Refractive Error and Retinopathy Outcomes in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

The relationship between refractive error and the risk of diabetic retinopathy: a systematic review and meta-analysis

Purpose

This meta-analysis was conducted to collect all available data and estimate the relationship between refractive error and the risk of diabetic retinopathy (DR) in patients with diabetes, and to assess whether vision-threatening DR (VTDR) is associated with refractive error.

Methods

We systematically searched several literature databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, CBM, Wan Fang Data, and VIP databases. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using fixed or random effects models. Four models were developed to assess the relationship between refractive error and the risk and DR, VTDR: hyperopia and DR, VTDR; myopia and DR, VTDR; spherical equivalent (SE per D increase) and DR, VTDR; and axial length (AL per mm increase) and DR, VTDR. The included literature was meta-analyzed using Stata 12.0 software, and sensitivity analysis was performed. Publication bias in the literature was evaluated using a funnel plot, Begg's test, and Egger's test.

Results

A systematic search identified 3,198 articles, of which 21 (4 cohorts, 17 cross-sectional studies) were included in the meta-analysis. Meta-analysis showed that hyperopia was associated with an increased risk of VTDR (OR: 1.23; 95% CI: 1.08-1.39; P = 0.001), but not with DR (OR: 1.05; 95% CI: 0.94-1.17; P = 0.374). Myopia was associated with a reduced risk of DR (OR: 0.74; 95% CI: 0.61-0.90; P = 0.003), but not with VTDR (OR: 1.08; 95% CI: 0.85-1.38; P = 0.519). Every 1 diopter increase in spherical equivalent, there was a 1.08 increase in the odds ratio of DR (OR: 1.08; 95% CI: 1.05-1.10; P<0.001), but not with VTDR (OR: 1.05; 95% CI: 1.00-1.10; P = 0.06). AL per mm increase was significantly associated with a decreased risk of developing DR (OR: 0.77; 95% CI: 0.71-0.84; P<0.001) and VTDR (OR: 0.63; 95% CI: 0.56-0.72; P<0.001). Analysis of sensitivity confirmed the reliability of the study's findings.

Conclusion

This meta-analysis demonstrates hyperopia was associated with an increased risk of VTDR in diabetes patients. Myopia was associated with a reduced risk of DR. AL is an important influencing factor of refractive error. Every 1 mm increase in AL reduces the risk of DR by 23% and the risk of VTDR by 37%.

Systematic review registration

identifier: CRD42023413420.

Association between low birth weight and impaired glucose tolerance in children: a systematic review and meta-analysis

Background

A potential association between the onset of diabetes and normal birth weight (NBW) has been discovered. Diverse conclusions and study methodologies exist regarding the connection between low birth weight (LBW) and impaired glucose tolerance in children, underscoring the need for further robust research. Our institution is embarking on this study to thoroughly examine the association between LBW and impaired glucose tolerance in children.

Methods

We conducted searches on Cochrane Library, ScienceDirect, EMBASE, PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature data (CBM) online database, VIP full-text Database, and Wanfang Database to identify correlation analyses or case-control studies investigating the relationship between LBW and abnormal glucose tolerance in children. The search spanned from January 2010 to September 2023. The quality of observational studies was evaluated using the Newcastle-Ottawa Scale (NOS) tool. Data synthesis was performed using the statistical software RevMan 5.3 for meta-analysis.

Results

Based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, we finally included 10 clinical control studies consisting of a total of 2971 cases. There wasn't considerably change in blood sugar levels among LBW, NBW and high birth weight (HBW) infants (P > 0.05). There was no significant difference in insulin levels between LBW infants and NBW infants (P > 0.05). The HOMA-IR of LBW infants was considerably higher than that of NBW infants (P < 0.05). The risk of abnormal glucose tolerance in LBW infants was 0.42 times higher than that in NBW and HBW infants [Fisher's Z = 0.42, 95% CI = (0.09, 0.75), P = 0.01].

Conclusion

LBW is associated with an increased risk of abnormal glucose tolerance, as indicated by elevated HOMA-IR level in LBW infants compared to NBW and HBW pediatric population. Further research is needed to confirm and expand upon these findings to better understand the complex relationship between LBW and impaired glucose tolerance in children.

Role of Machine Learning and Artificial Intelligence in the Diagnosis and Treatment of Refractive Errors for Enhanced Eye Care: A Systematic Review

A significant contributor to blindness and visual impairment globally is uncorrected refractive error. To plan effective interventions, eye care professionals must promptly identify people at a high risk of acquiring myopia, and monitor disease progress. Artificial intelligence (AI) and machine learning (ML) have enormous potential to improve diagnosis and treatment. This systematic review explores the current state of ML and AI applications in the diagnoses and treatment of refractory errors in optometry. A systematic review and meta-analysis of studies evaluating the diagnostic performance of AI-based tools in PubMed was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find relevant studies on the use of ML or AI in the diagnosis or treatment of refractive errors in optometry, a thorough search was conducted in various electronic databases such as PubMed, Google Scholar, and Web of Science. The search was limited to studies published between January 2015 and December 2022. The search terms used were "refractive errors," "myopia," "optometry," "machine learning," "ophthalmology," and "artificial intelligence." A total of nine studies met the inclusion criteria and were included in the final analysis. ML is increasingly being utilized for automating clinical data processing as AI technology progresses, making the formerly labor-intensive work possible. AI models that primarily use a neural network demonstrated exceptional efficiency and performance in the analysis of vast medical data, rivaling board-certified, healthcare professionals. Several studies showed that ML models could support diagnosis and clinical decision-making. Moreover, an ML algorithm predicted future refraction values in patients with myopia. AI and ML models have great potential to improve the diagnosis and treatment of refractive errors in optometry.

Genome-wide DNA methylation analysis of extreme phenotypes in the identification of novel epigenetic modifications in diabetic retinopathy

Background

Aberrant epigenetic modifications such as DNA methylation may contribute to the pathogenesis of DR. We aimed at elucidating the role of novel DNA methylation modifications in diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) using an extreme phenotypic design.

Methods/results

Two consecutive studies were conducted. A cross-sectional study using an extreme phenotypic design was conducted to identify rare methylation modifications that might contribute to DR pathogenesis. A 2-year longitudinal nested case–control study was conducted to validate the results and assess whether these novel methylation modifications could be used as biomarkers for predicting DR onset. A large number of differentially methylated CpG sites were identified in the cross-sectional study, and two (cg12869254 and cg04026387) corresponding to known genes were replicated in the longitudinal study. Higher methylation of cg12869254 significantly correlated with macular RNFL thinning in the superior and nasal subregions, and that of cg04026387 correlated with reduced deep capillary plexus VD in the superior and inferior subregions after adjusting for covariates.

Conclusions

Cg12869254 and cg04026387 hypermethylation may complement the known risk factors that contribute to the pathogenesis of DR and as novel biomarkers for disease prediction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13148-022-01354-z.

Longitudinal associations of ocular biometric parameters with onset and progression of diabetic retinopathy in Chinese adults with type 2 diabetes mellitus

AIMS

To investigate the associations of ocular biometric parameters with incident diabetic retinopathy (DR), incident vision-threatening DR (VTDR) and DR progression.

METHODS

This community-based prospective cohort study recruited participants with type 2 diabetes aged 35-80 years from 2017 to 2019 in Guangzhou, China. Refractive error and ocular biometric parameters were measured at baseline, including axial length (AL), axial length-to-corneal radius (AL/CR) ratio, corneal curvature (CC), lens thickness (LT), anterior chamber depth (ACD), lens power and corneal diameter (CD).

RESULTS

A total of 1370 participants with a mean age of 64.3±8.1 years were followed up for two consecutive years. During the follow-up period, 342 out of 1195 (28.6%) participants without DR at baseline had incident DR, 15 out of 175 (8.57%) participants with baseline DR had DR progression and 11 of them progressed to VTDR. After multiple adjustments, a longer AL (OR=0.76; 95% CI, 0.66 to 0.86; p<0.001) and a larger AL/CR ratio (OR=0.20; 95% CI, 0.07 to 0.55; p=0.002) were associated with significantly reduced risks of incident DR but were not associated with incident VTDR or DR progression. Refractive status and other ocular biometric parameters investigated, including ACD, CC, CD, lens power and LT were not associated with any of the DR outcomes (all p>0.05).

CONCLUSIONS

A longer AL and a larger AL/CR ratio are protective against incident DR. These parameters may be incorporated into future DR risk prediction models to individualise the frequency of DR screening and prevention measures.

Eye disorders other than diabetic retinopathy in patients with diabetes

AIM

While diabetic retinopathy is the most specific complication of chronic hyperglycaemia, numerous other ocular conditions also can involve the eyes of people with diabetes. Cataract, glaucoma, age-related macular degeneration, retinal vascular occlusion, and acute ischaemic optic neuropathy combine to impair vision in people with diabetes, especially when they are old. This report provides a critical analysis and an overview of the current knowledge of the main ocular disorders (excluding diabetic retinopathy) and their association in patients with diabetes.

METHODS

A literature search strategy was conducted for all English-language literature with a systematic review of key references until 2021.

RESULTS

Patients with diabetes have a high-to-moderate increased risk for most of the usual ocular disorders we reviewed with the exception of age-related macular degeneration. Exposure to chronic hyperglycaemia promotes the development of many eye disorders while acute glucose changes are involved in refractive disorders, diabetic papillopathy and acute cataract.

CONCLUSION

Diabetes, beyond diabetic retinopathy, increases the risk of numerous eye disorders leading to low vision with implications for daily diabetes management. Even in the absence of clearly demonstrated benefit from glucose control in all eye conditions, achieving good glycaemic control and adherence to diabetes treatment will likely help avoid an additional risk of visual impairment in people with diabetes. In perspective, interesting findings suggesting a preventive effect of metformin use on age-related macular degeneration occurrence justify further studies.