Thinner Average Choroidal Thickness Is a Risk Factor for the Onset of Diabetic Retinopathy

Abstract

Purpose: To analyze the relationships between choroidal thickness (CT) and diabetes mellitus (DM), diabetic retinopathy (DR), and DR severity in community residents diagnosed with type 2 DM, and to explore whether CT can improve the discriminatory ability of other risk factors to predict the incidence of DR. Methods: A total of 1,250 type 2 DM residents and 1,027 healthy controls in Xinjing community of Shanghai participated a cross-sectional survey of eye diseases in 2016. CT was measured using swept-source optical coherence tomography. DR was classified according to the 2002 international clinical classification of DR. A total of 537 subjects with type 2 DM without DR at the 2016 survey were followed up in 2018 to investigate the 2-year incidence of DR. Receiver operating characteristic curve analysis was used to test the accuracy of different indicators in predicting the onset of DR. Results: The central CT of the control, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and PDR groups were 223. 40, 216.22, 213.57, 211.91, 178.47, and 168.15 μm, respectively (p for trend < 0.001), and the average CT (ACT) were 197. 83, 186.94, 182.03, 178.00, 156.91, and 136.72 μm respectively (p for trend < 0.001). Body mass index (BMI), DM duration, fasting blood glucose, glycosylated hemoglobin (HbA1C), and ACT were risk factors for 2-year DR incidence. For the onset of DR, as predicted by ACT, after tenfold cross validation the average area under the curve was 0.55 (p = 0.048). Addition of ACT did not improve the discriminatory ability of DM duration, BMI, glucose and HbA1C on the incidence of DR (Z = 0.48; p = 0.63). Conclusions: As the severity of DR increased, the CT of community type 2 DM patients showed a significant downward trend compared with the healthy controls. Thinner ACT was found to be a risk factor for DR incidence, but it did not improve the discriminatory ability of other risk factors to predict the incidence of DR.

Reduced macular thickness and vascular density in abnormal glucose metabolism patients: A meta-analysis of optical coherence tomography (OCT) and OCT angiography studies

“…The basic characteristics of the included studies are summarized in Table 1, which comprised 13,773 participants and 15,416 eyes from 23 countries worldwide. In all the studies, there were participants with T2D ( n = 49), [2–6,9,19,21,26–29,32,38–73] T1D ( n = 27), [1,17,18,20,24,30–32,36,37,46,55,56,70,71,74–85] T1D/T2D mixed ( n = 9), [22,25,33,86–91] prediabetes ( n = 5) [9,10,42,92,93] and unclear ( n = 4). [16,94–96]…”

“…The choroid, a highly vascularized tissue that provides blood supply and nutrition to the outer retina, plays a vital role in retinal diseases, including DR. [ 107 ] Choroidal thickness has been found to change in different DR stages. [ 42 , 54 , 85 , 91 , 95 ] Pooled results from a past meta-analysis displayed that SFCT was significantly thicker in DR after adjusting axial length than in NDR patients. [ 107 ] Nonetheless, trends of SFCT of prediabetic and diabetic patients in different research appear to be controversial.…”

“…[ 107 ] Nonetheless, trends of SFCT of prediabetic and diabetic patients in different research appear to be controversial. Some studies have found that AGM patients have thinner choroids relative to HC, [ 54 , 65 , 85 , 91 ] while others believed that SFCT increased [ 20 , 93 ] or did not change [ 60 , 61 , 70 , 75 , 87 ] with disease progression. Our analysis shows no SFCT-related significant difference between AGM patients and HC [Table 2 , Supplementary Figure 4B, http://links.lww.com/CM9/B936 ].…”

Early Retinal Microvasculopathy in Prediabetic Patients and Correlated Factors

“…Written informed consent was obtained from all study participants before enrollment. All the subjects were enrolled in the Shanghai Cohort Study of Diabetic Eye Disease (SCODE, NCT03665090), a 3-year (2016-2018) community-based cohort study of ocular health screening and epidemiological analysis for diabetic eye disease in Shanghai [14]. The subjects were enrolled in the SCODE study from 2016 to 2018, and they were divided into three groups: group A included 47 prediabetic (impaired fasting glucose and/or IGT) individuals (9 males and 38 females, 65.85 years ± 7.78 [SD]), group B included 29 control individuals (6 males and 23 females, 69.07 years ± 3.42 [SD]), and group C included 81 T2DM patients (23 males and 58 females, 66.00 years ± 6.56 [SD]).…”