Glaucoma incidence in an unselected cohort of diabetic patients: is diabetes mellitus a risk factor for glaucoma?
John D Ellisa b c, Josie M M Evansb, Danny A Rutac, Paul S Bainesa, Graham Leesed e, Thomas M MacDonaldb, Andrew D Morrisb d e, for the DARTS/MEMO Collaboration
a Department of
Ophthalmology, Ninewells Hospital and Medical School, Ninewells Road,
Dundee DD1 9SY, UK, b Medicines Monitoring Unit, c Department of Epidemiology and Public Health, d University
Department of Medicine, e Diabetes Centre
Correspondence to: Dr John Ellis JDE{at}14bing.freeserve.co.uk
Accepted for publication 3 May 2000
AIMS
To evaluate
whether diabetes mellitus is a risk factor for the development of
primary open angle glaucoma or ocular hypertension (OHT).
METHODSA historical
cohort study of an unselected population comprising all residents of
the Tayside region of Scotland was performed using record linkage
techniques followed by case note review. Ascertainment of prevalent
diabetes was achieved using the Diabetes Audit and Research in Tayside
Study (DARTS) validated regional diabetes register. Glaucoma and
treated OHT were defined by encashment of community prescriptions and
the statutory surgical procedure coding database.
RESULTSThe study
population comprised 6631 diabetic subjects and 166 144 non-diabetic
subjects aged >40 years without glaucoma or OHT at study entry. 65 patients with diabetes and 958 without diabetes were identified as new
cases of glaucoma or treated OHT during the 24 month study period,
yielding a standardised morbidity ratio of 127 (95% CI, 96-158). Case
note review demonstrated non-differential misclassification of
prevalent glaucoma and OHT as incident disease (diabetic cohort 20%,
non-diabetic cohort 24%; p=0.56) primarily as a result of
non-compliance in medically treated disease. Removing misclassified
cases and adjusting for age yielded an incidence of primary open angle
glaucoma in diabetes of 1.1/1000 patient years (95% CI, 0.89-1.31)
compared to 0.7/1000 patient years (95% CI, 0.54-0.86) in the
non-diabetic cohort; RR 1.57 (95% CI, 0.99-2.48).
CONCLUSIONSThis study
failed to confirm an association between diabetes mellitus and primary
open angle glaucoma and ocular hypertension. A non-significant increase
in diagnosed and treated disease in the diabetic population was
observed, but evidence was also found that detection bias contributes
to this association.
© 2000 by British Journal of Ophthalmology
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- Diabetes and primary open angle glaucoma
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Br. J. Ophthalmol. 2000 84: 1216.[Extract] [Full Text]
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