School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Department of Endocrinology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Optom Vis Sci. 2024 Sep 1;101(9):563-570. doi: 10.1097/OPX.0000000000002178. Epub 2024 Sep 16.
This study establishes an increased risk of developing dry eye disease (DED) in patients with diabetic peripheral neuropathy using validated diagnostic criteria for both conditions.
The disruption of ocular surface homeostasis has been associated with diabetes. However, it remains unclear if this association is independently influenced by peripheral neuropathy secondary to diabetes. This study aimed to investigate the clinical signs and symptoms of DED and their association with the severity of peripheral neuropathy in participants with type 2 diabetes.
This prospective cross-sectional study recruited 63 participants with type 2 diabetes. All participants underwent a detailed assessment of DED using dry eye questionnaires (Ocular Surface Disease Index, Dry Eye Questionnaire-5), tear osmolarity, lipid layer thickness, noninvasive keratographic tear breakup time, phenol red thread test (PRT), and ocular surface staining. Corneal nerve morphology was imaged using corneal confocal microscopy. Based on the Total Neuropathy Scale, participants were stratified into no/mild (n = 48) and moderate/severe (n = 15) neuropathy groups.
Dry eye disease was diagnosed in 31 participants (50%) of the total cohort, and the odds of developing DED in the moderate/severe neuropathy group were four times (95% confidence interval, 1.10 to 13.80; p=0.030) higher compared with the no/mild neuropathy group. The Dry Eye Questionnaire-5 scores were significantly higher (p=0.020), and PRT values (p=0.048) and corneal nerve fiber length (p<0.001) were significantly reduced in the moderate/severe neuropathy group compared with the no/mild neuropathy group. In regression analysis, neuropathy scores were independently associated with PRT measurements ( β = -0.333, p=0.023) and nerve fiber length ( β = -0.219, p=0.012) while adjusting for age, gender, hemoglobin A 1c , and duration of diabetes.
Type 2 diabetic patients with peripheral neuropathy have a risk of developing DED, which increases with the severity of neuropathy. The observation that worsening peripheral neuropathy is associated with reduced tear secretion suggests that it may contribute to aqueous insufficiency.
本研究使用经验证的两种疾病的诊断标准，确定患有糖尿病外周神经病变的患者发生干眼疾病（DED）的风险增加。
眼表面稳态的破坏与糖尿病有关。然而，尚不清楚这种关联是否独立于糖尿病继发的周围神经病变的严重程度。本研究旨在调查 2 型糖尿病患者 DED 的临床体征和症状及其与周围神经病变严重程度的关系。
这项前瞻性的横断面研究招募了 63 名 2 型糖尿病患者。所有参与者均使用干眼问卷（眼表面疾病指数、干眼问卷-5）、泪液渗透压、脂质层厚度、非侵入性角膜泪膜破裂时间、苯酚红线试验（PRT）和眼表面染色对 DED 进行详细评估。使用角膜共聚焦显微镜对角膜神经形态进行成像。根据总神经病变量表，将参与者分为无/轻度（n=48）和中度/重度（n=15）神经病变组。
在总队列的 31 名参与者（50%）中诊断出 DED，中度/重度神经病变组发生 DED 的几率是无/轻度神经病变组的 4 倍（95%置信区间，1.10 至 13.80；p=0.030）。与无/轻度神经病变组相比，干燥眼问卷-5 评分明显更高（p=0.020），PRT 值（p=0.048）和角膜神经纤维长度（p<0.001）明显降低。在回归分析中，神经病变评分与 PRT 测量值（β=-0.333，p=0.023）和神经纤维长度（β=-0.219，p=0.012）独立相关，同时调整年龄、性别、血红蛋白 A1c 和糖尿病病程。
患有周围神经病变的 2 型糖尿病患者发生 DED 的风险增加，并且随着神经病变的严重程度增加而增加。观察到周围神经病变恶化与泪液分泌减少相关表明其可能导致水液不足。
