubMed1994

Open-angle glaucoma and older-onset diabetes. The Beaver Dam Eye Study.

PURPOSE: To evaluate the relation of older-onset diabetes to open-angle glaucoma. METHODS: During a population-based study of age-related eye disease (n = 4926), participants were evaluated for the presence of glaucoma. Glycosylated hemoglobin levels were measured, and a medical history was obtained. RESULTS: Rates of persons meeting optic disc, visual field, and intraocular pressure criteria for definite glaucoma were more common in those with older-onset diabetes than in those without (4.2% versus 2.0%; P = 0.004). When persons with a history of treated glaucoma, despite whether they met the other criteria for glaucoma, were included, rates were 7.8% in those with diabetes compared with 3.9% in those without diabetes (P = 0.0005). CONCLUSIONS: The presence of open-angle glaucoma is increased in people with older-onset diabetes.

Adult↗

PubMed1994

The influence of combined kidney-pancreas transplantation on the progression of diabetic retinopathy. A case series.

PURPOSE: To evaluate the impact of combined kidney and pancreas transplantation on the progression of advanced diabetic retinopathy. METHODS: The changes in diabetic retinopathy severity in patients with insulin-dependent diabetes mellitus who had kidney-pancreas transplantation (n = 51) and in those who had kidney transplantation only (n = 21) were compared. Patients were invited to baseline and 1 year follow-up examinations. Fundus photographs were graded in a masked fashion using standardized protocols. RESULTS: The mean age and duration of diabetes were similar for both groups. After combined transplantation, none of the patients used insulin, and their mean glycosylated hemoglobin was significantly lower (6.4% versus 10.6%) than those who underwent only kidney transplantation. There was a nonsignificant difference in overall progression of retinopathy for combined transplantation compared with kidney transplantation only (risk ratio = 0.73; 95% confidence interval, 0.31, 1.71). CONCLUSION: The authors found no evidence that the normalization of glycemia associated with a combined kidney-pancreas transplantation in patients with advanced proliferative diabetic retinopathy (mostly treated with photocoagulation) accelerated retinopathy progression. These data suggest that the normalization of glycemia associated with a combined kidney-pancreas transplantation does not have beneficial influence on the progression of advanced diabetic retinopathy.

Adult↗

PubMed1994

Ten-year incidence of visual loss in a diabetic population.

PURPOSE: The purposes of this study are to estimate the 10-year incidence of blindness and visual loss in a diabetic population, examine risk factors for visual loss, and examine temporal trends in rates of blindness and visual loss. METHODS: The design is a population-based cohort study, which includes 891 younger-onset persons with diabetes, 485 persons with older-onset diabetes who are taking insulin, and 502 persons with older-onset diabetes who are not taking insulin and who participated in baseline, 4-year, and 10-year examinations. The main outcome measures are incidence of blindness (visual acuity, 20/200 or worse), doubling of the visual angle, and visual impairment (visual acuity, 20/40 or worse). RESULTS: The 10-year incidences of blindness were 1.8%, 4.0%, and 4.8% in persons in the younger-onset, older-onset taking insulin, and older-onset not taking insulin groups, respectively. Respective 10-year rates of visual impairment were 9.4%, 37.2%, and 23.9%. Rates for doubling of the visual angle were similar. Doubling of the visual angle was more common in women with older-onset diabetes and in persons with younger-onset and older-onset diabetes who were taking insulin and who had higher glycosylated hemoglobin or proteinuria levels. The presence of macular edema or more severe retinopathy was associated with more visual loss in all three groups. Smoking was associated with visual loss in persons with younger-onset diabetes, and systolic blood pressure was associated in persons with older-onset diabetes who were taking insulin. Rates of blindness and doubling of the visual angle decreased in persons with younger-onset diabetes in the second part of the follow-up. In the older-onset groups, only the rate of blindness declined. These decreases could not be explained entirely by treatment or mortality. CONCLUSIONS: Several modifiable risk factors are associated with loss of vision. Although visual loss is still common in this diabetic population, the incidence of blindness may be decreasing.

Adolescent↗

PubMed1994

Relation between lens opacities and vitamin and mineral supplement use.

PURPOSE: The authors evaluated the cross-sectional and longitudinal relations between lens opacities and intake of vitamins and minerals in supplements. METHODS: Type and quantity of vitamins and minerals taken currently and 10 years before interview were obtained in a population-based sample of persons in the Nutritional Factors in Eye Disease Study (n = 2152). RESULTS: In persons without diabetes, regular use of multivitamin preparations 10 years in the past was associated with decreased risk for nuclear sclerosis (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5, 0.8) and increased the risk for cortical opacities (OR, 1.6; CI, 1.1, 2.2). In persons with diabetes, past multivitamin use was not associated with nuclear sclerosis (OR, 1.1; CI, 0.4,2.7) but with decreased risk for cortical opacities (OR, 0.1; CI, 0.0, 0.9). Cross-sectional associations with current intake of supplements were weaker, but in the same direction. Multivitamin use was not cross-sectionally or longitudinally related to posterior subcapsular cataract in persons with or without diabetes. CONCLUSION: Use of vitamin supplements is longitudinally associated with nuclear and cortical opacities. However, the direction of the association is influenced by the type of opacity and diabetes status.

Adult↗

PubMed1994

Ocular factors in the incidence and progression of diabetic retinopathy.

PURPOSE: To investigate the association of intraocular pressure (IOP), ocular perfusion pressure, and myopia with the incidence and progression of diabetic retinopathy. METHODS: The design is a cohort study of a population-based sample (n = 1210) of persons with younger-onset diabetes (diagnosis was made before 30 years of age, and subjects were taking insulin) and a random sample (n = 1780) of persons with older-onset diabetes (diagnosis made after 30 years of age). Baseline and 4-year follow-up examinations were completed by 891 younger-onset and 987 older-onset persons. Retinopathy was graded from stereoscopic fundus photographs. Endpoints were incidence of retinopathy, progression of retinopathy, and progression to proliferative diabetic retinopathy (PDR). Ocular perfusion pressure was calculated from IOP and blood pressure. Myopia was a refractive error of -2 diopters or less. RESULTS: In univariate analyses, ocular perfusion pressure was associated with incidence of retinopathy (P < 0.005), progression of retinopathy (P = 0.07), and progression to PDR (P < 0.001) in the younger-onset group but not in older-onset subjects taking or not taking insulin. Intraocular pressure and myopia were not associated with any endpoint in any group. Using logistic regression to control for covariates, ocular perfusion pressure was significantly associated only with incidence of retinopathy in younger-onset persons. The odds ratio for a 10-mmHg increase in ocular perfusion pressure was 2.13 (95% confidence interval, 1.30-3.50). Also, myopia was protective for progression to PDR in younger-onset persons with an odds ratio of 0.40 (95% confidence interval, 0.18-0.86). CONCLUSIONS: These results suggest that pressure phenomena may be related to the development of retinopathy in younger-onset persons. This would have implications for treatments affecting both IOP and blood pressure.

Adult↗

PubMed1994

The relation of socioeconomic factors to the incidence of proliferative diabetic retinopathy and loss of vision.

PURPOSE: To investigate the relations between socioeconomic factors and the incidence of proliferative retinopathy and loss of vision. METHODS: A population-based sample of younger-onset persons with diabetes 25 years of age or older (n = 334) and older-onset persons with diabetes (n = 906) was followed over a 4-year period. Education, occupational status, employment status, and marital status were measured at baseline and follow-up. Main outcome measures were incidence of proliferative retinopathy and loss of vision measured using standard protocols. RESULTS: Proliferative retinopathy was more likely to develop in younger-onset women with less education than in those with more education; no relation was found in the older-onset group. Education was associated inversely with incidence of loss of vision in younger-onset women and older-onset men. CONCLUSION: These data suggest that education is associated with the development of loss of vision, independent of other risk factors. The associations vary between men and women and between younger-onset and older-onset people with diabetes. Further understanding of these relationships may lead to interventions to prevent loss of vision in people with diabetes.

Adult↗