Gao Fei , Emmanuel Eric Pazo , Miao Xiaoxia , Hu Liying , Li Xiaorong , Liu Juping
  • Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China;
Liu Juping, Email: tydljp@126.com
Age-related macular degeneration; Diabetic retinopathy; Epidemiology study; Risk factor; Multimorbidity study
10.3760/cma.j.cn511434-20250326-00135
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Objective To explore the multimorbidity of age-related macular degeneration (AMD) and diabetic retinopathy (DR) in diabetic patients, and observe the association between AMD and the two-year progression of DR. Methods A prospective cohort study. The data were obtained from the Phase I baseline and Phase II follow-up of the Beichen Eye Study, which was conducted from June 2020 to August 2023, and the data from participants with diabetes were extracted for analysis. The baseline study included demographic data, anthropometric indices, ocular biometry, visual acuity, fundus imaging, Lens Opacities Classification System Ⅲ grade, questionnaires and laboratory information, etc., and follow-up was performed after two years. DR diagnosis and grading was performed based on the DR International Classification Criteria, and the eye with the heavier DR classification was taken as the affected eye. According to whether there was new-onset DR or DR progression at the follow-up visit, patients were divided into DR non-progressing group and progressing group. The Wisconsin AMD grading standard was used for AMD diagnosis and grading. Quantitative data were compared using the Mann-Whitney U test, and categorical variables were compared using the χ2 test or Fisher's exact test. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval. Sub-group analysis would be executed if the primary analysis had no significant results. Sensitivity analysis was conducted after the application of multiple imputation for missing data. Results A total of 1 190 eligible diabetic patients were included at baseline. The observed prevalence rates were 22.69% (270/1 190) for DR, 25.97% (309/1 190) for AMD, and 6.64% (79/1 190) for DR-AMD co-morbidity. Among the 741 patients who completed the 2-year follow-up, 95 cases (12.82%) were in the DR Progression group and 646 cases (87.18%) were in the non-progression group. Compared with those without AMD, the prevalence of DR In patients with early (24.44%, 66/270), middle (4.07%, 11/270), late atrophic AMD (0.37%, 1/270), and exudative AMD (0.37%, 1/270) showed an increasing trend. However, the differences were not statistically significant (P＞0.05). The results of logistic regression analysis showed that having AMD at baseline was an independent risk factor for DR (OR=1.532, P=0.026). During the follow-up period, subgroup analysis revealed that in AMD patients with an axial length of 22.9-23.5 mm (OR=4.507, P=0.028) OR a platelet-lymphocyte ratio of 99.5-122.0 (OR=4.107, P=0.015), the risk of DR Progression was significantly increased. The results of the sensitivity analysis after multiple imputation of the missing data remained stable. Conclusion AMD in DM patients over 50 years of age is an independent risk factor for DR prevalence and progression.

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