Association Between Diabetes and Keratoconus

Naderan, Mohammad; Naderan, Morteza; Rezagholizadeh, Farzaneh; Zolfaghari, Masoome; Pahlevani, Rozhin; Rajabi, Mohammad Taher

doi:10.1097/ico.0000000000000282

Cited by 40 publications

(30 citation statements)

References 17 publications

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“…A higher hysteresis suggests a more rigid and less deformable cornea. Seven cross-sectional clinic-based studies in Western Europe, 87, 90, 91, 92 United States, 93 Brazil, 89 Israel 88 and Iran 94 have found type 1 and type 2 DM participants to have higher hysteresis, whereas only one study (Turkish study) 95 found them to have a lower hysteresis, compared with age-matched controls. In one study, it was found that the fasting blood glucose level was significantly but weakly correlated ( r =0.28) to the corneal hysteresis.…”

Section: Cornea Stroma and Biomechanicsmentioning

confidence: 99%

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A systematic review on the impact of diabetes mellitus on the ocular surface

2017

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Diabetes mellitus is associated with extensive morbidity and mortality in any human community. It is well understood that the burden of diabetes is attributed to chronic progressive damage in major end-organs, but it is underappreciated that the most superficial and transparent organ affected by diabetes is the cornea. Different corneal components (epithelium, nerves, immune cells and endothelium) underpin specific systemic complications of diabetes. Just as diabetic retinopathy is a marker of more generalized microvascular disease, corneal nerve changes can predict peripheral and autonomic neuropathy, providing a window of opportunity for early treatment. In addition, alterations of immune cells in corneas suggest an inflammatory component in diabetic complications. Furthermore, impaired corneal epithelial wound healing may also imply more widespread disease. The non-invasiveness and improvement in imaging technology facilitates the emergence of new screening tools. Systemic control of diabetes can improve ocular surface health, possibly aided by anti-inflammatory and vasoprotective agents.

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Section: Cornea Stroma and Biomechanicsmentioning

confidence: 99%

“…104 Unfortunately, the published cross-sectional studies did not demonstrate a consistent association between DM and such alteration of corneal shapes. 93, 94 …”

Section: Cornea Stroma and Biomechanicsmentioning

confidence: 99%

A systematic review on the impact of diabetes mellitus on the ocular surface

2017

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“…5–8 The biomechanical theory of KCN postulates that elevated glucose in patients with DM leads to glycosylation of corneal fibers, which causes collagen crosslinking and strengthens the cornea thus reducing the risk of developing ectasia and KCN. 9–12 While some clinical evidence supports this theory, 5,6 a recent case-control study of 1377 patients with KCN actually found that patients with DM were more likely to have KCN compared to controls.…”

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confidence: 99%

The Association Between Sociodemographic Factors, Common Systemic Diseases, and Keratoconus

2016

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Purpose Several small-scale studies have reported associations between keratoconus (KCN) and an array of systemic diseases but no large-scale study has fully investigated this topic. The purpose of this study is to determine whether an association exists between common systemic diseases, sociodemographic factors, and KCN among a large, diverse group of insured individuals in the United States. Design Retrospective longitudinal cohort study Participants 16,053 patients with KCN were matched 1:1 to 16,053 persons without KCN. Methods Persons with KCN were identified using International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) billing codes and matched by age, sex, and overall health to a control group with no record of KCN. A multivariable logistic regression assessed whether sociodemographic factors and certain systemic diseases affected the odds of KCN. Main Outcome Measures Odd ratios (OR) with 95% confidence intervals (CI) of KCN Results After adjustment for confounders, blacks (adjusted OR=1.57, CI: 1.38–1.79, p<0.001) had 57% higher odds and Latinos (adjusted OR=1.43, CI: 1.26–1.62, p<0.001) had 43% higher odds of being diagnosed with KCN compared with whites. Asians had 39% reduced odds (OR=0.61, CI: 0.50–0.75, p<0.001) of being diagnosed with KCN compared to whites. Patients with uncomplicated diabetes mellitus (DM) had 20% lower odds of KCN (adjusted OR=0.80, CI: 0.71–0.90, p=0.002) while patients with DM complicated by end-organ damage had 52% lower odds of having KCN (adjusted OR=0.48, CI: 0.40–0.58, p<0.001) compared to those without DM. Persons with collagen vascular disease had 35% lower odds of KCN (adjusted OR=0.65, CI: 0.47–0.91, p=0.01). Other conditions found to have increased odds of KCN included sleep apnea (adjusted OR=1.13, CI: 1.00–1.27, p=0.05), asthma (adjusted OR=1.31, CI: 1.17–1.47, p<0.001), and Down syndrome (adjusted OR=6.22, CI: 2.08–18.66, p<0.001). There was no association between KCN and allergic rhinitis, mitral valve disorder, aortic aneurysm, or depression (p>0.1, for all comparisons). Conclusions Clinicians caring for persons with KCN should inquire about difficulties with breathing or sleeping and, when appropriate, refer patients to undergo evaluation for conditions such as sleep apnea or asthma. Lower risk of KCN in those with DM, potentially due to corneal glycosylation, opens an interesting area of research.

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“…Although they concluded that diabetes mellitus (DM) provides a statistically significant protective effect against the development of keratoconus (KC), the link between DM and KC is still not clear. [1][2][3] We found it interesting that the age range of their consecutive patients was 18 to 48 years in the KC group, although there were no stated exclusion criteria based on age. 1 Did the authors look at the association between DM and KC by specific age groups as was done by Seiler et al 2 ?…”

Section: To the Editormentioning

confidence: 99%