Abstract
To determine the impact of type 2 diabetes mellitus (T2DM) on visual functions, identify different modifiers as risk or protective factors, and find out how these factors affect patients' visual symptoms and visual functions as a whole. We performed an online survey among 1030 participants (400 patients, 630 non-patients). Demographic features and severity of disease were documented, while visual functions were evaluated using National Eye Institute Visual Functioning questionnaire-25 (NEI VFQ-25). Independent t-test, analysis of variance, linear and nonlinear regression models were used to assess all data. Scores other than color vision among T2DM patients were significantly lower compared with non-T2DM participants. There was significant difference after stratification of age and education, but no significant difference between different genders was observed. Parameters including duration of T2DM, fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) negatively impacted on the scores, with 20years' of diabetic duration, 10mmol/L of FPG, 7.5% of HbA1c being potential cut-off points. Poorer best corrected visual acuity (BCVA) and diagnosis of diabetic retinopathy were risk factors, while they simultaneously produced mediation effect, contributing 5%-78% of effect in the deterioration of visual functions caused by longer diabetic duration and higher blood glucose. Significant visual impairments and faster deterioration in visual functions were seen in T2DM patients, with older age, lower educational level, longer diabetic duration, poorer blood glucose administration, limited BCVA, and the presence of diabetic retinopathy identified as risk factors. Average BCVA and diabetic retinopathy also yielded mediation effect as diabetic duration lengthened and blood glucose elevated.
Highlights
Type 2 Diabetes Mellitus (T2DM) is one of the most common yet severe metabolic diseases affecting millions of people worldwide[1]
Significant visual impairments and faster deterioration in visual functions were seen in T2DM patients, with older age, lower educational level, longer diabetic duration, poorer blood glucose administration, limited Best corrected visual acuity (BCVA), and the presence of diabetic retinopathy identified as risk factors
The questionnaire was divided into three parts, with the first part collecting basic information, the second part featuring severity of disease, and the last part determined visual performance of patients using NEI VFQ-25, which was considered as a valid tool demonstrating multiple levels of functional defects and inconvenience in conducting daily tasks among patients with chronic ophthalmologic diseases[3,6]
Summary
Type 2 Diabetes Mellitus (T2DM) is one of the most common yet severe metabolic diseases affecting millions of people worldwide[1]. T2DM is associated with multiple ophthalmologic complications, diabetic retinopathy[3] and diabetic macular edema[4], which are thought to severely impact on patients’ vision and led to decreased vision-related quality of life and other adverse clinical outcomes. Other minor visual problems related to alterations in refractive error, contrast sensitivity, straylight and presbyopia contributed to visual impairments and disturbance in T2DM patients. As estimated by the WHO Multinational Study of Vascular Disease in Diabetes (WMSVDD) in a 8.4-year follow-up covering 10 centers across the globe, the cumulative incidence of mild, moderate and severe visual impairments in T2DM patients were 9.43%, 3.21% and. The evaluation of visual function should serve as an importance component to assess the well-being of T2DM patients and be treated as valuable trackers or predictors that promote the overall administration of T2DM
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