Retinopathy and survival in a population without diabetes: The Beaver Dam Eye Study

Retinopathy is relatively common in nondiabetic populations, and its long-term prognostic implications are not certain. For this reason, the authors hypothesized that retinal alterations were associated with all-cause and cause-specific mortality in nondiabetic individuals participating in the Beaver Dam Eye Study in Wisconsin. Included in the analysis were 4,294 nondiabetic subjects aged 43-84 years examined at baseline (1988-1990). Retinopathy was classified into four groups by using retinal photographs: 1) no retinopathy, 2) presence of retinal hemorrhages only, 3) presence of retinal microaneurysms only, and 4) presence of moderate or worse retinopathy. The authors analyzed survival during 14 years of follow-up and in 5-year intervals by using time-varying covariates. Baseline prevalence of retinopathy was 7.7%. Adjusting for age, sex, and significant confounders, they observed that moderate retinopathy at baseline was associated with all-cause (hazard ratio = 1.76, 95% confidence interval: 1.16, 2.69) and ischemic heart disease (hazard ratio = 3.17, 95% confidence interval: 1.73, 5.78) mortality after 14 years of follow-up. In the 5-year-interval analysis, the presence of hemorrhages only was significantly related to increased all-cause (hazard ratio = 1.49, 95% confidence interval: 1.05, 2.12) and ischemic heart disease (hazard ratio = 2.43, 95% confidence interval: 1.48, 4.01) mortality. Study results suggest that retinal changes have possible prognostic implications regarding survival of persons without diabetes.