Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 25;12(4):727.
doi: 10.3390/biomedicines12040727.

The Association between Diabetic Retinopathy and Macular Degeneration: A Nationwide Population-Based Study

Hsin-Ting Lin  1   2 , Cai-Mei Zheng  3   4   5   6 , Cheng-Hung Tsai  7 , Ching-Long Chen  1   2 , Yu-Ching Chou  7 , Jing-Quan Zheng  6   8 , Yuh-Feng Lin  2   3   5   6 , Chia-Wei Lin  9   10   11 , Yong-Chen Chen  12 , Chien-An Sun  13 , Jiann-Torng Chen  1   2
Affiliations

The Association between Diabetic Retinopathy and Macular Degeneration: A Nationwide Population-Based Study

Hsin-Ting Lin et al. Biomedicines. .

Abstract

Objective: Age-related macular degeneration (AMD), particularly its exudative form, is a primary cause of vision impairment in older adults. As diabetes becomes increasingly prevalent in aging, it is crucial to explore the potential relationship between diabetic retinopathy (DR) and AMD. This study aimed to assess the risk of developing overall, non-exudative, and exudative AMD in individuals with DR compared to those without retinopathy (non-DR) based on a nationwide population study in Taiwan.

Methods: A retrospective cohort study was conducted using the Taiwan National Health Insurance Database (NHIRD) (2000-2013). A total of 3413 patients were placed in the study group (DR) and 13,652 in the control group (non-DR) for analysis. Kaplan-Meier analysis and the Cox proportional hazards model were used to calculate the hazard ratios (HRs) and adjusted hazard ratios (aHRs) for the development of AMD, adjusting for confounding factors, such as age, sex, and comorbid conditions.

Results: Kaplan-Meier survival analysis indicated a significantly higher cumulative incidence of AMD in the DR group compared to the non-DR group (log-rank test, p < 0.001). Adjusted analyses revealed that individuals with DR faced a greater risk of overall AMD, with an aHR of 3.50 (95% CI = 3.10-3.95). For senile (unspecified) AMD, the aHR was 3.45 (95% CI = 3.04-3.92); for non-exudative senile AMD, it was 2.92 (95% CI = 2.08-4.09); and for exudative AMD, the aHR was 3.92 (95% CI = 2.51-6.14).

Conclusion: DR is a significant risk factor for both overall, senile, exudative, and non-exudative AMD, even after adjusting for demographic and comorbid conditions. DR patients tend to have a higher prevalence of vascular comorbidities; however, our findings indicate that the ocular pathologies inherent to DR might have a more significant impact on the progression to AMD. Early detection and appropriate treatment of AMD is critically important among DR patients.

Keywords: Taiwan National Health Insurance Database (NHIRD); age-related macular degeneration (AMD); diabetes mellitus (DM); diabetic retinopathy (DR); non-diabetic retinopathy (non-DR).

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flowchart. AMD = age-related macular degeneration, LHID = Longitudinal Health Insurance Database.
Figure 2
Figure 2
Cumulative risk of all types of AMD (age-related macular degeneration) (ICD-9 code 362.50, 362.51, and 362.52) in the DR group and the non-DR group.
Figure 3
Figure 3
Cumulative risk of senile (unspecified) age-related macular degeneration (ICD-9 code 362.50) in the diabetic retinopathy cohort and the comparison cohort.
Figure 4
Figure 4
Cumulative risk of non-exudative age-related macular degeneration (ICD-9 code 362.51) in the diabetic retinopathy cohort and the comparison cohort.
Figure 5
Figure 5
Cumulative risk of exudative age-related macular degeneration (ICD-9 code 362.52) in the diabetic retinopathy cohort and the comparison cohort.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Donath M.Y., Shoelson S.E. Type 2 diabetes as an inflammatory disease. Nat. Rev. Immunol. 2011;11:98–107. doi: 10.1038/nri2925. - DOI - PubMed
    1. Pickup J.C. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care. 2004;27:813–823. doi: 10.2337/diacare.27.3.813. - DOI - PubMed
    1. Adamis A.P., Miller J.W., Bernal M.T., D’Amico D.J., Folkman J., Yeo T.K., Yeo K.T. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am. J. Ophthalmol. 1994;118:445–450. doi: 10.1016/S0002-9394(14)75794-0. - DOI - PubMed
    1. Kauppinen A., Paterno J.J., Blasiak J., Salminen A., Kaarniranta K. Inflammation and its role in age-related macular degeneration. Cell Mol. Life Sci. 2016;73:1765–1786. doi: 10.1007/s00018-016-2147-8. - DOI - PMC - PubMed
    1. Al-Kharashi A.S. Role of oxidative stress, inflammation, hypoxia and angiogenesis in the development of diabetic retinopathy. Saudi J. Ophthalmol. 2018;32:318–323. doi: 10.1016/j.sjopt.2018.05.002. - DOI - PMC - PubMed