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Using propensity score matching, we created a control sample of equal number to the DM sample based on observable covariates. We then created a control pool of persons never diagnosed with DM, with the same exclusion restrictions described above. To ensure that an anterior ischemic optic neuropathy (AION) diagnosis occurred after the diagnosis of DM, we excluded any individual initially diagnosed with AION prior to DM diagnosis in 1994. for 12 months or more during the look back period. We also excluded all individuals ever diagnosed with giant cell arteritis (ICD-9-CM: 446.5), individuals age 95+ in 1994, and persons who entered a Medicare risk plan (HMO) or lived outside of the U.S.
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To ensure these were incident cases of DM and to identify other comorbidities, we employed a 3-year look back period, which necessitated all individuals to be age 68+ in 1994 in order to have a full look-back.
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We composed a sample of individuals first diagnosed with diabetes mellitus (DM: ICD-9-CM code 250.xx) in 1994. A secondary aim identified the incidence of NAION over a 13-year period. This paper analyzes the likelihood of developing an incident diagnosis of NAION among Medicare beneficiaries after receiving a new diagnosis of diabetes mellitus (DM) compared to a matched control group.
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3 - 9 Diabetes mellitus has the highest prevalence among patients with NAION, however to our knowledge, the incidence of NAION among a group of patients with a particular risk factor has not been studied. 8, 10, 11 Each of these factors has been disputed, 12 and, in many cases, a study identified one risk factor and discounted another. The most commonly cited risk factors suggest vasculopathic disorders such as diabetes mellitus (DM), 3 - 6 systemic hypertension, 4 - 7 hyperlipidemia, 7 - 9 and smoking. The exact pathophysiology of NAION remains unknown, but numerous risk factors have been proposed based on retrospective observations of relatively small groups of patients.
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1, 2 These estimates are based on small local studies and then extrapolated to the U.S. Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute, optic neuropathy among individuals over the age of 50 years with an estimated annual incidence of 2.3 – 10.2/100,000 in the United States (U.S.).