523 • Vol 8 • August 2006 Risk Factors and Patient Awareness in Diabetic Retinopathy Diabetic retinopathy is the leading cause of new cases of blind- ness in adults aged 20–74 and is responsible for 8% of all cases of legal blindness in the United States [1]. In Israel, DR is the leading cause of new cases of blindness in adults aged 19–80, and it accounts for 14.8% of new blindness certificates issued DR = diabetic retinopathy during 2004 [2]. Several studies have identified risk factors for DR and vision loss, including hyperglycemia, high blood pressure and hypercholesterolemia [3-7]. Accordingly, glycemic control with a reduction of HbA1c to 7% was found to be associated with de- creased development and progression of DR in patients with type 1 diabetes mellitus [8-10], as well as a reduction in microvascular endpoints, including the need for retinal laser photocoagulation, in patients with type 2 DM [11]. Blood pressure control was found to have similar effects on the incidence of microvascular complications in type 2 DM. Moreover, a recent study showed that persistent diabetic macular edema following focal laser treat- ment was associated with elevated HbA1c [12]. The purpose of the present study was to evaluate risk fac- tors in patients treated for DR in our university hospital-based outpatient retinal vascular clinic. These included glycemic control, BP, serum cholesterol and lipid levels, and systemic micro- and macrovascular complications. We also assessed patients’ knowl- edge of their own glycemic control and compared the findings to those in patients with type 2 DM followed in a community-based general ophthalmology clinic. Patients and Methods The study was approved by the Rabin Medical Center Institutional Review Board, and informed consent forms were signed by the patients. All consecutive patients with type 2 DM treated and followed in the Retinal Vascular Service of Rabin Medical Center from 1 September to 31 December 2004 were enrolled in the study. A parallel arm of the study included all consecutive patients with type 2 DM examined by a single ophthalmologist (M.G.) in a community-based general ophthalmology clinic during the same period. A detailed questionnaire was completed for each patient, including gender; age; duration of DM; treatment of DM (insulin versus tablets); family history of DM; smoking; patient’s acquaintance with HbA1c; patient’s knowledge of last HbA1c level; treating physician (family doctor versus endocri- DM = diabetes mellitus BP = blood pressure Abstract Background: Hyperglycemia, high blood pressure and hypercholesterolemia are risk factors for diabetic retinopathy and vision loss in diabetic patients. Objectives: To evaluate risk factors in patients treated for diabetic retinopathy in our hospital clinic and assess patients’ awareness of the impact of glycemic control; and to compare the fndings with those in patients followed in a community clinic. Methods: We performed a cross-sectional comparative study that included 178 consecutive patients with type 2 diabetes mellitus treated in the Retinal Vascular Service of Rabin Medical Center from 1 September to 31 December 2004, and 107 consecutive patients with type 2 diabetes mellitus examined in a community clinic during the same period. A questionnaire was completed; the main outcome measures were glycemic and risk factor control and their correlation with diabetic retinopathy and visual acuity. Results: Although only 43% of the patients had heard of HbA1c, 98% of them had undergone this analysis, with a mean level of 8.2% (SD 1.9) in the hospital patients and 7.7% (SD 1.6) in the community patients (P = 0.01, t-test). HbA1c was lower in hospital patients who were aware of the test. Correlations were found for visual acuity, diabetic retinopathy and laser treatment with HbA1c ≤ 7%, cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg. Conclusions: Since our study and previous reports have shown that HbA1c level ≤ 7%, serum cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg are associated with better preservation of vision in patients with type 2 diabetes mellitus, we propose that the ophthalmologist has a role in educating patients about glucose, lipid and blood pressure control as part of the treatment of diabetic retinopathy. IMAJ 2006;8:523–526 For Editorial see page 568 The Relationship between Diabetic Retinopathy, Glycemic Control, Risk Factor Indicators and Patient Education Ruth Axer-Siegel MD 1,2 , Zvi Herscovici MD 1 , Meirav Gabbay MD 1 , Karin Mimouni MD 1 , Dov Weinberger MD 1,2 and Uri Gabbay MD MPH 2 1 Department of Ophthalmology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel 2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel Key words: diabetic retinopathy, HbA1c, glycemic control, hypertension, cholesterol level Original Articles