Systemic and ocular factors influencing diabetic retinopathy
Epidemiologic studies have established that certain systemic factors have associations with incidence and progression of diabetic retinopathy (DR). These provide a foundation for treating the manifestations of diabetic retinopathy. Before an ophthalmologist considers using laser treatment, intravitreal injections, and surgery, optimizing the systemic factors that influence diabetic retinopathy is prudent.1 In general these factors apply to both genders and all races, although the strengths of the associations may vary across subgroups.2-4 Many more associations are present with univariate testing than with multivariate testing, suggesting that the information carried by these associations may be redundant across more than one factor.5 For example, hyperglycemia is associated with dyslipidemia. Thus in a study with the goal of determining the importance of dyslipidemia as a predictor of DR, it is important to analyze the data adjusting for baseline glycemic control (HbA1c) to determine if dyslipidemia is independently important as a predictive variable.6 Accordingly predictive variables found on multivariate testing are more important than those found by univariate testing. In addition, predictive factors are not always the same for different end points. For example, those factors that predict proliferative diabetic retinopathy (PDR), any diabetic retinopathy, and diabetic macular edema (DME) may be different.6,7 © 2010 Springer-Verlag New York.
- Diabetic Retinopathy: Evidence-Based Management
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International Standard Book Number 13 (ISBN-13)
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