Perspective from Kyle Sandberg, OD, FAAO
Disclosures: Martinho report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
November 16, 2021
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Ocular risk markers effective at predicting vision-threatening complications in diabetes

Perspective from Kyle Sandberg, OD, FAAO
Disclosures: Martinho report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Ocular markers are more effective than systemic markers at predicting the risk for vision-threatening complications in patients with diabetes with mild retinopathy, according to a study published in Diabetes Care.

The prospective longitudinal observational cohort study assessed one eye from each of 172 patients with type 2 diabetes and mild nonproliferative diabetic retinopathy. Patients were followed for 5 years or until the development of center-involved macular edema (CIME), clinically significant macular edema (CSME) or proliferative diabetic retinopathy (PDR).

According to the study, 8% of eyes developed CSME, 6% developed CIME, and 2% developed PDR, with one eye developing both CSME and PDR. Patients who developed CSME or PDR were younger (P < .001) and had lower BMI (P = .040), higher HbA1c values (P = .030) and higher LDL (P = .041). Systolic blood pressure was lower in patients who developed CIME (P = .044).

“Regarding ocular characteristics and their relationship with vision-threatening outcomes, it was possible to identify statistically higher values of MAT [microaneurysm turnover] in patients who developed CSME (P = .001) or PDR (P = .007) and higher central retinal thickness (CRT) values in patients who developed CIME or CSME (both P < .001),” António C.-V. Martinho and colleagues wrote.

The development of CSME, CIME and PDR was determined to be associated with MAT, CRT and ganglion cell layer-inner plexiform layer (GCL + IPL) thickness, with the study authors noting that these ocular risk markers are more helpful than systemic markers of metabolic control at predicting the development of complications.

“In summary, ocular risk markers (MAT, CRT and GCL + IPL thickness) are good predictors of the development of CSME with an AUC of 0.87. For CIME, the predictive value of the ocular markers is even higher with an AUC of 0.97. When considering CIME, CSME and PDR, the ocular risk markers remain determinant,” Martinho and colleagues wrote.