Impact of Type 2 Diabetes Mellitus Without Retinopathy on Longitudinal OCT and Visual Field Changes in Primary Open-Angle Glaucoma

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Introduction/Purpose: Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness, and diabetes mellitus (DM) is common in this population. However, the effect of DM without diabetic retinopathy (DR) on glaucoma progression is unclear. We evaluated whether structural and functional progression differ between POAG eyes with DM, but no DR, and age- and visual field (VF) mean deviation (MD)-matched non-diabetic POAG eyes. Methods: We conducted a retrospective longitudinal study at three academic centers comparing POAG+DM (no DR) with POAG-only eyes. Eligibility required ≥3 qualified OCT scans and ≥3 reliable VFs over ≥1 year; eyes with DR or other major intraocular disease were excluded. Cohorts were matched by baseline age and VF MD, and linear mixed-effects models were used to estimate and compare rates of change for the circumpapillary retinal nerve fiber layer (cpRNFL), ganglion cell–inner plexiform layer (GCIPL), macular RNFL, outer retina, and VF MD. Results: Matched cohorts included 136 eyes per group with similar baseline OCT and VF measures. POAG+DM eyes had slower cpRNFL thinning than POAG-only eyes (difference 0.62 μm/year; p=0.010). Outer retinal thickness was relatively preserved in POAG+DM (difference 0.38 μm/year; p=0.023). GCIPL, macular RNFL, and VF MD changes were similar between groups. Conclusions: In age- and MD-matched POAG, DM without DR was associated with slower peripapillary and outer retinal thinning but similar macular and functional progression. DM, without DR, may modify OCT thickness measures, potentially via subclinical fluid, and thus confound longitudinal glaucoma assessment. Stratifying or separately analyzing eyes with DM is warranted for monitoring and research.

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