The Correlation between Changes in Biochemical Parameters and Central Macular Thickness in Patients with Non-Proliferative Diabetic Retinopathy



This study aimed at evaluating the correlation between changes in Hemoglobin A1c (HbA1c) and fasting serum lipids, and Central Macular Thickness (CMT) in patients with Non-Proliferative Diabetic Retinopathy (NPDR).

In the current research, both eyes of 68 patients with mild or moderate NPDR, without clinically significant macular edema, were studied. Levels of fasting serum lipids, HbAlc, and CMT were measured during the first visit and at the end of the follow-up period (3 months). For statistical analysis, CMTs of each eye were studied and the correlation of changes was investigated. Additionally, the direction of changes in CMT for each eye was determined, and whether the changes in both eyes were symmetrical was investigated.

Out of 68 patients, 24 were male and 44 were female. The mean CMT of all eyes was 290.05 ± 48.90 µm during the first visit and 286.80 ± 37.57 µm on the 3rd month follow-up. The mean HbAlc was 8.71 ± 1.82% at first visit to the hospital and the mean HbAlc was 8.39 ± 1.65% at the final visit. Although the changes in HbA1c and CMT during the follow-up period were statistically insignificant, the correlation of these 2 values was statistically significant (p=0.01). However, amongst l3 patients, the CMTs were asymmetrically changed in each eye during the follow-up period.

To the best of the author’s knowledge, this was the first study, which indicated a significant correlation in changes of CMT and HbA1c, even amongst patients with low-grade diabetic retinopathy. Demonstration of asymmetric changes in CMT of each treatment-naive eye of the same patient, during changes in systemic conditions, was another important finding of this study.


Martinell M, Dorkhan M, Stalhammar J, Storm P, Groop L, Gustavsson C. Prevalence and risk factors for diabetic retinopathy at diagnosis (DRAD) in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA). J Diabetes Complications. 2016;30(8):1456-61. DOI: 10.1016/j.jd iacomp.2016.08.009 PMID: 27593902

Suwal B, Shrestha JK, Joshi SN, Sharma AK. Diabetic retinopathy with or without clinically significant macular edema: The influencing factors. Nepal J Ophthalmol. 2016;7(2):142-7.

Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM, Group UKPDS. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol. 2004;122(11):1631-40. DOI: 10.10 01/archopht.122.11.1631 PMID: 15534123

Tajunisah I, Nabilah H, Reddy SC. Prevalence and risk factors for diabetic retinopathy--a study of 217 patients from University of Malaya Medical Centre. Med J Malaysia. 2006;61(4):451-6. PMID: 17243523

Jew OM, Peyman M, Chen TC, Visvaraja S. Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes. Int J Ophthalmol. 2012;5(4):499-504. DOI: 10.3980/j.issn.2 222-3959.2012.04.18 PMID: 22937513

Thapa R, Bajimaya S, Sharma S, Rai BB, Paudyal G. Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal. Nepal J Ophthalmol. 2015;7(1):26-32. DOI: 10.3126/nepjoph.v 7i1.13163 PMID: 26695602

Wilkinson CP, Ferris FL, 3rd, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677-82. DOI: 10.1016/S0161-6420(03) 00475-5 PMID: 13129861

Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985;103(12):1796-806. PMID: 2866759

Abraham EC, Huff TA, Cope ND, Wilson JB, Jr., Bransome ED, Jr., Huisman TH. Determination of the glycosylated hemoglobins (HB AI) with a new microcolumn procedure. Suitability of the technique for assessing the clinical management of diabetes mellitus. Diabetes. 1978;27(9):931-7. PMID: 689304

American Diabetes A. Executive summary: Standards of medical care in diabetes--2014. Diabetes Care. 2014;37 Suppl 1(Supplement_1):S5-13. DOI: 10.2337/dc14-S005 PMID: 24357214

Pieramici DJ, Wang PW, Ding B, Gune S. Visual and Anatomic Outcomes in Patients with Diabetic Macular Edema with Limited Initial Anatomic Response to Ranibizumab in RIDE and RISE. Ophthalmology. 2016;123(6):1345-50. DOI: 10.1016/j.ophtha.2016.02 .007 PMID: 26992841

Canadian Ophthalmological Society Diabetic Retinopathy Clinical Practice Guideline Expert C, Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, et al. Canadian Ophthalmological Society Evidence-based Clinical Practice Guidelines for the Management of Diabetic Retinopathy - executive summary. Can J Ophthalmol. 2012;47(2):91-6. DOI: 10.1016/j.jcjo. 2012.01.022 PMID: 22560411

Benarous R, Sasongko MB, Qureshi S, Fenwick E, Dirani M, Wong TY, et al. Differential association of serum lipids with diabetic retinopathy and diabetic macular edema. Invest Ophthalmol Vis Sci. 2011;52(10):7464-9. DOI: 10.1167/iovs.11-7598 PMID: 21862642

Unsal E, Eltutar K, Zirtiloglu S, Dincer N, Ozdogan Erkul S, Gungel H. Choroidal thickness in patients with diabetic retinopathy. Clin Ophthalmol. 2014;8:637-42. DOI: 10.2147/OPTH.S59395 PMID: 24707168

Cetin EN, Bulgu Y, Ozdemir S, Topsakal S, Akin F, Aybek H, et al. Association of serum lipid levels with diabetic retinopathy. Int J Ophthalmol. 2013;6(3):346-9. DOI: 10.3980/j.issn.2222-3959.2013.03.17 PMID: 238265 31

Bandello F, Midena E, Menchini U, Lanzetta P. Recommendations for the appropriate management of diabetic macular edema: Light on DME survey and consensus document by an expert panel. Eur J Ophthalmol. 2016;26(3):252-61. DOI: 10.5301/ejo.50 00736 PMID: 26776698

Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol. 2006;142(3):405-12. DOI: 10.1016/j.ajo .2006.04.023 PMID: 16935584

Browning DJ, Altaweel MM, Bressler NM, Bressler SB, Scott IU, Diabetic Retinopathy Clinical Research N. Diabetic macular edema: what is focal and what is diffuse? Am J Ophthalmol. 2008;146(5):649-55, 55 e1-6. DOI: 10.1016/j.ajo.2008.07.013 PMID: 18774122

Ozturk BT, Kerimoglu H, Adam M, Gunduz K, Okudan S. Glucose regulation influences treatment outcome in ranibizumab treatment for diabetic macular edema. J Diabetes Complications. 2011;25(5):298-302. DOI: 10.1016/j.jdiacomp.2010.09.006 PMID: 21075650

Kocak Altintas A, Citirik M, Gulpamuk B. Relationship of Serum HbA1c and Fasting Serum Lipids with Central Macular Thickness in Patients with Type 2 Diabetes Mellitus. J Clin Res Ophthalmol. 2016;3(1):23-6. DOI: 10.17352/2455-1414.00003

Full Text: Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.