Influence of serum lipids on the incidence and progression of diabetic retinopathy and macular oedema: Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study-II

Clin Exp Ophthalmol. 2017 Dec;45(9):894-900. doi: 10.1111/ceo.12990. Epub 2017 Jun 22.


Importance: The importance of lipids on incidence and progression of diabetic retinopathy has not been studied in the Indian population.

Background: To elucidate the influence of serum lipid control on the incidence and progression of diabetic retinopathy and diabetic macular oedema in subjects with type 2 diabetes.

Design: Population-based longitudinal observational study in a hospital setting.

Participants: Eight hundred ninety subjects were examined at baseline and follow-up.

Methods: Diabetic retinopathy was graded per Modified Early Treatment Diabetic Retinopathy Study scales; 45°, 4-field dilated stereoscopic digital photography was performed with an additional 30°, 7-field for those who had retinopathy. Macular oedema was evaluated per Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Disease Severity Scales.

Main outcome measures: Association of serum lipids and incidence and progression of diabetic retinopathy.

Results: Poor control of total cholesterol was associated with the incidence of sight-threatening retinopathy (odds ratio = 7.2 [95% confidence interval: 1.5-34.3], P = 0.012) and macular oedema (odds ratio = 5.5 [95% confidence interval: 1.4-27.4], P = 0.037) after adjusting for potential confounders. Poor control of triglycerides was associated with progression to proliferative diabetic retinopathy (odds ratio = 3.2 [95% confidence interval: 1.1-10.5], P = 0.048). Risk for incident macular oedema (P = 0.041) and progression to proliferative diabetic retinopathy (P = 0.028) was greater when all lipid types were abnormal.

Conclusions and relevance: Poor control of lipids is a risk factor for incidence of and progression to late stages of retinopathy. Abnormal levels of all lipid types are associated with risk of incident macular oedema and progression to proliferative diabetic retinopathy.

Keywords: cholesterol; diabetic macular oedema; diabetic retinopathy; risk factor; triglyceride.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • India / epidemiology
  • Lipids / blood*
  • Macular Edema / blood
  • Macular Edema / diagnosis
  • Macular Edema / epidemiology*
  • Male
  • Middle Aged
  • Molecular Biology / methods*
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Time Factors


  • Biomarkers
  • Lipids