Elsevier

Ophthalmology

Volume 117, Issue 3, March 2010, Pages 524-530
Ophthalmology

Original article
Are Myopic Eyes Less Likely to Have Diabetic Retinopathy?

https://doi.org/10.1016/j.ophtha.2009.07.044Get rights and content

Purpose

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

Design

Population-based, cross-sectional study.

Participants

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.

Main Outcome Measures

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.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The Singapore Malay Eye Study is a population-based, cross-sectional study of urban Malay adults 40 to 80 years of age residing in Singapore. Study design and population details have been described elsewhere.22, 23, 24, 25 In brief, Malay subjects were selected from a national database using an age-stratified random sampling process. Of those eligible, 3280 (78.7% participation rate) were examined between 2004 and 2006. Diabetes mellitus was identified from plasma glucose of 200 mg/dl (11.1

Results

A total of 629 subjects with diabetes were included in the analysis. The mean age±standard deviation was 61.4±9.3 years, 265 (42.1%) were male, and the mean AL and SE were 23.40±1.01 mm and 0.02±2.09 D, respectively. The SE ranged from 16 to –25.5 D. Table 1 summarizes the demographic and systemic characteristics of study participants. Significant trends were noted for age, education, and smoking across refractive error groups. Myopic subjects tended to be younger (P<0.001), tended to have

Discussion

This article reports on the relationship between refractive errors and axial dimensions with DR over the range of hyperopia to high myopia in a population-based study in Singapore. Eyes that were more myopic and with longer AL and deeper ACD were less likely to have any DR, particularly vision-threatening DR, with no evidence seen for a threshold. The study suggests a continuous protective effect of myopia over the range of mild to high myopia on the risk of DR.

Many studies14, 15, 16, 20, 21

References (47)

  • Q. Mohamed et al.

    Management of diabetic retinopathy: a systematic review

    JAMA

    (2007)
  • R.N. Frank

    Diabetic retinopathy

    N Engl J Med

    (2004)
  • D.S. Fong et al.

    Subretinal fibrosis in diabetic macular edema: ETDRS report 23

    Arch Ophthalmol

    (1997)
  • The prevalence of diabetic retinopathy among adults in the United States

    Arch Ophthalmol

    (2004)
  • S.M. Haffner et al.

    Diabetic retinopathy in Mexican Americans and non-Hispanic whites

    Diabetes

    (1988)
  • R.F. Hamman et al.

    Prevalence and risk factors of diabetic retinopathy in non-Hispanic whites and Hispanics with NIDDM: San Luis Valley Diabetes Study

    Diabetes

    (1989)
  • I.M. Stratton et al.

    UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis

    Diabetologia

    (2001)
  • F.L. Ferris et al.

    Serum lipids and diabetic retinopathy

    Diabetes Care

    (1996)
  • C.A. Wilson et al.

    Optic disk neovascularization and retinal vessel diameter in diabetic retinopathy

    Am J Ophthalmol

    (1988)
  • G. Hovener

    The influence of refraction on diabetic retinopathy

    Klin Monatsbl Augenheilkd

    (1975)
  • J.D. Grange et al.

    Diabetic retinopathy and severe myopia

    Bull Soc Ophtalmol Fr

    (1984)
  • L. Pierro et al.

    Axial length in patients with diabetes

    Retina

    (1999)
  • P.A. D'Amore

    Mechanisms of retinal and choroidal neovascularization

    Invest Ophthalmol Vis Sci

    (1994)
  • Cited by (0)

    Manuscript no. 2009-668.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Medical Research Council (grant no.: 0796/2003; and Biomedical Research Council grant no.: 501/1/25-5).

    View full text