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[edit] Relation of maculopathy to proliferative retinopathy

I would consider that maculopathy may exist seperately from retinopathy, but can also be present together with retinopathy. This would lead to three different disease states in progressive eye disease:

• <maculopathy alone>
• <proliferative retinopathy alone>
• <combined state>

1. From all thre states a transition probability would go to <unspecific diabetes related mortality> (retinopathy does not kill the people)
2. From all thre states a transition probability would lead to <blindness in at least one eye>
3. from <non-proliferative retinopathy> transition probabilities would go either to <prolifertive retinopathy alone> and to <maculopathy alone>
4. from these single states transition probabilites to the <combined state>

This means basically: We have a one-way street model. There is no regression or remission at all.

I have been looking for references:

1. Palmer et al. (The cost-effectiveness of different management strategies

for Type I diabetes: a Swiss perspective. Diabetologia (2000) 43: 13-26) shows following structure (1st Thumbnail)

1. Another structure I found is as follows (2nd Thumbnail): It assumes that first proliferative retinopathy exists, before maculopathy occurs.
2. My personal favorite looks like described above: The problem is, will we be able to get enough evidence for proposal three?

What do you think? Could you make a bubble diagram with these specifications?

Best regards and greetings from the Bavarian wild south!

[edit] Regression from non-proliferative Retinopathy to no Retinopathy

I would agree, that the structural damage caused to the small retinal vessels leads to irreversible damage.

Most likely the process can be stopped completely (transition 0%), if

• optimal diabetes treatment is provided
• no presence of hypertension
• no smoking habits

Any more influences?