| Diabetic retinopathy(DR) and dry eye(DE)are common clinical eye diseases,which not only affect the quality of life of patients,but also cause serious social disease burden.They have become major global public health problems.In order to achieve better prevention and treatment effects of DR and DE,it is necessary to fully investigate their risk factors to explore their exact pathogenesis.However,in China with the highest prevalence,there are few studies on the incidence of DR and DE in large sample sizes.Some recent studies have found that DR and DE are closely related in patients with diabetes mellitus(DM).If DR and DE are indeed closely related to each other in DM patients,it is necessary for us to change our current thinking of diagnosis and treatment in clinical work,and we can no longer diagnose and treat these two eye diseases in isolation.However,the correlation between DR and DE in DM patients is controversial at present,because both may be associated with microvascular disease and neuropathy,and these confounders may lead to a significant correlation between the two eye diseases.In terms of pathogenesis,there is no obvious similarity between DR and DE.Therefore,there is no definite conclusion on the correlation between DR and DE in DM patients.We want to analyze the correlation between DE and DR in DM patients and their respective risk factors from the perspective of population-based epidemiological investigation,so as to provide etiological clues to further clarify the pathogenesis of DR and DE.Part ?:A cross-sectional study on the prevalence and related factors of dry eye and diabetic retinopathy in adult diabetic population.Objective:to investigate the prevalence of DE and DR in adult residents with type 2 DM in Xinjing community,Shanghai,and to explore the relationship between DE and DR and other diabetic microvascular complications.Methods:A cross-sectional study was conducted to collect basic demographic information and subjective dry eye questionnaire information,as well as eye and body examination results of adult DM 2 residents in xinjing community,Shanghai in 2018.Eye examination included Log MAR daily visual acuity,automatic optometry,corneal perception,tear film rupture time(BUT),corneal fluorescence staining(FL),Schirmer I test(SIT),intraocular pressure,anterior posterior segment slit lamp examination,fundus photography and choroidal thickness(CT).Choroidal thickness was measured by swept-source optical coherence tomography(SS-OCT).Diabetic retinopathy was diagnosed according to the International Clinical Classification of Diabetic Retinopathy in 2002.The diagnosis of DE was based on the criteria established by the Asian dry Eye Association in 2016.The diagnosis of diabetic nephropathy(DN)was based on the albumin/creatinine value of the urine sample.The examination of diabetic peripheral neuropathy(DPN)included 10 g nylon wire,128 Hz tuning fork,and tip-therm temperature shallow sensing test.Chi-square test was used to compare the differences between qroups of counting data.Spearman correlation analysis was used to measure the correlation between measurement data.Results:A total of 1718 adult type 2 DM residents in the community were included in the cross-sectional study.1.The prevalence rates of DE,DR,DPN and DN were 35.2%,25.6%,26.8%and 20.5%,respectively.2.The factors related to DE include age(r=0.08,P<0.0l)and DPN(r=0.06,P<0.05).3.The factors associated with DR included gender(?~2=18.31,P=0.00),DPN(r=0.11,P<0.01),DN(r=0.07,P<0.01),corneal fluorescence staining(r=0.13,P<0.01)and corneal perception(r=-0.07,P<0.01).There was a significant negative correlation between average choroid thickness(ACT)and DE,DR,DPN and DE(r=-0.05,P<0.05;r=-0.06,P<0.05;r=-0.07,P<0.01 and r=-0.05,P<0.05).Conclusion:There was no significant correlation between DE and DR in adult patients with type 2 DM,but there were confounders such as DPN and ACT that affected both the two eye diseases.Part ?:A retrospective study of 2-year follow-up of retinopathy in adult patients with diabetes mellitus.Objective:To investigate the incidence,progression and regression of DR among adult type 2 DM residents in Xinjing community,Shanghai,and to explore the related factors.Methods:A retrospective cohort study was conducted to collect the basic demographic information,and results of general examination,fundus slit lamp examination,fundus photography and DR diagnosis of adult type 2DM residents in Xinjing community,Shanghai in 2016 and 2018.Age-and sex-matched residents without diabetes were included as the control group,and the difference of fundus OCT data between them and DM residents was analyzed.The DR progression rate,DR regression rate and related risk factors were calculated based on the data of subjects who were examined in2016 and 2018 with complete fundus diagnosis.Progression was defined as the DR stage worsened in at least one eye,and regression was defined as the DR stage reduced in at least one eye without any invasive eye treatment.Based on the DR diagnosis results in 2018 of subjects without DR in 2016,the 2-year incidence and related risk factors of DR were analyzed.The receiver operating characteristic curve(ROC)was used to test the accuracy of different indicators in predicting the incidence of DR.Result:1.In the 2016 survey,1,250 adults with type 2 DM were included,among which 946,214,39,33 and 19 were non-DR,mild non-proliferative diabetic retinopathy(NPDR),moderate NPDR,severe NPDR and proliferative diabetic retinopathy(PDR)cases,respectively.In addition,1027 residents without DM were selected as healthy controls.Central choroid thickness(CCT)was 223.40?m,216.22?m,213.57?m,211.91?m,178.47?m,and 168.15?m in the healthy control group,no DR,NPDR,moderate NPDR,severe NPDR and PDR groups,respectively,and average choroid thickness(ACT)were 197.83?m,186.94?m,182.03?m,178.00?m,156.91?m,and 136.72?m,respectively.With the increasing severity of DR,CT showed a continuous thinning trend(P for trend<0.001).2.There were 885 DM residents with complete data in 2016 and 2018.(1)Among them,161 residents experienced DR progression within 2 years(the2-year progression rate was 18.19%).High baseline BMI(OR=1.12,95%CI 1.04-1.21,P<0.01),poor glycemic control(OR=1.26,95%CI 1.06-1.50,P=0.01),and older age at the onset of DR(OR=1.05,95%CI 1.01-1.08,P=0.01)is an independent risk factor associated with DR progression.(2)Diabetic retinopathy regression occurred in 63 DM residents within 2 years(the 2-year regression rate was 7.12%).Low baseline age(OR=0.84,95%CI 0.76-0.91,P<0.01),low glycated hemoglobin(Hb A1C)(OR=0.86,95%CI 0.79-0.94,P<0.01),and short duration of diabetes(OR=0.90,95%CI 0.80-0.99,P=0.04)were independent factors associated with DR regression.(3)Among the 537 residents who did not have DR in 2016,82developed DR in 2018(2-year DR incidence was 15.3%).Body mass index(BMI),diabetes course,fasting blood glucose,Hb A1C and ACT were risk factors for 2-year DR onset(P<0.05).There was no correlation between DE and DR onset(?~2=0.46,P=0.50).(4)When the incidence of DR was predicted by ACT,the area under the curve(AUC)was 0.58(P=0.03).The addition of ACT did not improve the predictive ability of DM duration,BMI,fasting blood glucose,and glycated hemoglobin(Hb A1C)for DR incidence(Z=0.85;P=0.40).Conclusion:The CT of adult residents with type 2 DM in the community was significantly thinner,and the CT tended to be thinner with the increasing degree of DR.Thinner ACT was a risk factor for the development of DR.Good blood glucose control is beneficial to the stability and even regression of DR patients.No correlation was found between DE and the onset of DR.Part ?:A retrospective study of 2-year follow-up of dry eye in adult patients with diabetes mellitus.Objective:To investigate the 2-year incidence and related risk factors of DE in adults with type 2 DM in xinjing community,Shanghai.Methods:A retrospective cohort study was conducted to collect basic demographic information,questionnaire information on subjective symptoms of dry eyes,questionnaire information on depressive symptoms,results of eye and body examinations,and laboratory results of blood and urine samples of adult residents with type 2 DM in xinjing community of Shanghai in 2016 and 2018.Eye examination included slit lamp examination,corneal perception,BUT,SIT,FL,fundus photography and CT.Depression symptoms were assessed using the Center for Epidemiologic Studies Depression(CES-D)Self-Report Depression Scale.The results were the incidence of DE and related risk factors.The diagnosis of DE is based on the diagnostic criteria established by the Asian Dry Eye Association in 2016.Results:A total of 460 adults with type 2 DM were enrolled in this study,and 155 developed DE within 2 years,with a 2-year incidence rate of33.7%(95%CI=29.6%-38.3%).With the increase of age,the incidence of DE increased significantly(P<0.01).There was no significant difference in the incidence of females(35.7%)compared with males(31.0%).There was no correlation between DR and DE incidence(?~2=1.54,P=0.22).In the multivariate logistic regression model,age(OR=1.03,95%CI=1.01-1.06,P=0.04),corneal sensitivity(OR=0.97,95%CI=0.94-0.99,P=0.03),and depressive symptoms(OR=1.04,95%CI=1.00-1.08,P=0.04)were independent related factors of the incidence of DE.In the CES-D scale,two items,“I felt that everything I did was an effort”and“I felt sad,”were significantly correlated with DE onset.Conclusion:The incidence of DE among community residents with type 2DM was high.Screening for DE among DM residents,especially residents with advanced age,corneal hypoesthesia,and depression,should be strengthened.No correlation was found between DR and the onset of DE. |
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