. 2021 Sep 29;21(1):349.

doi: 10.1186/s12886-021-02114-y.

The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

Chan-Wei Nien^#^{1

2

3}, Chia-Yi Lee^#², Hung-Chi Chen^{4

5

6}, Shih-Chun Chao^{2

3

7}, Hung-Jui Hsu^{1

2}, Shih-Hao Tzeng^{2

4}, Shang-Jung Yang^{8

9}, Jing-Yang Huang¹⁰, Shun-Fa Yang^{11

12}, Hung-Yu Lin^{13

14

15

16}

Affiliations

¹ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.
² Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.
³ Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.
⁴ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁵ Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁶ Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁷ Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.
⁸ Department of Radiology, Shuang-Ho Hospital, Taipei Medical University and School of Medicine, Zhonghe, Taiwan.
⁹ College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁰ Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹¹ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. ysf@csmu.edu.tw.
¹² Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. ysf@csmu.edu.tw.
¹³ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. anthonyhungyulin@hotmail.com.
¹⁴ Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. anthonyhungyulin@hotmail.com.
¹⁵ Department of Optometry, Chung Shan Medical University, Taichung, Taiwan. anthonyhungyulin@hotmail.com.
¹⁶ College of Medicine, National Chung Hsing University, Taichung, Taiwan. anthonyhungyulin@hotmail.com.

^# Contributed equally.

PMID: 34587923
PMCID: PMC8480064
DOI: 10.1186/s12886-021-02114-y

The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

Chan-Wei Nien et al. BMC Ophthalmol. 2021.

. 2021 Sep 29;21(1):349.

doi: 10.1186/s12886-021-02114-y.

Authors

Affiliations

¹ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.
² Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.
³ Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.
⁴ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁵ Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁶ Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁷ Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.
⁸ Department of Radiology, Shuang-Ho Hospital, Taipei Medical University and School of Medicine, Zhonghe, Taiwan.
⁹ College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁰ Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹¹ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. ysf@csmu.edu.tw.
¹² Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. ysf@csmu.edu.tw.
¹³ Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. anthonyhungyulin@hotmail.com.
¹⁴ Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. anthonyhungyulin@hotmail.com.
¹⁵ Department of Optometry, Chung Shan Medical University, Taichung, Taiwan. anthonyhungyulin@hotmail.com.
¹⁶ College of Medicine, National Chung Hsing University, Taichung, Taiwan. anthonyhungyulin@hotmail.com.

^# Contributed equally.

PMID: 34587923
PMCID: PMC8480064
DOI: 10.1186/s12886-021-02114-y

Abstract

Background: The effect of diabetic retinopathy (DR) on the development of sight-threatening cataracts was assessed using the National Health Insurance Research Database of Taiwan.

Methods: Patients diagnosed with diabetes mellitus (DM) and DR were enrolled in the study group. Age- and sex-matched DM individuals without DR and patients without DM served as the DM control group and non-DM control group, respectively, both with 1:4 ratios. The outcome was set as the performance of cataract surgery. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (aHR) of DR considering multiple factors underlying cataract formation.

Results: A total of 3297 DR patients, 13,188 DM control patients and 13,188 non-DM control subjects were enrolled. The study group included 919 events of sight-threatening cataracts (27.87%), the DM control group included 1108 events (8.40%), and the non-DM control group included 957 events (7.26%). A multivariable analysis indicated that the study group presented a higher aHR of cataract surgery (2.93, 95% CI: 2.60-3.30) and a higher cumulative probability of cataract surgery than both the DM control and non-DM control groups (both log rank P < 0.001). In addition, both the proliferative DR (3.90, 95% CI: 3.42-4.45) and nonproliferative DR (2.35, 95% CI: 2.08-2.65) subgroups showed a higher aHR of cataract surgery than the DM control group.

Conclusion: The presence of DR increases the risk of sight-threatening cataracts that warrant surgery, and the effect is prominent among patients with both proliferative DR and nonproliferative DR.

Keywords: Cataract surgery; Diabetes mellitus; Diabetic retinopathy; Epidemiology.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
The flowchart of patients selection. LHID: Longitudinal Health Insurance Database 2005 version. DM: diabetes mellitus. DR: diabetic retinopathy

**Fig. 2**
The cumulative probability of sight-threatening cataract among the study and control groups. * denotes Log rank P < 0.001, diabetic retinopathy versus Non-DM control. ^# denotes Log rank P < 0.001, diabetic retinopathy versus DM control

See this image and copyright information in PMC

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The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

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The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study

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