Risk factors that worsen 
diabetic retinopathy
Down with hypertension. 1977 
International Year of Hypertension.
9th World Congress of Gynaecology and Obstetrics.
27th European Congress of Renal 
Dialysis and Transplantation.
World Health Day. Giving up 
Eat sensibly for health and well-being.
Section 3 Risk Factors
(click the retinal picture for an enlarged view)
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.
Table 1 Risk factors for development of diabetic retinopathy
  • Duration of diabetes
  • Poor glucose control
  • Hypertension
  • Pregnancy
  • Puberty
  • Renal disease
  • Hyperlipidaemia
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.
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.
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.
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.
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)
Epidemiology Clinical features Risk factors Screening
Lasers and lenses. NVD,, NVE.. Maculopathy
Vitrectomy. Cataract Special problems Counselling
References.. AAO guidelines Atlas of Retinopathy Contact lenses
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