Aura Falck

Prevalence and risk factors of retinopathy in children with diabetes A population-based study on Finnish children

Abstract. The prevalence of retinopathy in children with insulin‐dependent diabetes mellitus (IDDM) was studied in a population‐based survey on 194 of the 216 subjects (89.8%) with IDDM aged 4.6 to 16.6 years living in the county of Oulu, Finland. The diagnosis of retinopathy was based on fundus photography. The median age of the children was 12.2 years and the median duration of diabetes 4.5 years (range 0–14.2 years). Retinopathy was found in 21 (10.8%) of cases. All of the changes seen were mild and did not require treatment. All the children with retinopathy were pubertal or postpubertal, and an association was found between the presence of retinopathy and the long‐term diabetes control, duration of diabetes, age and albuminuria. Logistic regression analysis showed increasing duration of diabetes, puberty and elevated blood glycated haemoglobin to be the main risk factors explaining the occurrence of retinopathy. In patients aged 13–16 years retinopathy was also related to female sex and diastolic blood pressure, but in logistic regression analysis duration of diabetes and glycated haemoglobin were the best predictors.

Marked reductions in visual impairment due to diabetic retinopathy achieved by efficient screening and timely treatment

Diabetic retinopathy (DR) is the most common complication of diabetes and needs to be diagnosed early to prevent severe sight‐threatening retinopathy. Digital photography with telemedicine connections is a novel way to deliver cost‐effective, accessible screening to remote areas. Screening for DR in a mobile eye examination unit (EyeMo) is compared to traditional service models (i.e. local municipal services or a commercial service provider). The quality of images, delays from screening to treatment, the stage of DR, coverage of screening and the rate of visual impairment due to DR are evaluated.

Genetic Markers in Early Diabetic Retinopathy of Adolescents With Type I Diabetes

The aim of this study was to evaluate the role of HLA (human leucocyte antigen) class I (A, B, C) and class II (DR) alleles and familial insulin-dependent diabetes mellitus as possible risk markers for early retinopathy in a population of 103 Finnish adolescents with type I diabetes mellitus for 3.6-16.2 years. Fifty-one of the patients (49.5%) had signs of retinopathy in fundus photographs. HLA DR1 was found in 31% of the subjects with retinopathy, but in only 5% of those without retinopathy (p = 0.02). The corresponding figures for HLA DR1/4 were 17% and 2.6%, respectively (p = 0.22). The frequency of HLA DR3, DR4, or DR3/4 heterozygosity did not differ between the two groups of patients. Signs of early retinopathy showed thus an association with the presence of the HLA DR1 allele, and a mild protective effect of the HLA A9 and B40 alleles was indicated. Other HLA A, B, C, or DR alleles did not have any effect on the risk for early development of retinopathy, neither had a positive family history of type I diabetes.

A prospective, longitudinal study examining the development of retinopathy in children with diabetes

A prospective longitudinal study of 182 children and adolescents with diabetes revealed that during a follow‐up of 2.5 ± 0.5 years the prevalence of retinopathy increased from 10.8% to 28.0%, corresponding to an annual increase of 7%. Retinopathy was diagnosed at a mean age of 15.3 years (95% CI, 14.8–15.8 years) after a mean duration of diabetes of 8.9 years (95% CI, 8.0 9.7 years). Prepubertal years of diabetes contributed to the risk of developing retinopathy. The initial signs of retinopathy were microaneurysm(s) in 56%, microaneurysm(s) and haemorrhage(s) in 30%, and haemorrhage(s) in 10%. A combination of microaneurysm, haemorrhage and cotton‐wool spot was observed in 2%, and microaneurysms, haemorrhage and an IRMA lesion were seen in 2%. Most of the initial lesions disappeared during the follow‐up period, but at the same time new lesions developed elsewhere in the retina in all but 2 cases. In 8 patients (15% of patients with retinopathy) aged 13.7 19.8 years and having had diabetes for 3.7–14.8 years, retinal changes progressed from mild to a more advanced background retinopathy. A higher glycated haemoglobin level during puberty was the only factor which differentiated these patients from control patients matched for sex, age, puberty and duration of diabetes.

Prevalence of retinopathy in Finnish children and adolescents with type 1 diabetes: a cross-sectional population-based retrospective study

Aim A population-based study was carried out to evaluate the prevalence and risk factors of diabetic retinopathy (DR) in children with type 1 diabetes (T1D) in The Northern Osthrobothnia Hospital District, Finland. The aim was to compare the current prevalence and the risk factors with those obtained in a study performed in a similar setting 17 years earlier. Methods and patients The prevalence of DR was evaluated from fundus photographs in a cross-sectional manner in children and adolescents with T1D (n=297) living in the Northern Osthrobothnia Hospital District on 1 January 2007. Results The prevalence of DR was 7.6% (12/158) in males and 16.5% (23/139) in females in the present study and 7.3% in males and 12.9% in females in the former study. The mean age of the patients was 11.9 and 11.8 years, and the mean duration of diabetes was 4.9 and 5.0 years in the present and the former study, respectively. DR was associated with older age (p<0.001), longer duration of diabetes (p<0.001), higher glycated haemoglobin A1c (GHbA1c) (9.3% in those with DR vs 8.3% in those without DR, p=0.001, or 78 vs 67 mmol/mol, respectively) and female sex (p=0.016); in a logistic regression analysis, these factors explained 35% of DR. These risk factors are essentially the same as identified in the cohort 17 years earlier. GHbA1c levels had not significantly improved during that time. Conclusions The overall prevalence of DR among children with T1D was 11.8% (35/297) showing no decrease over the past 17 years; in girls, DR was diagnosed more often in the present than in the former study, but there was no change in the prevalence among the boys. Glycaemic control had remained unchanged.

The sensitivity and specificity of Heidelberg Retina Tomograph parameters to glaucomatous progression in disc photographs

Aim: To determine the sensitivity and specificity of the stereometric optic nerve head (ONH) parameters of the Heidelberg Retina Tomograph (HRT) to detect an event of progression verified in serial stereoscopic ONH photography. Methods: A retrospective study of 476 eyes of 342 patients with more than 18 months of follow-up with successful stereoscopic ONH photography was conducted. All eyes had good-quality HRT examinations with perfect image alignment. 51 (11%) eyes showed progression in the stereoscopic ONH photographs between visits. The photographs were evaluated by experienced masked observers, whose interobserver agreement (kappa) varied between 0.403 and 0.510. Results: The change in most (13/22) of the stereometric ONH parameters showed a statistically significant correlation with progression. The parameter with the best correlation for progression (p<0.0005) was the cup:disc area ratio. The parameter with the largest area under the receiver operating characteristics curve (0.726) was the vertical cup:disc ratio. The linear discriminant function with the best correlation with progression was [(12.241×cup:disc area ratio)+(3.540×mean cup depth)−(2.146×horizontal cup:disc ratio)+(27.486×average variability)]. An optimised change in the linear discriminant function value was 0.34 with a 65% sensitivity and a 69% specificity for progression. Conclusions: Despite good image quality, the change in the stereometric ONH parameters did not have a high sensitivity and specificity for progression detected with photographs. This indicates that the evaluation of glaucomatous progression in the ONH should not rely solely on the stereometric parameters of the HRT.

The Pyhäjärvi Cataract Study. I. Study design, baseline characteristics and the demand for cataract surgery

Purpose:  The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland.

Health-related quality of life – using the 15D instrument – of young adults with type 1 diabetes since childhood. Population-based Oulu cohort study of diabetic retinopathy

Purpose:  The aim of this study was to evaluate the health‐related quality of life (HRQoL) of young adults with type 1 diabetes (T1D) since childhood using the 15D instrument. The possible impact of diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) on the HRQoL was focused on.

A four-year prospective study on intraocular pressure in relation to phacoemulsification cataract surgery.

Aim of study:  To follow up prospectively the intraocular pressure (IOP) of healthy eyes with senile cataract undergoing phacoemulsification surgery over a duration of 4 years.

Prevalence of diabetic retinopathy in young adults with type 1 diabetes since childhood: the Oulu cohort study of diabetic retinopathy

To evaluate the prevalence and stage of diabetic retinopathy (DR) in a population‐based cohort of young Finnish adults who have had type 1 diabetes (T1D) since childhood.