ABSTRACT
Glaucoma is considered the leading cause of irreversible blindness worldwide. Patients with diabetes are at risk of different eye complications, mainly retinopathy. Patients with diabetes are also at risk of developing cataract, uveitis and glaucoma. Three systematic reviews examined the associations between diabetes and glaucoma. Pooled analysis from those studies reported different OR 1.37, (95% CI=0.72-2.02), OR=1.36, (95% CI=1.25-1.50) and OR=1.48, (95% CI=1.29-1.71). Although the results seem close and suggest an increased risk in the diabetic population, the systematic reviews report significant heterogenicity and come short in explaining causality. Indeed, in one systematic review where 3 out of 7 studies suggested a non-significant association, the results were skewed to the positive side with a one-record based study that had a population size exceeding 2 million patients, while the rest of the studies had collectively 100 thousand patients. In our view, a case control study design that combines the patient surveys and electronic medical records ensure accurate data and more valid study results to validate or refute the association. This short communication article discusses the condition associations, theories for increased risk in the diabetic population and implications for future research.
ABSTRACT
Background: Diabetic patients are at increased risk of glaucoma compared to the general population. Risk factors for glaucoma that is specific to diabetic patients include increased IOP, retinopathy and neovascular changes and years since diagnosis of diabetes. This cross-sectional study aims to report on the prevalence of glaucoma in diabetic patients in community diabetes centre in Sudan and examine associations with previously reported risk factors.Methods: A cross-sectional study was carried out in Omdurman specialised diabetic healthcare centre in Sudan. A total of 300 patients consented to participation. All patients filled in a survey for both demographics and diabetic disease history then had an assessment for glaucoma by an ophthalmologist. The assessment included examination of the anterior segment, optic nerve assessment and fundus examination using a stereoscopic slit lamp, intraocular pressure (IOP) measurement using tonometry, peripheral anterior chamber configuration and depth assessments using gonioscopy and central visual field assessment using perimetry.Results: Prevalence of open-angle glaucoma diagnosis was 2.8% among diabetic patients who were included in this study. Family history for glaucoma was significantly associated with increased risk of open-angle glaucoma (OR 5.67, 95% CI 1.74-18.45). Retinopathy was also associated with an increased risk of developing the condition (OR 3.1, 95% CI 1.11-8.51). Gender, years since diabetes diagnosis and medications did not have significant associations.Conclusions: Patients with diabetes are at increased risk of developing open-angle glaucoma, but the prevalence among the diabetic population attending community diabetes centre in Sudan remains low. Among different clinical determinants, diabetic retinopathy and genetic determinants may explain the increased risk in the diabetic population.