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      Relationship between Diabetic Retinopathy and Primary Open-Angle Glaucoma: A Systematic Review and Meta-Analysis


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          Background: Pathophysiological overlaps exist between diabetes and primary open-angle glaucoma (POAG) and presence of diabetes increases the risk of POAG. Considering that diabetic retinopathy (DR) is an ocular complication of diabetes, one could speculate that DR as a severity measure may associate with or even predict POAG. Given that POAG is asymptomatic in early stages, an association to DR may prove clinically important and facilitate an earlier diagnosis of POAG. Objectives: The aim of the study was to investigate if DR is associated with and predictive of POAG. Method: We systematically searched 11 literature databases on May 12, 2021. We screened a total of 1,535 records and found six studies eligible for qualitative and quantitative analysis. Two independent authors reviewed the studies, extracted data, and evaluated risk of bias within individual studies. Studies were reviewed qualitatively, and meta-analyses were made based on the odds ratios (ORs) with 95% confidence intervals (CI) of the association between DR and POAG using the random-effects model. Subgroup analyses were made on the association between subtypes of DR and POAG. Results: Six studies (two longitudinal and four cross-sectional) were eligible for review with a total of 255,614 patients with diabetes, of which 20,483 patients had any degree of DR and 5,258 had POAG. All studies were based on patients with type 2 diabetes except one with both type 1 and type 2 patients. Any DR was not associated with POAG (OR 1.17; 95% CI: 0.58–2.35; p = 0.65). Further stratification revealed that neither cross-sectional (OR 1.00; 95% CI: 0.56–1.81, p = 0.99) nor longitudinal studies (OR 1.47; 95% CI: 0.57–3.78, p = 0.43) demonstrated an association between DR and POAG. Conclusions: We did not find convincing evidence of an associations between DR and prevalent or incident POAG.

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          Most cited references27

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          Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

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            Cochrane Handbook for Systematic Reviews of Interventions

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              Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025

              Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.

                Author and article information

                Ophthalmic Res
                Ophthalmic Research
                S. Karger AG
                August 2022
                21 March 2022
                : 65
                : 4
                : 377-386
                [_a] aDepartment of Ophthalmology, Odense University Hospital, Odense, Denmark
                [_b] bDepartment of Clinical Research, University of Southern Denmark, Odense, Denmark
                [_c] cSteno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
                [_d] dDepartment of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
                Author information
                523940 Ophthalmic Res 2022;65:377–386
                © 2022 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                : 26 September 2021
                : 27 February 2022
                Page count
                Figures: 2, Tables: 4, Pages: 10
                No funding was obtained for this study.

                Vision sciences,Ophthalmology & Optometry,Pathology
                Primary open-angle glaucoma,Systematic review,Diabetic retinopathy,Meta-analysis


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