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Lydia Alekseevna Mineeva, Irina Glebovna Slezkina, Leonid Shubin, Andrey Kabanov; A study of the dynamics of refraction in patients with insulin dependent Diabetes Mellitus type 2. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4705.
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© ARVO (1962-2015); The Authors (2016-present)
We have previously shown a significant positive correlation between the level of HbA1c and data of ARM (sph, cyl, ax) (Slezkina I. et al., ARVO 2014). In the present study, we aimed to track changes of refraction in patients with insulin dependent Diabetes Mellitus (DM) type 2 in subcompensation phase in the prospective single-center controlled trial.
The sample consisted of 32 patients (84.4% females and 15.6% males) with DM type 2 without severe complications of diabetes and concomitant eye pathology in age of 60.4±5.3. Overall monitoring lasted for 3 years, including 0.5 years of modified design for this study, insulin treatment duration was 6 years. The levels of blood sugar and HbA1c were regularly determined. For all patients visometry, autorefractometry (sph, cyl, ax), pneumotonometry (for Po), height and weight were performed. Two-tailed Student's t-test and Fisher’s exact two-tailed test were used for search of statistical significant differences.
We have previously shown (Mineeva et al., ARVO 2013) that blood sugar significantly decreased from 9,48±2,9 mmol/L to 7,9±2,2 mmol/L (p=0,02) and the level of HbA1c remained almost constant: 8,7±0,86% at the beginning and 8,54±0,91% at the end of the study (p<0,05). But no significant differences (p≥0.05) were found under combined evaluation of refractive index (sph, cyl, ax) in all subjects at the beginning and the end of the monitoring. However, division of the patients into two groups with myopia and hyperopia refraction revealed an important regularity: transition phenomenon from myopia to hyperopia was detected in 40% of patients (Fisher exact p = 0.043 two-tailed, df = 1, n = 32) and in 50% of cases (Fisher exact p = 0.021 two-tailed, df = 1, n = 32), this occurred in both right and left eyes. Meanwhile, relationship between the weight of the patient, P0 and the refraction was not detected (Rs ≠ 0, p≥0.05).
In patients with insulin dependent DM type 2 with increasing or constant HbA1c, persistent changes occur leading to a transition from myopic to hyperopic refraction. More detailed study of this phenomenon will probably allow to confirm our hypothesis on irreversible changes of the vision in diabetes mellitus type 2, even under increasing or constant HbA1c.
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