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Longitudinal associations of ocular biometric parameters with onset and progression of diabetic retinopathy in Chinese adults with type 2 diabetes mellitus
  1. Wei Wang1,2,3,
  2. Yifan Chen4,
  3. Kun Xiong1,2,3,
  4. Xia Gong1,2,3,
  5. Xiaoling Liang1,2,3,
  6. Wenyong Huang1,2,3
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  2. 2Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  3. 3Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
  4. 4John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Wenyong Huang, Sun Yat-Sen University, Guangzhou, China; huangwenyong{at}


Aims To investigate the associations of ocular biometric parameters with incident diabetic retinopathy (DR), incident vision-threatening DR (VTDR) and DR progression.

Methods This community-based prospective cohort study recruited participants with type 2 diabetes aged 35–80 years from 2017 to 2019 in Guangzhou, China. Refractive error and ocular biometric parameters were measured at baseline, including axial length (AL), axial length-to-corneal radius (AL/CR) ratio, corneal curvature (CC), lens thickness (LT), anterior chamber depth (ACD), lens power and corneal diameter (CD).

Results A total of 1370 participants with a mean age of 64.3±8.1 years were followed up for two consecutive years. During the follow-up period, 342 out of 1195 (28.6%) participants without DR at baseline had incident DR, 15 out of 175 (8.57%) participants with baseline DR had DR progression and 11 of them progressed to VTDR. After multiple adjustments, a longer AL (OR=0.76; 95% CI, 0.66 to 0.86; p<0.001) and a larger AL/CR ratio (OR=0.20; 95% CI, 0.07 to 0.55; p=0.002) were associated with significantly reduced risks of incident DR but were not associated with incident VTDR or DR progression. Refractive status and other ocular biometric parameters investigated, including ACD, CC, CD, lens power and LT were not associated with any of the DR outcomes (all p>0.05).

Conclusions A longer AL and a larger AL/CR ratio are protective against incident DR. These parameters may be incorporated into future DR risk prediction models to individualise the frequency of DR screening and prevention measures.

  • epidemiology
  • optics and refraction
  • retina

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • WW and YC are joint first authors.

  • WW and YC contributed equally.

  • Contributors WW, YC contributed to study concept and design. WW, KX, XG, WH contributed to acquisition, analysis or interpretation. WW, YC contributed to drafting of the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content. WW contributed to statistical analysis. WW and WH contributed to obtained funding. WW, WH, XL contributed to administrative, technical or material support. WH, XL contributed to study supervision. WH is the guarantor who responsible for the overall content.

  • Funding This study was supported by the National Natural Science Foundation of China (82171084; 82000901; 81900866), the Guangzhou Science & Technology Plan of Guangdong Pearl River Talents Program (202102010162), the Fundamental Research Funds of the State Key Laboratory of Ophthalmology (303060202400362).

  • 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.