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G. K. Singh, M. L. Subramanian; The Impact of Prolonged Duration of Diabetes Mellitus on the Presence of Drusen. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2172.
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Age related macular degeneration (AMD) is an eye disorder that can cause irreversible central vision loss in the elderly. Diabetes Mellitus (DM) is the leading cause of new blindness in individuals between the ages of 20-64. The purpose of this study was to determine if a relationship exists between duration of diabetes and drusen. Our hypothesis is that prolonged duration of diabetes exerts a protective effect over the formation of macular drusen.
Thirty-five diabetic patients with drusen in the macula were selected from a database of nonmydriatic fundus images, which were acquired in the outpatient clinical setting. Each subject was matched with a control image of a diabetic patient without drusen for sex, age, and eye color. The main outcome measured was duration of impaired glycemic control. Secondary outcomes measured include degree of diabetic retinopathy, level of hemoglobin AIC, and renal function.
Stepwise logistic regression models demonstrated that subjects (with drusen) showed a significant difference in duration of DM and degree of retinopathy as compared to controls (without drusen). The duration of DM was markedly higher in controls (mean=18.43 yrs, SD=10.39) as compared to the study group (mean=6.60 yrs, SD=5.27). Odds ratio indicate that an increased duration of DM may lead to a reduction of macular drusen formation (OR=0.74, p= 0.001). In addition, the severity of retinopathy was also significantly (p=0.001) different between the study and control groups. The study group had either no retinopathy (86%) or mild retinopathy (14%), compared to controls, which had all degrees of retinopathy (mild 30.2%, moderate 25.7%, and severe, 5.7%). Further analysis showed a significant reduction in odds of developing drusen for patients with retinopathy (OR=0.10, p=0.001). The level of glycemic control as measured by hemoglobin AIC levels and renal function was not significantly different between the two groups.
We deduce that prolonged impaired glycemic control as seen in DM may exert a protective effect over the formation of macular drusen. The exact physiologic mechanism for this protective effect needs further investigation.
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