Effects of refraction and axial length on the development and progression of diabetic retinopathy
DOI: 10.32364/2311-7729-2021-21-4-205-209
M.M. Bikbov, O.I. Orenburkina, A.E. Babushkin, A.A. Fakhretdinova
Ufa Research Institute of Eye Diseases, Ufa, Russian Federation
Eye disorders have a special place in diabetes since visual impairment has a significant effect on the quality of life. Therefore, determining risk factors and prognostic criteria for disease course are essential for developing strategies for early prevention of diabetic retinopathy (DR). This paper addresses studies on various aspects of DR in patients with myopia. It was demonstrated that DR arises, develops, and progresses in different ways under various axial lengths (AL). Thus, many authors report that DR barely occurs in high myopia. Some of them account for this phenomenon for poor blood circulation in a long myopic eye. Others refer to a significantly lower vascular endothelial growth factor (VEGF) concentration in longer eyes or eyes with myopic refraction. The third authors argue a focal disintegration of retinal pigment epithelium to eliminate metabolic end products through the choroid and sclera. As a result, neither acidosis nor venous congestion develops, and end othelial barrier function remains unaffected
Keywords: diabetic retinopathy, myopia, axial length, vascular endothelial growth factor, emmetropia, hyperopia, diabetes.
For citation: Bikbov M.M., Orenburkina O.I., Babushkin A.E., Fakhretdinova A.A. Effects of refraction and axial length on the development and progression of diabetic retinopathy. Russian Journal of Clinical Ophthalmology. 2021;21(4):205–209 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-205-209.
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23. Man R.E., Sasongko M.B., Sanmugasundram S. et al. Longer axial length is protective of diabetic retinopathy and macular edema. Ophthalmology. 2012;119:1754–1759. DOI: 10.1016/j.ophtha.2012.03.021.
24. Man R.E., Sasongko M.B., Wang J.J., Lamoureux E.L. Association between myopia and diabetic retinopathy: a review of observational findings and potential mechanisms. Clin. Exp. Ophthalmol. 2013;41(3):293–301. DOI: 10.1111/j.1442-9071.2012.02872.x.
25. Gupta P., Liang Gan A., Man R.E. Impact of Incidence and Progression of Diabetic Retinopathy on Vision-Specific Functioning Ophthalmology. 2018;125(9):1401–1409. DOI: 10.1016/j.ophtha.2018.02.011.
26. Xu L., Li Y., Zheng Y., Jonas J.B. Associated factors for age-related maculopathy in the adult population in China: the Beijing eye study. Br J Ophthalmol. 2006;90:1087–1090.
27. Wang Q., Wang Y.X., Wu S.L. et al. Ocular Axial Length and Diabetic Retinopathy: The Kailuan Eye Study. Invest Ophthalmol Vis Sci. 2019;60:3689–3695. DOI: 10.1167/iovs.19-27531.
28. Balashevich L.I. Ocular manifestations of diabetes. StP.: StPMAPO; 2004 (in Russ.).
29. Bobr T. Peculiarities of the course of diabetic retinopathy depending on the size of the anteroposterior axis of the eyeball. Ophthalmology. Eastern Europe. 2017;2(7):152–156 (in Russ.).
30. Fu Y., Geng D., Liu H., Che H. Myopia and/or longer axial length are protectiveagainst diabetic retinopathy: a meta-analysis. Acta Ophthalmol. 2016;94:346–352. DOI: 10.1111/aos.12908.
31. Wang X., Tang L., Gao L. et al. Myopia and diabetic retinopathy: A systematic review and metaanalysis. Diabetes Res Clin Pract. 2016;111:1–9. DOI: 10.1016/j.diabres.2015.10.020.
32. Wat N., Wong R.L., Wong I.Y. Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med. J. 2016;22(6):589–599. DOI: 10.12809/hkmj164869.
33. Bazzazi N., Akbarzadeh S., Yavarikia M. High myopia and diabetic retinopathy: A Contralateral Eye Study in Diabetic Patients With High Myopic Anisometropia. Retina. 2017;37(7):1270–1276. DOI: 10.1097/IAE.0000000000001335.
34. Moss S.E., Klein R., Klein B.E. Ocular factors in the incidence and progression of diabetic retinopathy. Ophthalmology. 1994;101(1):77–83.
35. Khismatullin R.R., Orenburkina O.I., Babushkin A.E. Analysis of phacoemulsification in patients with diabetes mellitus with different clinical refraction. Point of view. East-West. 2016;2:57–60 (in Russ.).
36. Yamamoto S., Nitta K., Kamiyama M. Cone electroretinogram to chromatic stimuli in myopic eyes. Vision Res. 1997;37:2157– 2159.
37. Lin Z., Li D., Zhai G. et al. High myopia is protective against diabetic retinopathy via thinning retinal vein: A report from Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT) Diab Vascr Dis Res. 2020;2:1–8. DOI: 10.1177/1479164120940988.
38. Srinivas S., Tan O., Nittala M.G. et al. Assessment of retinal blood flow in diabetic retinopathy using Doppler Fourier-domain optical coherence tomography. Retina. 2017;37:2001–2007. DOI: 10.1097/IAE.0000000000001479.
39. Mirzabekova K.A. Clinical and technological features of laser treatment of diabetic retinopathy with ametropia: Thesis. M.; 2004 (in Russ.).
40. Wenger G.E., Wenger L.V., Burdeiny S.I. Modern views on the pathogenesis of progressive myopia and the possibilities of its treatment Tavrichesky medico-biological bulletin. 2012;15(3):25–29 (in Russ.).
41. Jonas J.B., Tao Y., Neumaier M., Findeisen P. VEGF and Refractive Error. Ophthalmology. 2010;117:2234–2234. DOI: 10.1016/j.ophtha.2009.12.006.
42. Wilkinson-Berka J.L. Vasoactive factors and diabetic retinopathy: vascular endothelial growth factor, cyclooxygenase-2 and nitric oxide. Curr Pharm Des. 2004;10:3331–3348.
43. Shin Y.J., Nam W.H., Park S.E., Kim J.H. Aqueous humor concentrations of vascular endothelial growth factor and pigment epithelium-derived factor in high myopic patients. Mol Vis. 2012;18:2265–2270.
44. Kulshrestha A., Singh N., Moharana B. Axial Myopia, a Protective Factor for Diabetic Retinopathy-Role of Vascular Endothelial Growth Factor. Research square. 2021. DOI: 10.21203/rs.3.rs-789805/v1.
45. Ikram M.K., van Leeuwen R., Vingerling J.R. et al. Relationship between refraction and prevalent as well as incident age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci. 2003;44:3778–3782.
46. Nesterov A.P. The role of local factors in the pathogenesis of diabetic retinopathy. Vestnik oftal’mologii. 1994;4:7–9 (in Russ.).
47. Luo J., Liu S.Z., Wu X.Y., Xia Z.H. Distributive character of multifocal electroretinogram in high myopia subjects. Int J Ophthalmol. 2006;6:1339–1341.
48. Luu C.D., Lau A.M.I., Lee S.Y. Multifocal electroretinogram in adults and children with myopia. Arch Ophthalmol. 2006;124:328–334.
49. Wolsley C.J., Saunders K.J., Silvestri G., Anderson R.S. Investigation of changes in the myopic retina using multifocal electroretinograms, optical coherence tomography and peripheral resolution acuity. Vision Res. 2008;48:1554–1561.
50. Wen X., Li Z., Xiao J. et al. Association of Myopia With Microvascular Alterations in Patients With Type 2 Diabetes: An Optical Coherence Tomography Angiography Study. Front. Med. Oct. 2021;8:715074. DOI: 10.3389/fmed.2021.715074.
51. Hong F., Yang D., Li L. Relationship between aqueous humor levels of cytokines and axial length in patients with diabetic retinopathy. Asia Pac J Ophthalmol. 2020;9:149–155. DOI: 10.1097/APO.0000000000000270.
2. Balashevich L.I., Izmailova A.S. Diabetic ophthalmology. SPb.: Chelovek; 2012 (in Russ.).
3. Flaxman S.R., Bourne R.R.A., Resnikoff S. et al. Vision Loss Expert Group of the Global Burden of Disease Study. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:1221–1234. DOI: 10.1016/S2214-109X(17)30393-5.
4. Rodriguez-Poncelas A., Miravet-Jiménez S., Casellas A. et al. Prevalence of diabetic retinopathy in individuals with type 2 diabetes who had recorded diabetic retinopathy from retinal photographs in Catalonia (Spain). Br J Ophthalmol. 2015;99:1628–1633. DOI: 10.1136/bjophthalmol-2015-306683.
5. Simó R., Stehouwer C.D.A., Avogaro A. Diabetic retinopathy: looking beyond the eyes. Diabetologia. 2020;63:1662–1664. DOI: 10.1007/s00125-020-05195-4.
6. Bikbov M.M., Surkova V.K. Prognostic value of conjunctival and corneal changes in diabetes mellitus. Vestnik oftal’mologii. 2019;135(1):90–97 (in Russ.). DOI: 10.17116/oftalma201913501190.
7. Bikbov M.M., Fayzrakhmanov R.R., Kazakbaeva G.M. et al. Prevalence, awareness and control of diabetes in Russia: The Ural Eye and Medical Study on adults aged 40+ years. PLoS One. 2019;14(4):e0215636. DOI: 10.1371/journal.pone.0215636.
8. Bikbov M.M., Gilmanshin T.R., Zainullin R.M. et al. To the question of the epidemiology of diabetes mellitus and diabetic retinopathy in the Republic of Bashkortostan. Acta Biomedica Scientifica. 2019;4(4):66–69 (in Russ.).
9. Bikbov M.M, Kazakbaeva G.M, Gilmanshin T.R. et al. Axial length and its associations in a Russian population: The Ural Eye and Medical Study. PLoS One. 2019;14(2):e0211186. DOI: 10.1371/journal.pone.0211186.
10. Shimada N., Ohno-Matsui K., Harino S. et al. Reduction of retinal blood flow in high myopia. Graefes Arch Clin Exp Ophthalmol. 2004;242:284–288.
11. Linsenmeier R.A., Braun R.D., McRipley M.A. et al. Retinal hypoxia in long-term diabetic. Invest Ophthalmol Vis Sci. 1998;39:1647–1657.
12. Bhandari M. Can Myopia Delay Diabetic Retinopathy? Optical Journal and Review of Optometry. 2012;15:82–89.
13. Yang K.J., Sun C.C., Ku W.C. et al. Axial length and proliferative diabetic retinopathy. Optom Vis Sci. 2012;89:465–470. DOI: 10.1097/OPX.0b013e31824c5270.
14. Man R.E., Gan A.T., Gupta P. et al. Is myopia associated with the incidence and progression of diabetic retinopathy. Am J Ophthalmol. 2019;208:226–233. DOI: 10.1016/j.ajo.2019.05.012.
15. Bolshunov A.V. Features of the clinical course of diabetic retinopathy in myopia. Vestnik oftal’mologii. 1998;6:54–55 (in Russ.).
16. Lim L.S. Are myopic eyes less likely to have diabetic retinopathy? Ophthalmology. 2010;117(3):524–530. DOI: 10.1016/j.ophtha.2009.07.044.
17. Shams K., Salman A. EL-R., Hamdi M. The Relation between High Myopia and Diabetic Retinopathy. Med J Cairo Univ. 2020;88(4):1621–1628. DOI: 10.21608/mjcu.2020.116255.
18. Gadzhiev R.V. Diabetic retinopathy: intraocular risk and protective factors in the pathogenesis of diabetic retinopathy: study guide. M.; 1999 (in Russ.).
19. Sultanov M.I., Gadzhiev R.V. Features of the course of diabetic retinopathy with myopia. Vestnik oftal’mologii. 1990;1:49–51.
20. Rogozina R.D. On the role of some general and local factors in the development of diabetic retinopathy. Vestnik oftal’mologii. 1973;5:36–38 (in Russ.).
21. Tayyab H., Haider M.A., Haider Bukhari Shaheed S.A. Axial myopia and its influence on diabetic retinopathy. J. Coll. Physicians Surg. Pak. 2014;24(10):728–731. DOI: 10.2014/JCPSP.728731.
22. Chao D.L., Lin S-Ch., Chen R. et al. Myopia is Inversely Associated With the Prevalence of Diabetic Retinopathy in the South Korean Population Am J Ophthalmol. 2016;172:39–44. DOI: 10.1016/j.ajo.2016.09.011.
23. Man R.E., Sasongko M.B., Sanmugasundram S. et al. Longer axial length is protective of diabetic retinopathy and macular edema. Ophthalmology. 2012;119:1754–1759. DOI: 10.1016/j.ophtha.2012.03.021.
24. Man R.E., Sasongko M.B., Wang J.J., Lamoureux E.L. Association between myopia and diabetic retinopathy: a review of observational findings and potential mechanisms. Clin. Exp. Ophthalmol. 2013;41(3):293–301. DOI: 10.1111/j.1442-9071.2012.02872.x.
25. Gupta P., Liang Gan A., Man R.E. Impact of Incidence and Progression of Diabetic Retinopathy on Vision-Specific Functioning Ophthalmology. 2018;125(9):1401–1409. DOI: 10.1016/j.ophtha.2018.02.011.
26. Xu L., Li Y., Zheng Y., Jonas J.B. Associated factors for age-related maculopathy in the adult population in China: the Beijing eye study. Br J Ophthalmol. 2006;90:1087–1090.
27. Wang Q., Wang Y.X., Wu S.L. et al. Ocular Axial Length and Diabetic Retinopathy: The Kailuan Eye Study. Invest Ophthalmol Vis Sci. 2019;60:3689–3695. DOI: 10.1167/iovs.19-27531.
28. Balashevich L.I. Ocular manifestations of diabetes. StP.: StPMAPO; 2004 (in Russ.).
29. Bobr T. Peculiarities of the course of diabetic retinopathy depending on the size of the anteroposterior axis of the eyeball. Ophthalmology. Eastern Europe. 2017;2(7):152–156 (in Russ.).
30. Fu Y., Geng D., Liu H., Che H. Myopia and/or longer axial length are protectiveagainst diabetic retinopathy: a meta-analysis. Acta Ophthalmol. 2016;94:346–352. DOI: 10.1111/aos.12908.
31. Wang X., Tang L., Gao L. et al. Myopia and diabetic retinopathy: A systematic review and metaanalysis. Diabetes Res Clin Pract. 2016;111:1–9. DOI: 10.1016/j.diabres.2015.10.020.
32. Wat N., Wong R.L., Wong I.Y. Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med. J. 2016;22(6):589–599. DOI: 10.12809/hkmj164869.
33. Bazzazi N., Akbarzadeh S., Yavarikia M. High myopia and diabetic retinopathy: A Contralateral Eye Study in Diabetic Patients With High Myopic Anisometropia. Retina. 2017;37(7):1270–1276. DOI: 10.1097/IAE.0000000000001335.
34. Moss S.E., Klein R., Klein B.E. Ocular factors in the incidence and progression of diabetic retinopathy. Ophthalmology. 1994;101(1):77–83.
35. Khismatullin R.R., Orenburkina O.I., Babushkin A.E. Analysis of phacoemulsification in patients with diabetes mellitus with different clinical refraction. Point of view. East-West. 2016;2:57–60 (in Russ.).
36. Yamamoto S., Nitta K., Kamiyama M. Cone electroretinogram to chromatic stimuli in myopic eyes. Vision Res. 1997;37:2157– 2159.
37. Lin Z., Li D., Zhai G. et al. High myopia is protective against diabetic retinopathy via thinning retinal vein: A report from Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT) Diab Vascr Dis Res. 2020;2:1–8. DOI: 10.1177/1479164120940988.
38. Srinivas S., Tan O., Nittala M.G. et al. Assessment of retinal blood flow in diabetic retinopathy using Doppler Fourier-domain optical coherence tomography. Retina. 2017;37:2001–2007. DOI: 10.1097/IAE.0000000000001479.
39. Mirzabekova K.A. Clinical and technological features of laser treatment of diabetic retinopathy with ametropia: Thesis. M.; 2004 (in Russ.).
40. Wenger G.E., Wenger L.V., Burdeiny S.I. Modern views on the pathogenesis of progressive myopia and the possibilities of its treatment Tavrichesky medico-biological bulletin. 2012;15(3):25–29 (in Russ.).
41. Jonas J.B., Tao Y., Neumaier M., Findeisen P. VEGF and Refractive Error. Ophthalmology. 2010;117:2234–2234. DOI: 10.1016/j.ophtha.2009.12.006.
42. Wilkinson-Berka J.L. Vasoactive factors and diabetic retinopathy: vascular endothelial growth factor, cyclooxygenase-2 and nitric oxide. Curr Pharm Des. 2004;10:3331–3348.
43. Shin Y.J., Nam W.H., Park S.E., Kim J.H. Aqueous humor concentrations of vascular endothelial growth factor and pigment epithelium-derived factor in high myopic patients. Mol Vis. 2012;18:2265–2270.
44. Kulshrestha A., Singh N., Moharana B. Axial Myopia, a Protective Factor for Diabetic Retinopathy-Role of Vascular Endothelial Growth Factor. Research square. 2021. DOI: 10.21203/rs.3.rs-789805/v1.
45. Ikram M.K., van Leeuwen R., Vingerling J.R. et al. Relationship between refraction and prevalent as well as incident age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci. 2003;44:3778–3782.
46. Nesterov A.P. The role of local factors in the pathogenesis of diabetic retinopathy. Vestnik oftal’mologii. 1994;4:7–9 (in Russ.).
47. Luo J., Liu S.Z., Wu X.Y., Xia Z.H. Distributive character of multifocal electroretinogram in high myopia subjects. Int J Ophthalmol. 2006;6:1339–1341.
48. Luu C.D., Lau A.M.I., Lee S.Y. Multifocal electroretinogram in adults and children with myopia. Arch Ophthalmol. 2006;124:328–334.
49. Wolsley C.J., Saunders K.J., Silvestri G., Anderson R.S. Investigation of changes in the myopic retina using multifocal electroretinograms, optical coherence tomography and peripheral resolution acuity. Vision Res. 2008;48:1554–1561.
50. Wen X., Li Z., Xiao J. et al. Association of Myopia With Microvascular Alterations in Patients With Type 2 Diabetes: An Optical Coherence Tomography Angiography Study. Front. Med. Oct. 2021;8:715074. DOI: 10.3389/fmed.2021.715074.
51. Hong F., Yang D., Li L. Relationship between aqueous humor levels of cytokines and axial length in patients with diabetic retinopathy. Asia Pac J Ophthalmol. 2020;9:149–155. DOI: 10.1097/APO.0000000000000270.
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