Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006

  • Xi Wei Xie
  • Liang Xu
  • Ya Xing Wang
  • Jost B. Jonas
Retinal Disorders



To evaluate the prevalence and associated factors of diabetic retinopathy in adult Chinese with diabetes mellitus.


The Beijing Eye Study 2006 is a population-based cross-sectional study that included 3,251 (73.2%) subjects (aged 45+ years) out of 4,439 subjects originally participating in the Beijing Eye Study 2001. Diabetes defined as fasting glucose concentrations ≥7.0 mmol/L or self-reported diagnosis of diabetes was detected in 381/3,251 (12.9%) subjects. Diabetic retinopathy was defined by the presence of at least one microaneurysm in the diabetic subjects according to the Early Treatment of Diabetic Retinopathy Study (ETDRS).


Gradable fundus photographs were available for 362 (95.0%) subjects. Diabetic retinopathy was detected in 101 subjects (27.9%). Most of the diabetic retinopathy was of the mild type (74/101; 73%). Severe non-proliferative or proliferative diabetic retinopathy was present in 16 (16%) subjects, and clinically significant macular edema in four (4%) subjects. Presence of diabetic retinopathy was significantly associated with rural region (Odds ratio (OR): 3.52), duration of diabetes mellitus (OR: 1.08), fasting plasma glucose concentration (OR: 1.14), type of diabetes treatment (OR: 2.09), and marginally significantly, with hyperopic refractive error (OR: 1.13; P = 0.08). The stage of diabetic retinopathy was associated with rural region (P < 0.001), known duration of diabetes (P = 0.001), type of diabetes treatment (P = 0.001), concentrations of high-density lipoproteins (P = 0.004), and fasting glucose concentrations (P = 0.002).


Prevalence of diabetic retinopathy among adult diabetic Chinese was about 27.9%. The stage of retinopathy was mild in 75% of the subjects with diabetic retinopathy. Associated factors were diabetes duration, diabetic treatment type, low metabolic control, rural region, and marginally hyperopia.


Diabetic retinopathy Diabetes mellitus Visual impairment Low vision Visual field loss 


  1. 1.
    Tielsch JM, Sommer A, Witt K, Katz J, Royall RM (1990) Blindness and visual impairment in an American urban population: the Baltimore Eye Survey. Arch Ophthalmol 108:286–290Google Scholar
  2. 2.
    Attebo K, Mitchell P, Smith W (1996) Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology 103:357–364PubMedGoogle Scholar
  3. 3.
    Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT (1998) Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol 116:653–658PubMedGoogle Scholar
  4. 4.
    Munoz B, West SK, Rubin GS, Schein OD, Quigley HA, Bressler SB et al (2000) Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Arch Ophthalmol 118:819–825PubMedGoogle Scholar
  5. 5.
    Hyman L, Wu SY, Connell AM, Schachat A, Nemesure B, Hennis A et al (2001) Prevalence and causes of visual impairment in The Barbados Eye Study. Ophthalmology 108:1751–1756, doi:10.1016/S0161-6420(01)00590-5 PubMedCrossRefGoogle Scholar
  6. 6.
    Ramrattan RS, Wolfs RC, Panda-Jonas S, Jonas JB, Bakker D, Pols HA et al (2001) Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study. Arch Ophthalmol 119:1788–1794PubMedGoogle Scholar
  7. 7.
    Congdon N, O’Colmain B, Klaver CC, Klein R, Munoz B, Friedman DS, Eye Diseases Prevalence Research Group et al (2004) Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 122:477–485PubMedCrossRefGoogle Scholar
  8. 8.
    Varma R, Ying-Lai M, Klein R, Azen SP, Los Angeles Latino Eye Study Group (2004) Prevalence and risk indicators of visual impairment and blindness in Latinos: the Los Angeles Latino Eye Study. Ophthalmology 111:1132–1140, doi:10.1016/j.ophtha.2004.02.002 PubMedCrossRefGoogle Scholar
  9. 9.
    No authors listed (2000) Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N Engl J Med 342:381–389, doi:10.1056/NEJM200002103420603
  10. 10.
    Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2002) Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 287:2563–2569, doi:10.1001/jama.287.19.2563 CrossRefGoogle Scholar
  11. 11.
    Stevens RJ, Stratton IM, Holman RR, UK Prospective Diabetes Study (UKPDS58) (2002) UKPDS58—modeling glucose exposure as a risk factor for photocoagulation in type 2 diabetes. J Diabetes Complications 16:371–376, doi:10.1016/S1056-8727(02)00161-7 PubMedCrossRefGoogle Scholar
  12. 12.
    Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM, UK Prospective Diabetes Study Group (2004) Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol 122:1631–1640, doi:10.1001/archopht.122.11.1631 PubMedCrossRefGoogle Scholar
  13. 13.
    West SK, Munoz B, Klein R, Broman AT, Sanchez R, Rodriguez J et al (2002) Risk factors for Type II diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER. Am J Ophthalmol 134:390–398, doi:10.1016/S0002-9394(02)01595-7 PubMedCrossRefGoogle Scholar
  14. 14.
    Lyons TJ, Jenkins AJ, Zheng D, Lackland DT, McGee D, Garvey WT et al (2004) Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort. Invest Ophthalmol Vis Sci 45:910–918, doi:10.1167/iovs.02-0648 PubMedCrossRefGoogle Scholar
  15. 15.
    Varma R, Macias GL, Torres M, Klein R, Pena FY, Azen SP, The Los Angeles Latino Eye Study Group (2007) Biologic risk factors associated with diabetic retinopathy: the Los Angeles Latino Eye Study. Ophthalmology 114:1332–1340, doi:10.1016/j.ophtha.2006.10.023 PubMedCrossRefGoogle Scholar
  16. 16.
    Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M (2008) Risk factors for diabetic retinopathy in a South Indian Type 2 diabetic population-the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabet Med 2008(Mar):13. Epub ahead of printGoogle Scholar
  17. 17.
    Li S, Xu J, He M, Wu K, Munoz SR, Ellwein LB (1999) A survey of blindness and cataract surgery in Doumen County, China. Ophthalmology 106:1602–1608, doi:10.1016/S0161-6420(99)90459-1 PubMedCrossRefGoogle Scholar
  18. 18.
    Liu JH, Cheng CY, Chen SJ, Lee FL (2001) Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors. Ophthalmic Epidemiol 8:339–350PubMedGoogle Scholar
  19. 19.
    Michon JJ, Lau J, Chan WS, Ellwein LB (2002) Prevalence of visual impairment, blindness, and cataract surgery in the Hong Kong elderly. Br J Ophthalmol 86:133–139, doi:10.1136/bjo.86.2.133 PubMedCrossRefGoogle Scholar
  20. 20.
    Hsu WM, Cheng CY, Liu JH, Tsai SY, Chou P (2004) Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 111:62–69, doi:10.1016/j.ophtha.2003.05.011 PubMedCrossRefGoogle Scholar
  21. 21.
    Saw SM, Foster PJ, Gazzard G, Seah S (2004) Causes of blindness, low vision, and questionnaire-assessed poor visual function in Singaporean Chinese adults: The Tanjong Pagar. Surv Ophthalmol 111:1161–1168Google Scholar
  22. 22.
    Dunzhu S, Wang FS, Courtright P, Liu L, Tenzing C, Noertjojo K et al (2003) Blindness and eye diseases in Tibet: findings from a randomised, population based survey. Br J Ophthalmol 87:1443–1448, doi:10.1136/bjo.87.12.1443 PubMedCrossRefGoogle Scholar
  23. 23.
    Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes, estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053, doi:10.2337/diacare.27.5.1047 PubMedCrossRefGoogle Scholar
  24. 24.
    Xu L, Wang Y, Wang S, Wang Y, Jonas JB (2007) High myopia and glaucoma susceptibility. The Beijing Eye Study. Ophthalmology 114:216–220, doi:10.1016/j.ophtha.2006.06.050 PubMedCrossRefGoogle Scholar
  25. 25.
    Xu L, Li Y, Zheng Y, Jonas JB (2006) Associated factors for age-related maculopathy in the adult population in China. The Beijing Eye Study. Br J Ophthalmol 90:1087–1090, doi:10.1136/bjo.2006.096123 PubMedCrossRefGoogle Scholar
  26. 26.
    Early Treatment of Diabetic Retinopathy Study Research Group (1991) Grading diabetic retinopathy from stereoscopic colour fundus photographs: an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology 98:786–806Google Scholar
  27. 27.
    Wing TY, Klein R, Islam FM, Cotch FM, Folsom AR, Klein BE et al (2006) Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol 141:539–541, doi:10.1016/j.ajo.2005.11.038 CrossRefGoogle Scholar
  28. 28.
    Cikamantana L, Mitchell P, Rochtchina E, Foran S, Wang JJ (2007) Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study. Eye 21:465–471Google Scholar
  29. 29.
    Leske MC, Wu SY, Hennis A, Hyman L, Nemesure B, Yang L, Barbados Eye Study Group et al (2005) Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology 112:799–805, doi:10.1016/j.ophtha.2004.11.054 PubMedCrossRefGoogle Scholar
  30. 30.
    Brown JB, Pedula KL, Summers KH (2003) Diabetic retinopathy: contemporary prevalence in a well-controlled population. Diabetes Care 26:2691–2692, doi:10.2337/diacare.26.9.2637 CrossRefGoogle Scholar
  31. 31.
    Tapp RJ, Shaw JE, Harper CA, de Courten MP, Balkau B, McCarthy DJ, Taylor HR, Welborn TA, Zimmet PZ, AusDiab Study Group (2003) The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 26:1731–1737, doi:10.2337/diacare.26.6.1731 PubMedCrossRefGoogle Scholar
  32. 32.
    Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V (2005) Prevalence of diabetic retinopathy in urban India: The Chennai Urban Rural Epidemiology Study (CURES) Eye Study, I. Invest Ophthalmol Vis Sci 46:2328–2333, doi:10.1167/iovs.05-0019 PubMedCrossRefGoogle Scholar
  33. 33.
    van Leiden HA, Dekker JM, Moll AC, Nijpels G, Heine RJ, Bouter LM et al (2002) Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn study. Diabetes Care 25:1320–1325, doi:10.2337/diacare.25.8.1320 PubMedCrossRefGoogle Scholar
  34. 34.
    Moss SE, Klein R, Klein BE (1996) Cigarette smoking and ten-year progression of diabetic retinopathy. Ophthalmology 103:1438–1442PubMedGoogle Scholar
  35. 35.
    Klein R, Sharrett AR, Klein BE, Moss SE, Folsom AR, Wong TY, ARIC Group et al (2002) The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes: the atherosclerosis risk in communities study. Ophthalmology 109:1225–1234, doi:10.1016/S0161-6420(02)01074-6 PubMedCrossRefGoogle Scholar
  36. 36.
    Leung H, Wang JJ, Rochtchina E, Wong TY, Klein R, Mitchell P (2005) Dyslipidaemia and microvascular disease in the retina. Eye 19:861–868, doi:10.1038/sj.eye.6701668 PubMedCrossRefGoogle Scholar
  37. 37.
    van Leeuwen R, Klaver CC, Vingerling JR, Hofman A, van Duijn CM, Stricker BH et al (2004) Cholesterol and age-related macular degeneration: is there a link? Am J Ophthalmol 137:750–752PubMedCrossRefGoogle Scholar
  38. 38.
    Klein R, Klein BE, Tomany SC, Cruickshanks KJ (2003) The association of cardiovascular disease with the long-term incidence of age-related maculopathy: the Beaver Dam eye study. Ophthalmology 110:636–643, doi:10.1016/S0161-6420(02)01448-3 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Xi Wei Xie
    • 1
  • Liang Xu
    • 1
  • Ya Xing Wang
    • 1
  • Jost B. Jonas
    • 1
    • 2
  1. 1.Beijing Institute of Ophthalmology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of OphthalmologyMedical Faculty Mannheim of the Ruprecht-Karls-University of HeidelbergHeidelbergGermany

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