PHOTOGRAPHIC DETECTION OF RETINOPATHY IN INSULIN-TREATED DIABETES - APOPULATION STUDY IN THE CITY OF TARTU, ESTONIA

Purpose: To perform a cross-sectional baseline investigation of diabet ic retinopathy prevalence and metabolic control. Methods: Using a regi ster of insulin-dependent diabetes mellitus in Tartu (pop, 104, 791), 175 patients were invited to fundus photography; 149 (89%) participate d, 99 of them diagnosed with diabetes before the age of thirty. Four K odachrome 64 photographs per eye were taken with a Canon CR4 - 45NM ca mera through tropicamide-dilated pupils; slides were projected and sys tematically graded. Capillary blood samples (n = 132) for HbA(1c) dete rmination were mailed on filter paper. Following cysteine buffer eluti on, Mono S ion exchange chromatography was performed (reference range 3.7 to 5.3%). Results: Any diabetic retinopathy was found in 114 patie nts (76.5%; 95% confidence interval, CI, 70 to 83%); mild to moderate non-proliferative retinopathy in 59 (40%; 95% CI 32 to 48%); severe no n-proliferative retinopathy in 29 (19.5%; 95% CI 13 to 26%); prolifera tive retinopathy in 26 (17%; 95% CI 11 to 24%); 47 patients (32%) need ed laser photocoagulation. Vitreous haemorrhage was observed in 9 (6%) of subjects. In patients diagnosed with diabetes before the age of 30 years, prevalence of any retinopathy was 82% (95% CI 73 to 89%) and o f proliferative retinopathy 23% (95% CI 15 to 33%). Median HbA(1c) was 9.7% for women and 8.6% for men (95% CI for difference 0.7 to 2.1%). Conclusion: Retinopathy prevalences (76-82%) are the highest reported from population-based studies. Glycaemia levels were very high and sho uld be gradually lowered, Methods capable of validation can be success fully introduced for population-based assessment of hyperglycaemia and retinopathy prevalences.