CLINICALLY SIGNIFICANT MACULAR EDEMA IN TYPE-I DIABETES - INCIDENCE AND RISK FACTORS

Purpose: To examine incidence of and risk factors for clinically signi ficant macular edema in persons with type I diabetes. Methods: a group of 189 persons with type I deabetes, recruited from a summer camp for children with diabetes and from practices of local physicians, were p articipants in a longitudinal study with annual follow-up visits which included physical and ophthalmologic examinations and color stereo fu ndus photographs of each eye, centered on the disc and macula. Subject s were free of proliferative retinopathy at study baseline. Ages range d from 3 to 40 years, duration of diabetes ranged from 0 to 12 years, mean glycosylated hemoglobin (Hgb a1c) was 12.25 (range, 6.4%-21.5%), and average follow-up was 6.1 years. Presence of clinically significan t macular edema was defined as in the Early Treatment Diabetic Retinop athy Study. Results: In a total of 41 persons (62 eyes), clinically si gnificant macular edema developed during study follow-up. Cumulative r isk of clinically significant macular edema was 0 until 7 years' durat ion of diabetes. The cumulative risk of clinically significant macular edema increased linearly for each year of duration between 10 and 20 years, with an average annual increase of approximately 6.7%. Signific ant risk factors for clinically significant macular edema were older a ge at diagnosis, male sex, and higher Ggb a1c level. Systolic and dias tolic blood pressure, proteinurea, body mass index, race, initial pres ence of retinopathy, and use of antihypertensives did not significantl y affect the risk of clinically significant macular edema. Conclusion: Older age at diagnosis of diabetes, male sex, and higher Hgb A1c leve ls (poorer control of blood glycemic levels) significantly increase th e risk of clinically significant macular edema in persons with type I diabetes. These data extend the evidence implication worse glycemic co ntrol as a cause of clinically significant macular edema, even within a population with relatively loose control.