Santilli Christopher M, Johnson Shaun, Thunstrom Coltt R, Armbrust Karen R
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Clin Ophthalmol. 2023 Jun 10;17:1675-1682. doi: 10.2147/OPTH.S412187. eCollection 2023.
The effects of diabetes mellitus (DM) on visual function have been extensively studied. Fewer studies evaluate the effect of visual function on DM, and previous small studies have shown mixed results concerning the relationship between glycated hemoglobin (HbA1c) and cataract surgery. We performed a retrospective, observational, single-site study at a Veterans hospital to evaluate this relationship and the relationship between HbA1c and non-surgical eye care.
We compared pre- and post-operative/examination HbA1c in 431 surgical and 431 matched, non-surgical subjects who underwent eye examination at the same institution. Subgroup analysis was performed by age, elevated (≥8) pre-operative/examination HbA1c, and change in diabetic management. We also assessed for a relationship between changes in best-corrected visual acuity (BCVA) and HbA1c. The Minneapolis Veterans Affairs Health Care System Research Administration determined this study to be Institutional Review Board exempt from the requirements of 38 CFR 16 under Category 4 (iii).
Pairwise comparison of pre- versus post-operative HbA1c trended towards reduction at 3-6 months in all surgical subjects, with a statistically significant reduction in older subjects, and those with higher pre-operative HbA1c. Eye examination subjects experienced a significant HbA1c reduction 3-6 months after eye examination. Reduction in post-operative/examination HbA1c was associated with concurrent change in diabetic management.
We found an overall reduction in HbA1c in diabetic Veterans who interacted with an ophthalmologist, whether for cataract surgery or eye examination. HbA1c reduction was greatest when ophthalmic care was delivered as part of a multidisciplinary care team. Our findings add new evidence to further support the importance of ophthalmic care in patients with DM and suggest improved visual function may facilitate improved glycemic control.
糖尿病（DM）对视觉功能的影响已得到广泛研究。较少有研究评估视觉功能对DM的影响，并且先前的小型研究关于糖化血红蛋白（HbA1c）与白内障手术之间的关系呈现出混合结果。我们在一家退伍军人医院进行了一项回顾性、观察性、单中心研究，以评估这种关系以及HbA1c与非手术眼部护理之间的关系。
我们比较了在同一机构接受眼部检查的431名手术患者和431名匹配的非手术患者术前和术后/检查时的HbA1c。按年龄、术前/检查时HbA1c升高（≥8）以及糖尿病管理变化进行亚组分析。我们还评估了最佳矫正视力（BCVA）变化与HbA1c之间的关系。明尼阿波利斯退伍军人事务医疗保健系统研究管理部门认定本研究根据第4（iii）类可免于《联邦法规汇编》第38编第16条的要求。
所有手术患者术前与术后HbA1c的成对比较在3至6个月时呈下降趋势，年龄较大的患者以及术前HbA1c较高的患者下降具有统计学意义。眼部检查患者在眼部检查后3至6个月HbA1c显著降低。术后/检查时HbA1c的降低与糖尿病管理的同时变化相关。
我们发现与眼科医生接触的糖尿病退伍军人，无论进行白内障手术还是眼部检查，其HbA1c总体上有所降低。当眼科护理作为多学科护理团队的一部分提供时，HbA1c降低最为显著。我们的数据为进一步支持眼科护理在糖尿病患者中的重要性增添了新证据，并表明视觉功能的改善可能有助于改善血糖控制。
