Original articles
Dry eye in diabetic patients

https://doi.org/10.1016/j.ajo.2004.10.022Get rights and content

Purpose

To compare the prevalence of keratoconjunctivitis sicca (KCS) in a prospective cohort of 22,382 diabetic patients with that in the general population.

Design

Prospective, observational, cohort study.

Methods

setting: A district of Israel’s largest health maintenance organization. study population: We followed the electronic medical records of all patients in the district older than 50 years (159,634 patients) between January 1 and December 31, 2003. Of those, 22,382 (14.0%) had diabetes. observation procedure: The proportion of ocular lubrication consumers was compared among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tests), and glycemic control was correlated with the consumption of ocular lubrication. main outcome measures: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and ocular lubrication use.

Results

After age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, compared with nondiabetic patients (13.8%, P < .001). The difference was significant for all age groups and for both sexes (P < .001). A similar significant difference was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. Ocular lubrication consumption increased with poorer glycemic control (mean annual HbA1c levels). Multivariate analysis revealed this effect to be independent of age, sex, place of birth, or place of residence.

Conclusions

KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients.

Section snippets

Methods

The electronic medical records of all members (470,350 members) in the central district of the largest health maintenance organization (HMO) in Israel (Clalit Health Services) were followed prospectively between January 1 and December 31, 2003. All members older than 50 years on January 1, 2003, who did not terminate their membership during 2003 were included (159,634 members).

Of the 159,634 members, 22,382 (14%) were diabetic according to the Clalit Health Services diabetes registry. The

Results

Table 1 shows the characteristics of diabetic and nondiabetic members receiving ocular lubrication compared with all members in the district. The mean age of diabetic patients consuming ocular lubrication was slightly higher than that of the nondiabetic patients, as was the age of all diabetic patients compared with all nondiabetic patients in the district. More female than male members consumed lubrication, both in the diabetic group (male to female ratio 1:1.74) and the nondiabetic group

Discussion

We have shown that significantly more diabetic patients, of all age groups older than 50 years, consumed more ocular lubrication than nondiabetic patients. Dry eye can result from either interruption of the tearing reflex pathways or from any process that affects the ability of the lacrimal gland to secrete.14 In diabetes, it is possible that damage to the microvasculature of the lacrimal gland together with autonomic neuropathy may contribute to impaired function of the gland. Sensory

Dr. Igor Kaiserman M.D. M.Sc. MPA graduated cum-laude the Hebrew University in Jerusalem. Residency in ophthalmology at the Hadassah Medical Center. Lecturer in ophthalmology at the Hadassah College and head of several computers courses at the Hebrew University. Dr. Kaiserman’s research interests include uveal melanoma, refractive surgery and intercellular calcium signaling.

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    Citation Excerpt :

    Such variability may be caused by intervening factors as this syndrome suffers influence of patient’s age (being more common in those with older age); used medications (such as isotretinoin, tricyclic antidepressants, selective serotonin reuptake inhibitors, antihistamines), previous eye surgery (that damages tearing somatosensory reflex) [7] and, according to certain authors, diabetes control [5,6]. Kaiserman et al. [6] observed that poor glycemic control correlates with increased artificial tear use in diabetic patients. Animal studies showed that diabetic mice have significant decrease in aqueous tear production when compared to the non-diabetic ones [8].

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Dr. Igor Kaiserman M.D. M.Sc. MPA graduated cum-laude the Hebrew University in Jerusalem. Residency in ophthalmology at the Hadassah Medical Center. Lecturer in ophthalmology at the Hadassah College and head of several computers courses at the Hebrew University. Dr. Kaiserman’s research interests include uveal melanoma, refractive surgery and intercellular calcium signaling.

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