Diabetic Retinopathy as a Risk Factor for Ocular Hypertension or Primary Open-Angle Glaucoma in a United States-based Cohort Study.

PURPOSE

Assess the association between diabetic retinopathy (DR) and the risk of ocular hypertension (OHT) or primary open-angle glaucoma (POAG) in patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

This retrospective cohort study utilized the TriNetX US Collaborative Network, including 166,471 patients with T1DM and 5,745,652 patients with T2DM, categorized by DR status, ages ≥ 18 years. International Classification of Diseases 10th Revision (ICD-10) codes identified T1DM, T2DM, and DR. Propensity score matching (PSM) adjusted for age, sex, race/ethnicity, body mass index (BMI), relevant medical history, blood markers, glycemic-controlling medications, intravitreal injections, and ophthalmic service visits. The primary outcome was the development of coded OHT or POAG over 10 years and lifetime, expressed as adjusted hazard ratios (aHR).

RESULTS

DM patients with DR exhibited a significantly heightened risk of developing coded OHT or POAG. T1DM patients showed a 4.966 fold increased lifetime risk of developing OHT (95% confidence interval (CI): 2.178-11.325) and 4.262 fold increased lifetime risk of developing POAG (95%

CI

1.435-13.255), while T2DM patients had a 2.651 fold increased lifetime risk of developing OHT (95%

CI

2.412-2.915) and 2.62 fold POAG (95%

CI

2.37-2.89). This risk remained high in our sub-analysis, and patients with PDR were at a higher risk compared to those with any stage of NPDR. Sensitivity analyses confirmed these findings across various demographic and clinical variables.

CONCLUSIONS

DR is significantly associated with OHT and POAG, particularly in T1DM. These findings emphasize the need for vigilant screening and comprehensive management of diabetic patients with coexisting DR.

PRECIS

Diabetic retinopathy in diabetic patients significantly increases the risk of ocular hypertension and primary open angle glaucoma, with the highest risk in type 1 diabetics as high as 5-fold compared to those without diabetic retinopathy.