Refractive change in hyperglycaemia: hyperopia, not myopia.

Eva, Paul Riordan; Pascoe, P T; Vaughan, Daniel G.

doi:10.1136/bjo.66.8.500

Cited by 66 publications

(51 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there is some controversy, it appears that either hypermetropia or myopia may occur. Usually it is considered that myopia develops in hyperglycaemia,37,38 and that following ther apy the refraction changes back towards a less myopic, or more hypermetropic, state.39-43 However, hypermetropia is also reported with hyperglycaemia.44-48 Eva et al 46 found hypermetropia varying between +0.75 and +3.25 dioptres.…”

Section: Refractive Changesmentioning

confidence: 99%

The lens in diabetes

Bron

Sparrow

Brown

et al. 1993

Eye

161

112

View full text Add to dashboard Cite

SUMMARYThis paper reviews the changes which occur in the human lens in diabetes. They include refractive changes and cat aract and age-related increases in thickness, curvatures, light scattering, autofluorescence and yellowing. The inci dence of cataract is greatly increased over the age of 50 years, slightly more so in women, compared with non diabetics. Experimental models of sugar cataract provide some evidence for the mechanism of the uncommon, but morphologically distinct, juvenile form of human dia betic cataract, where an osmotic mechanism due to sugar alcohol accumulation has been thoroughly studied in dia betic or galactose-fed rats. The discrepancy between the ready accumulation of sugar alcohol in the lens in model systems and the very slow kinetics of aldose reductase (AR) has not been satisfactorily explained and suggests that the mechanism of polyol formation is not yet fully understood in mammalian systems. The activity of AR in the human lens lies mainly in the epithelium and there appears to be a marginal expectation that sufficient sorbi tol accumulates in cortical lens fibres to explain the lens swelling and cataract on an osmotic basis. This is even more so in the cataracts of adult diabetics, which re semble those of age-related non-diabetic cataracts in appearance. The very low levels of sorbitol in adult dia betic lenses make an osmotic mechanism for the increased risk of cataract even less likely. Other mech anisms, including glycation and oxidative stress, are dis cussed. The occurrence of cataract is a predictor for increased mortality in the diabetic.The diabetic lens is larger than normal, disposed to refrac tive change and at increased risk of cataract, sometimes of a specific type. This paper discusses the factors involved. ANATOMY AND PHYSIOLOGYThe lens is enclosed in a collagenous capsule containing other matrix proteins and proteoglycans. A monolayer of epithelial cells is interposed between the anterior capsule and the main cellular mass of lens fibres. The lens fibres are laid down in a series of onion-skin layers, which arch over the equator to meet their opposite numbers at the lens sutures. The innermost fibres comprising the nucleus of the lens are free of organelles and show limited metabolic activity. The outer fibres comprise the cortex. The most superficial fibres of the cortex are nucleated and, like the epithelium, show the normal complement of organelles. Glucose, which enters the lens by facilitated transport, I is its main energy supply, although energy may also derive from amino acids? The metabolism of the cortex is chiefly anaerobic, with 70% of the energy supply of the lens deriving from anaerobic glycolysis. If a lens is incubated in nutrient medium in anaerobic conditions with an adequate supply of glucose it remains transparent for a number of hours.3.4 The metabolism of the epithelium is aerobic. New lens fibres arise by cell division in the germi native zone in the pre-equatorial region of the lens. The epithelium and superficial cortical cells are major ...

show abstract

Section: Refractive Changesmentioning

confidence: 99%

The lens in diabetes

Bron

Sparrow

Brown

et al. 1993

Eye

161

112

View full text Add to dashboard Cite

show abstract

“…The association of myopia with hyperglycaemia and hyperopia with hypoglycaemia have been reported in diabetic patients [3]. There are studies which show that an abrupt reduction in plasma glucose in diabetic patients with marked hyperglycaemia, induce transient hyperopia [1,2,4]. It has been seen that the degree of hyperopia is highly dependent on the magnitude of the change in plasma glucose concentration [2].…”

Section: Discussionmentioning

confidence: 98%

“…Many authors, who investigated the effect of acute changes in plasma glucose level, have reported that decreasing plasma glucose levels cause hyperopic changes [1,5,6]. Although some conflicting reports are there, recently, several papers have reported an abrupt reduction in plasma glucose in diabetic patients with marked hyperglycaemia induced transient hyperopia [1,2,4]. It has been seen that the degree of hyperopia is highly dependent on the magnitude of the change in plasma glucose concentration [2].…”

Section: Discussionmentioning

confidence: 99%

Acute Incapacitating Hyperopia during Hypoglycemic Treatment

Srivastava¹

2003

Medical Journal Armed Forces India

View full text Add to dashboard Cite

“…Both myopic (25,(28)(29)(30) and hyperopic changes (31)(32)(33)(34) have been observed in adolescents and adults with acute and chronic DM. Some of these changes may result from metabolic and structural changes within the lens.…”

Section: Discussionmentioning

confidence: 99%