Ocular risk markers effective at predicting vision-threatening complications in diabetes – Healio

Martinho AC, et al. Diabetes Care. 2021;doi:10.2337/dc20-1125.
Martinho AC, et al. Diabetes Care. 2021;doi:10.2337/dc20-1125.
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.
Kyle Sandberg, OD, FAAO
We all know that lowering HbA1c and keeping cholesterol and blood pressure in check lead to healthier outcomes in our patients with diabetes. Here, the authors offer a few ocular findings that may outweigh even those systemic metrics in predicting sight-threatening complications of diabetes.
Over the 5-year study, they found that closely monitoring MAT, baseline central retinal thickness and ganglion cell layer-inner plexiform layer thickness is an important factor in predicting if our patients will develop some form of macular edema. Interestingly, these factors become even more important in our younger patients and those with lower BMI.
That said, the data are not ready for broad clinical application quite yet. First, there were only a handful of eyes in this small study that developed the negative endpoints. Second, the ocular characteristics mentioned may be challenging for the average eye care provider to follow. At minimum, access to spectral-domain OCT is needed. Further, the authors used an automated retinal image analysis system to monitor MAT, a technology that is not ubiquitous in primary eye care settings. Still, the data demonstrate that compared with traditional systemic markers, our ocular findings have an important role in predicting long-term outcomes in our patients with diabetes.
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