Ocular Axial Length and Diabetic Retinopathy: The Kailuan Eye Study

Abstract

Citation: Wang Q, Wang YX, Wu SL, et al. Ocular axial length and diabetic retinopathy: the Kailuan Eye Study. Invest Ophthalmol Vis Sci. 2019;60:3689-3695. https://doi.org/ 10.1167/iovs.19-27531 PURPOSE.To examine the role of ocular axial length as an ocular parameter for the prevalence and severity of diabetic retinopathy (DR). METHODS.The cross-sectional Kailuan Diabetic Retinopathy Study included patients with diabetes who participated in the community-based longitudinal Kailuan Study and who had undergone ocular fundus photography. The fundus photographs were graded using the Early Treatment of Diabetic Retinopathy Study criteria. RESULTS.The study included 1096 patients with diabetes (mean age: 60.8 6 9.4 years; axial length: 23.37 6 0.92 mm). In binary regression analysis, a higher DR prevalence was associated with shorter axial length (P ¼ 0.007; odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.70, 0.95) after adjusting for longer known duration of diabetes (P ¼ 0.02; OR: 1.13; 95%CI: 1.02, 1.24) and higher fasting blood glucose concentration (P < 0.001; OR: 1.38; 95%CI: 1.26, 1.52). A more severe DR stage was associated (regression coefficient r: 0.46) with shorter ocular axial length (P ¼ 0.047; standardized regression coefficient b: À0.06) after adjusting for higher fasting blood glucose (P < 0.001; b: 0.41) and longer known duration of diabetes (P ¼ 0.045; b: 0.07). Longer axial length was associated with a lower DR prevalence (P ¼ 0.003; b: À0.10) after adjusting for younger age (P < 0.001), male sex (P < 0.001), higher body mass index (P ¼ 0.016), and lower fasting blood glucose concentration (P ¼ 0.036). CONCLUSIONS.After adjusting for systemic risk factors, DR prevalence decreased by 19% (95%CI: 5, 30) for each millimeter increase in axial length. With longer axial length being a surrogate for axial myopia, the marked increase in myopia prevalence worldwide may lead to a relative decrease in the prevalence and incidence of DR in future.

Association between ocular biometrical parameters and diabetic retinopathy in Chinese adults with type 2 diabetes mellitus

“…Longer AL was associated with lower risk for both DR and VTDR, which was consistent with previous studies. Several population‐based studies suggested that AL played a different role in DR occurrence and development in different ethnicities, although some contradictory results existed in literature (He et al 2017; Bikbov et al 2019; Wang et al 2019). It was reported that AL was not related to DR based on Indian population(Ganesan et al 2012).…”

“…Whether the ocular structure or the refracting media, or both, could be a protective factor of DR is still under debate. Several studies have evaluated the association of axial length (AL), myopia and refracting media with DR (Chao et al 2016; He et al 2017; Bikbov et al 2019; Man et al 2019; Wang et al 2019). However, the investigators have not yet reached a consensus on the implications of these results.…”

Choroidal vascular changes in retinitis pigmentosa patients detected by optical coherence tomography angiography

“…The present study was a prospective observational cohort of 34 patients who were recruited from the Beijing Tongren Eye Centre with a diagnosis of RP from January 2019 to October 2019. For retinal evaluation, 32 normal control individuals were recruited from the Kailuan Eye Study as the control group, who were age- and gender-matched with the RP patients [ 10 ]. For choroidal evaluation, 17 normal control eyes from patients were recruited from the outpatient department in Beijing Tongren Eye Centre who underwent VG-200 OCTA examination and other ophthalmic examinations.…”

Association of axial length with retinal thickness and choroidal thickness in diabetic patients

“…The Kailuan Diabetic Retinopathy Study indicated that subfoveal CT decreased with AL elongation among 1,154 diabetic participants. 5 However, both these studies did not analyze the relationship between AL and CT in other macular subgrids. The reverse relationship between AL and foveal CT was also confirmed in high myopic eyes, 29 young health adults, 30 those with angle closure, 31 and population-based studies.…”