Are myopic eyes less likely to have diabetic retinopathy?
OBJECTIVE
Eyes with myopia may be less likely to develop diabetic retinopathy (DR). The relationship between refractive error, ocular biometry, and DR therefore was investigated.


METHODS
Population-based, cross-sectional study.


METHODS
Persons with diabetes from the Singapore Malay Eye Study (SiMES).


METHODS
Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Spherical equivalent refraction (SE) was assessed using an autokeratorefractometer and subjective refraction. Axial length (AL) and anterior chamber depth (ACD) were measured by IOLMaster (Carl Zeiss Meditec AG, Jena, Germany). Diabetic retinopathy was graded from retinal photographs.


METHODS
Any DR was defined by characteristic lesions defined by the Early Treatment Diabetic Retinopathy Study (ETDRS); moderate DR by ETDRS retinopathy severity scores of 43 or higher; and vision-threatening retinopathy by severe nonproliferative retinopathy, proliferative DR, or clinically significant macular edema.


RESULTS
Of 3280 adult Malay participants (78.7% response), 629 persons with diabetes contributed to this analysis. In multivariate analyses adjusting for age, gender, education, height, cataract, hypertension, hemoglobin A1c, and other factors, eyes with myopic SE were less likely to have any DR (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.84-0.96; P = 0.002, per 1-diopter [D] decrease), moderate DR (OR, 0.83; 95% CI, 0.73-0.93; P = 0.001, per 1-D decrease), and vision-threatening DR (OR, 0.77; 95% CI, 0.67-0.88; P<0.001, per 1-D decrease). Eyes with longer AL were less likely to have any DR (OR, 0.86; 95% CI, 0.75-0.99; P = 0.041, per 1-mm increase), moderate DR (OR, 0.80; 95% CI, 0.62-1.05; P = 0.11, per 1-mm increase), and vision-threatening DR (OR, 0.63; 95% CI, 0.40-0.99; P = 0.044, per mm increase). Eyes with deeper ACD were less likely to have moderate DR (OR, 0.32; 95% CI, 0.16-0.64; P = 0.001, per 1-mm increase) and vision-threatening DR (OR, 0.14; 95% CI, 0.06-0.36; P = 0.001, per 1-mm increase).


CONCLUSIONS
Myopic refraction and longer AL are associated with a lower risk of DR, particularly vision-threatening retinopathy, without any evidence of a threshold.
Lim
Laurence Shen
LS
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore.
Lamoureux
Ecosse
E
Saw
Seang Mei
SM
Tay
Wan Ting
WT
Mitchell
Paul
P
Wong
Tien Yin
TY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology; D044466:Asian People; D001699:Biometry; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005123:Eye / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012029:Refraction, Ocular / Q000502:physiology; D012846:Singapore
D001786:Blood Glucose; D006442:Glycated Hemoglobin