Association of Primary Open-Angle Glaucoma with Diabetic Retinopathy among Patients with Type 1 and Type 2 Diabetes: A Large Global Database Study

Abstract

PurposeTo assess the correlation between primary open-angle glaucoma (POAG) and the risk of developing diabetic retinopathy (DR) in patients with type 1 and type 2 diabetes mellitus (DM). DesignA retrospective cohort study leveraging the global patient database of TriNetX Research Network. SubjectsThe study included 44,359 DM patients with POAG and 4,393,300 DM patients without any glaucoma ≥18 years of age. Propensity score matching harmonized the cohorts to 39,680 patients each covering diagnoses from January 1, 2005, to January 1, 2023. MethodsWe analyzed data using specific ICD-10 codes for DM and glaucoma. We matched the cohorts using propensity score matching, adjusting for age, sex, race/ethnicity, blood markers, relevant medical history, and ophthalmic service utilization. Main Outcome MeasuresThe primary outcome was the first-time occurrence of DR, including non-proliferative DR (NPDR), and proliferative DR (PDR), in DM patients with and without glaucoma at 1, 5, and 10-year intervals from their individual index dates. ResultsAt 10 years, T1DM patients with POAG exhibited a heightened risk for any DR (adjusted risk ratios (RR): 4.12; 95% CI: 3.05-5.57, p<0.0001) and PDR (RR: 7.02; 95% CI: 3.62- 13.61, p<0.0001). T2DM patients with POAG also faced an increased 10-year risk for any DR (RR: 2.47; 95% CI: 2.28- 2.68, p<0.0001) and PDR (RR: 3.82; 95% CI: 3.09- 4.70, p<0.0001). The combined association of POAG on DR risk in T1DM and T2DM at 10 years was found to be significantly higher among POAG patients (5.45%) compared to those without glaucoma (2.12%) (adjusted hazard ratios (aHR): 2.33; 95% CI: 2.14-2.53). The cumulative incidence of DR was significantly higher in the POAG group compared to non-glaucoma counterparts after a decade (log-rank p < 0.001). ConclusionsOur findings underscore a substantial association between POAG and DR development in both T1DM and T2DM patients, emphasizing the need for vigilant screening and comprehensive management in glaucomatous patients with DM to mitigate the risk of DR. Future research should delve into elucidating the causal mechanisms driving these observed associations.