Refractive Changes Associated with Diabetes Mellitus

Kaštelan, Snježana; Gverović-Antunica, Antonela; Pelčić, Goran; Gotovac, Marta; Marković, Irena; Kasun, Boris

doi:10.1080/08820538.2018.1519582

Cited by 32 publications

(30 citation statements)

References 47 publications

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“…Previous observations show that maintaining strict glycaemic control before or during pregnancy is essential to prevent pregnancy-related complications and offspring congenital malformations [43]. These findings support the notion that the presence of diabetic complications could be considered as a key indicator of severe hyperglycaemia-related vasculopathy, neuropathy and retinopathy and are important contributors to metabolic and haemodynamic changes [22] that might be involved in refractive development regulation [18]. It was interesting to observe that hypermetropia occurred more frequently in childhood and myopia was more frequent in adolescence and young adulthood.…”

Section: Resultssupporting

confidence: 69%

“…In the fetus, hyperglycaemia may induce vascular endothelial dysfunction and neuropathy [12,34]. This may result in the leakage or breakdown of the blood-ocular barrier endothelial system [17,18], in turn leading to aqueous humour osmotic pressure changes and subsequent RE after birth [18,35,36].…”

Section: Resultsmentioning

confidence: 99%

“…Large cohort studies have demonstrated that maternal diabetes may affect the development of vasculopathy and metabolic diseases in offspring via the diabetic intrauterine environment [15,16]. An intact blood-ocular vascular endothelial barrier and metabolic homeostasis in the eyes are critical for healthy eyesight [17], whereas fluctuation of blood glucose levels may impair the blood-ocular barrier and lead to transient refractive changes or even permanent RE, as observed in the general population [18]. It has been suggested that the development of RE in offspring may partly be attributed to intrauterine exposure to high levels of glucose, particularly in pregnancies with diabetic complications [19].…”

Section: Introductionmentioning

confidence: 99%

“…In this large population-based cohort study, we aimed to investigate the associations between maternal diabetes before or during pregnancy and the risk of high RE in offspring until the age of 25 years. We further expected that the most pronounced associations would be observed among offspring of mothers with diabetic complications [18,22], a proxy of more severe diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study

Liu

et al. 2021

Diabetologia

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Aims/hypothesis We aimed to investigate the associations between maternal diabetes before or during pregnancy and the risk of high refractive error (RE) in offspring until the age of 25 years. Methods This nationwide register-based cohort study comprised 2,470,580 individuals born in 1977-2016. The exposure was maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes). Cox regression was used to examine the association between maternal diabetes and the risk of high RE in offspring from birth until the age of 25 years, adjusting for multiple potential confounders. Results During up to 25 years of follow-up, 553 offspring of mothers with diabetes and 19,695 offspring of mothers without diabetes were diagnosed with high RE. Prenatal exposure to maternal diabetes was associated with a 39% increased risk of high RE: HR 1.39 (95% CI 1.28, 1.51), p < 0.001; standardised cumulative incidence in unexposed offspring at 25 years of age 1.18% (95% CI 1.16%, 1.19%); cumulative incidence difference 0.72% (95% CI 0.51%, 0.94%). The elevated risks were observed for hypermetropia (HR 1.37 [95% CI 1.24, 1.51], p < 0.001), myopia (HR 1.34 [95% CI 1.08, 1.66], p = 0.007) and astigmatism (HR 1.58 [95% CI 1.29, 1.92], p < 0.001). The increased risks were more pronounced among offspring of mothers with diabetic complications (HR 2.05 [95% CI 1.60, 2.64], p < 0.001), compared with those of mothers with diabetes but no diabetic complications (HR 1.18 [95% CI 1.02, 1.37], p = 0.030). Conclusions/interpretation Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring, in particular among those of mothers with diabetic complications. Early ophthalmological screening should be recommended in offspring of mothers with diabetes diagnosed before or during pregnancy.

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Section: Resultssupporting

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study

Liu

et al. 2021

Diabetologia

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“…This happens due to an increase in the inflow of sugar into the lens through the sorbitol pathway catalysed by the aldose reductase activity [21,22]. People with diabetes have been observed to have a higher prevalence of myopia compared to those without diabetes [23]. In a study conducted by Jacobsen et al [24] it was determined that the prevalence of myopia (spherical equivalent 0.5 D) was 53.3% among 252 type 1 diabetic patient age 16-26 years old.…”

Section: Sugar and Refractive Errormentioning

confidence: 99%

Impact of Sugar on Vision

Ogbonna¹,

Ehigbo²,

Hannah³

2021

Sugar Intake - Risks and Benefits and the Global Diabetes Epidemic

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Sugar forms an integral part of the human body, and contributes to normal body function. However, sugar in high quantities can be detrimental to the body especially to the eye. In the normal concentration, sugar in the form of glucose is found in the aqueous humour, and tears, and serves to provide nourishment to the avascular cornea, and lens respectively. Sugar at this stage may also be used to determine the post mortem interval of a cadaver. However, when in excess as may be seen in patients with diabetes, sugar can cause oxidative stress to the cornea, lens, and retina resulting in cornea oedema, cataract, retinal aneurysm which can contribute significantly to the prevalence of low vision, and vision impairment.

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Association of Visual Acuity Improvement With Uncorrected Refractive Error in Patients New to Low Vision Clinics

2020

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IMPORTANCEThere is substantial socioeconomic and individual burden from uncorrected refractive error (URE) and chronic ocular disease. Understanding the association of visual acuity (VA) reduction with URE and the adults most likely to benefit from refraction may help support clinical decision-making in ophthalmologic care and maximize patient outcomes.OBJECTIVES To assess the magnitude of VA improvement associated with URE among adults under ophthalmic care who obtain low vision rehabilitation (LVR) services and identify the characteristics of the patients who are most likely to experience improvement. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series assessed patients 20 years or older who were new to the LVR clinics from August 1, 2013, to December 31, 2015, and who had habitual VA between 20/40 and counting fingers (not including) and underwent refraction. Data analysis was performed from April 4, 2018, to December 20, 2019. EXPOSURES Patient demographics and clinical data, including habitual and refraction VA, refraction, and disease diagnosis. Habitual VA was categorized as mild (VA worse than 20/40 and at least 20/60), moderate (VA worse than 20/60 and better than 20/200), severe (VA 20/200 or worse and better than 20/500), and profound (VA 20/500 or worse) vision impairment (VI). MAIN OUTCOMES AND MEASURES At least 2-line VA improvement and any VA improvement (Ն1-line) by refraction. RESULTS Among the 2923 patients new to LVR clinics, 1773 (mean [SD] age, 70 [18.2] years; 1069 [60.3%] female) were included in these analyses. The mean habitual VA was 20/100 (mean [SD], 0.67 [0.36] logMAR). At least 2-line improvement was observed in 493 patients (27.8%), and any VA improvement was seen in 1023 patients (57.7%). At least 2-line improvement was observed in 54 patients (34.8%) with corneal disorders and was more likely seen among patients aged 40 to <65 years compared with those aged 20 to <40 years (odds ratio [OR], 1.57; 95% CI, 1.02-2.41), African American patients compared with white patients (OR, 1.41; 95% CI, 1.08-1.85), or patients with moderate VI compared with mild VI (OR, 1.36; 95% CI, 1.07-1.72). CONCLUSIONS AND RELEVANCEThe findings suggest that URE is prevalent among patients with ocular disease and accessing LVR and that refractive evaluation should be considered for patients with ocular disease and reduced VA, especially working-age adults aged 40 to <65 years, African American patients, and those with moderate VI.

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Refractive Changes Associated with Diabetes Mellitus

Cited by 32 publications

References 47 publications

Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study

Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study

Impact of Sugar on Vision

Association of Visual Acuity Improvement With Uncorrected Refractive Error in Patients New to Low Vision Clinics

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