Diabetes mellitus as a Risk Factor for Glaucomatous Optic Neuropathy

Nakamura, Makoto; Kanamori, Akira; Negi, Akira

doi:10.1159/000081775

Cited by 100 publications

(63 citation statements)

References 141 publications

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“…There is increasing evidence that diabetes causes microvascular damage and compromises glial and neuronal function and metabolism in the retina, making retinal neurons including retinal ganglion cells more susceptible to glaucomatous damage [4] . Additionally, diabetes seems to increase the susceptibility of retinal ganglion cells to stresses related to OAG such as elevated intraocular pressure (IOP) [5] .…”

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confidence: 99%

Diabetes Mellitus Affects Biomechanical Properties of the Optic Nerve Head in the Rat

et al. 2011

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Background: To investigate the effect of diabetes on the biomechanical behavior of the optic nerve head (ONH) and the peripapillary sclera (ppSc) in streptozocine-induced diabetic rats. Methods: Diabetes mellitus was induced in 20 Wistar rats using streptozocine. Twenty-five nondiabetic rats served as controls. Eyes were enucleated after 12 weeks and 2 strips of one eye were prepared containing ONH or ppSc. The stress-strain relation was measured in the stress range of 0.05–10 MPa using a biomaterial tester. Results: At 5% strain the stress of the ONH in diabetic rats was 897 ± 295 kPa and in the control group it was 671 ± 246 kPa; there was a significant difference between both groups (p = 0.011). The stress of the diabetic ppSc (574 ± 185 kPa) increased compared to that of the nondiabetic ppSc (477 ± 171 kPa), but this did not reach statistical significance (p = 0.174). The calculated tangent modulus at 5% strain was 11.79 MPa in the diabetic ONH and 8.77 MPa in the nondiabetic ONH; there was a significant difference between both groups (p = 0.006). The calculated tangent modulus at 5% strain was 7.17 MPa in the diabetic ppSc and 6.12 MPa in the nondiabetic ppSc, without a statistically significant difference (p = 0.09). Conclusion: In contrast to the ppSc, the ONH of diabetic rats showed a significant increase in stiffness compared to nondiabetic rats, which might be explained by nonenzymatic collagen cross-linking mediated by advanced glycation end products due to high blood glucose levels in diabetes. Further studies are needed to investigate if these biomechanical changes represent a detrimental risk factor for intraocular pressure regulation in diabetic glaucoma patients.

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Diabetes Mellitus Affects Biomechanical Properties of the Optic Nerve Head in the Rat

et al. 2011

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“…23 In addition to altering vascular tissues, DM compromises glial and neuronal functions and metabolism in the retina, which can make retinal neurons including retinal ganglion cells more susceptible to glaucomatous damage. 24 Furthermore, DM increases the susceptibility of retinal ganglion cells to additional stresses relating to OAG such as elevated IOP. 25 It seems reasonable to consider that a longer duration of DM with a prolonged insult to the retina and optic nerve via vascular, glial, and neuronal factors would be associated with a higher risk of OAG.…”

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Type 2 Diabetes Mellitus and the Risk of Open-angle Glaucoma

et al. 2008

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Purpose-To examine the relationship between type 2 diabetes mellitus (T2DM) and the risk of having open-angle glaucoma (OAG) in an adult Latino population. Design-Population-based cross-sectional study.Participants-Latinos 40 years and older (n = 5894) from 6 census tracts in Los Angeles, California. Methods-Participants from the Los Angeles Latino Eye Study (LALES), a large populationbased study of self-identified adult Latinos, answered an interviewer-administered questionnaire and underwent a clinical and complete ocular examination, including visual field (VF) testing and stereo fundus photography. A participant was defined as having diabetes mellitus (DM) if she or he had a history of being treated for DM, the participant's glycosylated hemoglobin was measured at 7.0% or higher, or the participant had random blood glucose of 200 mg% or higher. Type 2 DM was defined if the participant was 30 years or older when diagnosed with DM. Open-angle glaucoma was defined as the presence of an open angle and a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Logistic regression analysis was used to identify the risk of having OAG in persons with T2DM. Main Outcome Measure-Prevalence of OAG.Results-Of the 5894 participants with complete data, 1157 (19.6%) had T2DM and 288 (4.9%) had OAG. The prevalence of OAG was 40% higher in participants with T2DM than in those without T2DM (age/gender/intraocular pressure-adjusted odds ratio, 1.4; 95% confidence interval, HHS Public Access Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript 1.03-1.8; P = 0.03). Trend analysis revealed that a longer duration of T2DM (stratified into 5-year increments) was associated with a higher prevalence of OAG (P<0.0001). Conclusion-The Participants and Methods DesignParticipants were identified through the LALES, 18 a large population-based survey, from 2000 to 2003. The LALES was designed to estimate the prevalence of ocular disease, associated risk factors, quality of life, and access to health care in noninstitutionalized selfidentified adult Latinos, 40 years and older, living in the city of La Puente, California. The LALES survey methods and socioeconomic characteristics of LALES participants have been described in detail previously. 18 In the LALES, 82% (n = 6357) of eligible persons (n = 7789) completed the clinical examination. 18 Participants with incomplete data (n = 463) were excluded from the analyses. Thus, our cross-sectional study cohort consisted of 5894 consecutively enrolled adult Latinos, predominantly of Mexican ancestry, who completed an in-home interview and a complete clinical eye examination, as well as additional laboratory testing for diabetes. The institutional review board at the University of Southern California approved the study protocol, and all study procedures conformed to the Health Insurance Clinical Procedures and DefinitionsAfter informed consent was obtained, participants underwent a complete ophthalmic examination, including det...

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“…3 Patients with diabetic retinopathy are at risk of developing glaucoma. 19 The measurement of visual field in eyes with glaucoma and coexisting diabetic retinopathy often is affected by retinal hemorrhage, exudates, and diabetesassociated retinal nerve fiber loss. 20 Previous studies have shown that MPC results in visual field defects in automated perimetry in a significant number of patients.…”

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confidence: 99%