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Rates of choroidal loss and ganglion cell–inner plexiform layer thinning in type 2 diabetes mellitus and healthy individuals: a 2-year prospective study
  1. Ziwen Hui1,2,
  2. Xiao Guo1,
  3. Gabriella Bulloch3,
  4. Meng Yuan1,
  5. Kun Xiong1,
  6. Shiran Zhang1,
  7. Yifan Chen4,
  8. Yuting Li1,
  9. Huan Liao5,
  10. Wenyong Huang1,
  11. Zhuoting Zhu3,
  12. Wei Wang1
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
  2. 2 Zhongs School of Medicine, Sun Yat-Sen University, Guangzhou, China
  3. 3 Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
  4. 4 University of Oxford, Oxford, UK
  5. 5 University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Wei Wang, Sun Yat-Sen University Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Guangzhou, Guangdong 510000, China; wangwei{at}; Dr Zhuoting Zhu; lisa.zhu{at}


Aims To investigate longitudinal choroid and ganglion cell–inner plexiform layer (GCIPL) changes in type 2 diabetes mellitus (T2DM) patients and healthy populations across 2 years.

Methods This prospective cohort study included T2DM patients and healthy controls. T2DM patients were divided into mild non-proliferative diabetic retinopathy (NPDR) or non-DR (NDR) groups. Macular choroidal and GCIPL thickness was measured using swept-source optical coherence tomography at baseline and follow-up after 2 years. A linear-mixed effect model compared rates of change in choroidal and GCIPL thicknesses between the three groups.

Results 895 T2DM patients (770 in the NDR group and 125 in the NPDR group) and 847 healthy controls were included. Following 2 years, choroidal thinning occurred at a rate of −7.7±9.2 µm/year, −8.1±8.7 µm/year and −5.2±8.1 µm/year in NDR, NPDR and control groups, respectively (p<0.001). GCIPL loss occurred quickest in NPDR patients (−0.97±0.97 µm/year), followed by NDR (−0.91±0.89 µm/year) and the control group (−0.04±0.55 µm/year) (p<0.001). Following multivariate adjustment, choroidal thinning was −2.04 µm/year (95% CI: −4.05 to –0.03; p=0.047) and −1.95 µm/year (95% CI: −3.14 to –0.75; p=0.001) faster in NPDR and NDR groups than in the control group, respectively, and GCIPL thinning was −1.02 µm/year (95% CI: −1.19 to –0.84; p<0.001) and −0.88 µm/year (95% CI: −0.98 to –0.78; p<0.001) faster in the NPDR and NDR groups than in the control group, respectively.

Conclusion Progressive choroidal and GCIPL thinning occurs in healthy individuals and T2DM patients; however, T2DM undergoes accelerated choroidal and GCIPL loss in NPDR patients.

  • Choroid
  • Epidemiology
  • Retina

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • ZH and XG are joint first authors.

  • ZZ and WW contributed equally.

  • Contributors WW and WH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: WW, YL, XG, ZZ and WH. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: all authors. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: WW. Obtained funding: WH and WW. Administrative, technical or material support: ZZ, WH and WW. Study supervision: WH. WH is guarantor.

  • Funding This study was supported by Guangzhou Science & Technology Plan of Guangdong Pearl River Talents Program (202102010162) and the National Natural Science Foundation of China (82000901) and the Fundamental Research Funds of the State Key Laboratory of Ophthalmology (303060202400362).

  • Disclaimer The funding organisations had no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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