Several risk factors exist for the development and the progression of 

retinopathy. These include pregnancy, puberty, hypertension, 

hyperlipidaemia and retinal disease. In addition, the duration fo diabetes 

and inadequate control of hyperglycaemia are established predictive 

factors for the development of retinopathy.

.

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3.1 Duration of diabetes.

There is a clear correlation between the duration of diabetes and 

the development of retinopathy16. Older patients have greater risk of 

visual impairment mostly due to maculopathy17.

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3.2 Control of diabetes

Prospective study of tight glycaemic control vs conventional control 

clearly demonstrated the greater risk of progression of retinopathy in

both IDDM and NIDDM18, 18b.

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3.3 Hypertension

Hypertension and pregnancy constitute two of the ‘second events’ 

which are associated with worsening retinopathy and particularly 

the development of 19-21. Hypertension is a greater 

risk factor in IDDM but is also important in NIDDM.

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3.4 Pregnancy

Although most pregnancy patients with BDR will not experience a 

worsening of their retinopathy during pregnancy, a small and 

predominantly unpredictable cohort of patients will progress rapidly 

to neovascularisation22-24. Predictive factors are poor pre-pregnancy 

control of diabetes, too rapid tightening of control during the early 

stages of pregnancy and the development of complications during 

pregnancy such as pre-eclampsia and fluid imbalance.

..

3.5 Renal disease

Patients with end-stage renal failure almost invariably develop 

worsening of their retinopathy, both affecting the macular (retinal 

oedema) and the development of new vessels. Conversely treatment 

to the renal disease may be associated with an improvement tin the 

retinopathy and a more beneficial response to treatment, as seen for 

instance after renal transplantation. patients with early nephropathy, 

as determined by the presence of micro-albuminuria, invariably have 

a rise in blood pressure further adding to the risk of retinopathy.

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3.6 Hyperlipidaemia

Overweight and particularly obese individuals with hyperlipidaemia are 

prone to florid exudative maculopathy. Hyperlipidaemia in the absence 

of obesity is also a risk factor for severe exudative maculopathy 

(Figure 22). The WESDR demonstrated a correlation between serum 

cholesterol and risk of retinopathy in the diabetic population generally25. 

Cigarette smoking may also be a significant risk factor for diabetic retinal 

microvascular disease in men. 

Figure 22 Florid exudative diabetic  retinopathy. (Click picture for a  larger view)