Individual and Combined Effects of Diabetes and Glaucoma on Total Macular Thickness and Ganglion Cell Complex Thickness: A Cross-sectional Analysis

Presence of diabetes in glaucoma patients may influence findings while documenting the progression of glaucoma. We conducted the study to compare individual and combined effects of diabetes and glaucoma on macular thickness and ganglion cell complex thickness.

The present study is a cross-sectional analysis of 172 eyes of 114 individuals. The groups were categorized according to the following conditions: glaucoma, diabetes mellitus, both glaucoma and diabetes (‘both’ group), and none of these conditions (‘none’ group). Patients with diabetes did not have diabetic retinopathy (DR). We compared retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, foveal loss of volume (FLV), and global loss of volume (GLV) among the groups. We used random effects multivariate analysis to adjust for potential confounders.

The mean (SD) age of these individuals was 60.7 (10.1) years. The total average RNFL and GCC were significantly lower in the glaucoma group (RNFL: -36.27, 95% confidence intervals [CI]: -42.79 to -29.74; P <0.05, and GCC: -26.24, 95% CI: -31.49 to -20.98; P<0.05) and the ‘both’ group (RNFL: -24.74, 95% CI: -32.84 to -16.63; P<0.05, and GCC: -17.92, 95% CI: -24.58 to -11.26; P<0.05) as compared with the ‘none’ group. There were no significant differences in the average RNFL values and total average GCC between the diabetes group and the ‘none’ group. The values of FLV and GLV were significantly higher in the ‘glaucoma’ group and the ‘both’ group as compared with the ‘none’ group. The foveal values were not significantly different across these four groups. Among the glaucoma cases, 25% were mild, 30% were moderate, and 45% were severe; there was no significant difference in the proportion of severity of glaucoma between the ‘glaucoma only’ and ‘both’ groups (p=0.32). After adjusting for severity and type of glaucoma, there were no statistically significant differences in the values of average RNFL (6.6, 95% CI: -1.9 to 15.2; P=0.13), total average GCC (3.6, -95% CI: -2.4 to 9.6; P=0.24), and GLV (-3.9, 95% CI: -9.5 to 1.6; P=0.16) in the ‘both group’ as compared with the glaucoma only group.

We found that diabetes with no DR did not significantly affect the retinal parameters in patients with glaucoma. Thus, it is less likely that thickness of these parameters will be overestimated in patients with glaucoma who have concurrent diabetes without retinopathy.