de Fine Olivarius et al. BMC Public Health 2011, 11:80 http://www.biomedcentral.com/1471-2458/11/80 Page 7 of 13 Table 2 Visual acuity at diabetes diagnosis according to age, sex, retinopathy, and cataract Age (years) 40- < 60 60- < 70 70+ Sex Male Female Retinopathya Diabetic retinopathy Microaneurysms only Further diabetic retinopathy Age-related macular degeneration, AMD Other No retinopathy Cataracta Ophthalmologist’s indication of reason for visual impairmenta,b Retinopathy of all sorts Cataract Other causes Combination of causes None Visual acuity a Normal n = 1,163 429 (36.9) 366 (31.5) 368 (31.6) 622 (53.5) 541 (46.5) 13 (1.1) 34 (2.9) 117 (10.1) 104 (8.9) 908 (78.3) 278 (24.2) 76 (6.5) 171 (14.7) 42 (3.6) 45 (3.9) 829 (71.3) Moderately impaired n = 67 1 (1.5) 10 (14.9) 56 (83.6) 28 (41.8) 39 (58.2) 0 (0) 2 (3.0) 30 (44.8) 7 (10.5) 32 (47.8) 55 (82.1) 13 (19.4) 25 (37.3) 6 (9.0) 20 (29.9) 3 (4.5) Blind n = 11 0 (0) 1 (9.1) 10 (90.9) 3 (27.3) 8 (72.7) 1 (9.1) 2 (18.2) 7 (63.6) 1 (9.1) 1 (9.1) 4 (36.4) 5 (45.4) 1 (9.1) 2 (18.2) 2 (18.2) 1 (9.1) All patients n = 1,241 430 (34.7) 377 (30.4) 434 (35.0) 653 (52.6) 588 (47.4) 14 (1.1) 38 (3.1) 154 (12.4) 112 (9.0) 941 (76.0) 337 (27.5) 94 (7.6) 197 (15.9) 50 (4.0) 67 (5.4) 833 (67.1) Data are numbers (column-%). aRefers to best seeing eye. bThe ophthalmologists answered this question even for patients who were mildly visually impaired although their visual acuity was normal per definition, i.e. ≥ 0.5. During the 6 years of follow up, DR had appeared in 11.7% (90/770) of patients without DR at diagnosis (Table 4). At 6-year follow up, DR and AMD were also relatively more common among the visually impaired (Table 5). The influence of eye complications at Table 3 Changes in visual acuity from diabetes diagnosis until 6-year follow up Visual acuity at diagnosisa Normal Moderately impaired Blind Total Visual acuity at 6-year follow upa Normal 720 (92.3) 48 (6.2) 14 (56.0) 5 (20.0) 0 (0) 1 (50.0) 734 (90.9) 54 (6.7) Moderately Blind impaired Total 12 (1.5) 780 (96.7) 6 (24.0) 25 (3.1) 1 (50.0) 2 (0.2) 19 (2.4) 807 (100) Data are numbers (row- and column-%). aRefers to best seeing eye at diabetes diagnosis and 6-year follow up, respectively. diagnosis on change in visual acuity over 6 years was investigated in linear mixed models (Table 1). The 112 patients in Table 1 with “other retinopathy” presented with133 retinal pathologies other than DR and AMD: hypertensive retinopathy (n = 43), retinal vasosclerosis (41), drusen (18) and other retinopathy (31). DR (n = 52), AMD (154), and cataract (337) were associated with the level of visual acuity and/or its annual change also in age- and sex-adjusted analyses. These effects are illu- strated with median decimal acuity values in Figure 2. Similarly, some socio-demographic, clinical, biochem- ical, and behavioural variables affected the level of visual acuity and/or its annual change over 6 years even when the effect of age and sex was considered (Table 1). All significant effects, except that of self-rated health and triglycerides, are illustrated in Figure 2. The effect of tri- glycerides was not picked up by the median values. This is because the median figures in Figure 2 emphasize typical developments in visual acuity, while the result of