Association of ocular biometric parameters with diabetic retinopathy

Shubhneek Kaur Dhillon Utaal, Rupali Chopra, Nitin Batra


Background: To study the association of ocular biometric parameters {Spherical equivalent (SE), Axial length (AL), Anterior chamber depth (ACD) and Corneal curvature (CC)} with diabetic retinopathy (DR) in subjects with Type 2 diabetes mellitus (DM).

Methods: This prospective observational study was conducted in the Outpatient Department of Ophthalmology of a tertiary care teaching hospital in North India. The study included 100 subjects having various grades of DR as cases and 100 diabetics without DR as controls. The SE was assessed using objective autorefraction, while AL, CC and ACD were measured using the NIDEK AL SCAN.  International Clinical Diabetic Retinopathy Disease Severity Scale was used for grading of DR.

Results: A total of 181 eyes in the study group and 200 eyes in the control group were analysed.  Progressive decrease in the mean AL was observed with the increasing severity of DR (p=0.017). Deeper ACD had a negative correlation with severity of DR (p=0.037). No statistically significant difference was observed for AL and ACD with the incidence of DR (p=0.147 and p=0.091 respectively). Likewise, there was no significant relation of DR with SE or CC.

Conclusions: Longer AL and deep ACD were protective against progression to the severe forms of DR. However, there was no correlation of AL and ACD with the incidence of DR. The SE and CC were not found to be significant determinants for either development or severity of DR.


Anterior chamber depth, Axial length, Corneal curvature, Diabetes mellitus, Diabetic retinopathy, Myopia, Spherical equivalent

Full Text:



Powers A. Harrison's Principles of Internal Medicine. 19th Edn. 2015:419;2424-5.

Pierro L, Brancato R, Robino X, Lattanzio R, Jansen A, Calori G. Axial length in patients with diabetes. Retina 1999;19(5):401-4.

Fu Y, Geng D, Liu H, Che H. Myopia and/or longer axial length are protective against diabetic retinopathy: A meta-analysis. Acta Ophthalmol 2015;94(4):346-52.

Meng W, Butterworth J, Malecaze F. Axial length of myopia: A review of current research. Ophthalmologica 2011;225:127-34.

Man RE, Sasongko MB, Sanmugasundram S, Nicolaou T, Jing X, Wang JJ et al. Longer axial length is protective of diabetic retinopathy and macular edema. Ophthalmol 2012;119(9):1754-9.

Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmol 2003;110(9):1677-82.

Raman R, Rani PK, Rachepalle SR, Gnanamoorthy P, Uthra S, Kumaramanickavel G et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study report 2. Ophthalmol 2009;116(2):311-8.

Xie XW, Xu L, Wang YX, Jonas JB. Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006. Graefes Arch Clin Exp Ophthalmol. 2008;246:1519-26.

Klein R, Klein BE, Moss SE, Cruick-Shanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XVII: the 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmol 1998;105(10):1801-15.

Fong DS, Aiello LP, Gardner TW, King GL, Blackenship G, Cavallerano JD et al. Retinopathy in diabetes. Diabetes Care 2004;27(1):84-7.

Kohner EM, Aldington SJ, Stratton IM. United Kingdom Prospective Diabetes Study, 30: Diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. Arch Ophthalmol 1998;116:297-303.

Bazzazi N, Akbarzadeh S, Yavarikia M, Poorolajal J, Fouladi DF. High myopia and diabetic retinopathy: a contralateral eye study in diabetic patients with high myopic anisometropia. Retina 2017;37(7):1270-6.

Saw SM, Gazzard G, Shih‐Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt 2005;25(5):381-91.

Lim LS, Lamoureux E, Saw SM, Tay WT, Mitchell P, Wong TY. Are myopic eyes less likely to have diabetic retinopathy? Ophthalmol 2010;3(117):524-30.

Ganesan S, Raman R, Reddy S, Krishnan T, Kulothungan V, Sharma T. Prevalence of myopia and its association with diabetic retinopathy in subjects with type II diabetes mellitus: A population-based study. Oman J Ophthalmol 2012;5(2):91-6.

Pan CW, Cheung CY, Aung T, Cheung CM, Zheng YF, Wu RY et al. Differential associations of myopia with major age-related eye diseases: The Singapore Indian Eye Study. Ophthalmol 2013;120(2):284-91.