Effect of Regulated Type-2 Diabetes Mellitus on the Ocular Surface

Diabetes Mellitus and Ocular Surface
Vol. 19 No. 1 : 2024 (283-291)

ercan ze ercan ze

Abstract
The aim of this study was to see whether well-regulated Type-2 diabetes mellitus (DM) under than 10 years impacted meibography and tear film break-up time. DM (n=45) and normal subjects (n=45) were recruited. Two years’ mean glycated hemoglobin data were calculated as the regulation indicator. Eye examination followed by noninvasive tear break‑up time (NTBUT) measurement and then meibography were conducted. Regression analyses corrected for age and gender were used for comparisons between groups. Pearson correlation analysis was used to examine the linear relationship between NTBUT and meibomian gland loss to mean glycated hemoglobin.  A value of p<0.05 was considered statistically significant. The meiboscale comparisons within groups did not show any statistical difference. The mean meibomian gland loss comparisons between groups for the right lower eyelid (r=0.017, p=0.69), right upper eyelid (r=0.04 p=0.24), left lower eyelid (r=0.009, p=0.68) and left upper eyelid (r=0.027, p=0.13) were all similar. NTBUT for right and left eye were similar between groups (p=0.69 and p=0.36 respectively). Pearson’s correlation did not show any significant correlation between glycated hemoglobin, NTBUT and gland loss. In conclusion, it was found that patients with less than 10-year disease duration under DM regulation had similar ocular surfaces to normal subjects.
Keywords : Diabetes mellitus, eye lids, ocular surface, ophthalmological diagnostic techniques, tears,
Abstrak
Tujuan kajian ini adalah untuk melihat sama ada diabetes melitus jenis 2 yang terkawal dengan baik yang kurang daripada 10 tahun memberi kesan kepada meibografi dan masa pecah filem air mata. Pesakit diabetes (n=45) dan subjek normal (n=45) telah direkrut. Data purata hemoglobin glikat dua tahun dianggap sebagai penanda pengawalan. Pemeriksaan mata diikuti dengan pengukuran masa pecah filem air mata tanpa invasif (NTBUT) dan kemudian meibografi telah dilakukan. Analisis regresi yang diselaraskan dengan umur dan jantina digunakan untuk membandingkan antara kumpulan. Analisis korelasi Pearson digunakan untuk mengkaji hubungan linear antara NTBUT dan kehilangan kelenjar meibomian terhadap purata hemoglobin glikat. Nilai p<0.05 dianggap signifikan secara statistik. Perbandingan skala meibum dalam kumpulan tidak menunjukkan perbezaan statistik. Perbandingan kehilangan kelenjar meibomian purata antara kumpulan untuk kelopak mata bawah kanan (r=0.017, p=0.69), kelopak mata atas kanan (r=0.04 p=0.24), kelopak mata bawah kiri (r=0.009, p=0.68) dan kelopak mata atas kiri (r=0.027, p=0.13) adalah serupa. NTBUT bagi mata kanan dan kiri adalah serupa antara kumpulan (p=0.69 dan p=0.36 masing-masing). Korelasi Pearson tidak menunjukkan sebarang korelasi yang signifikan antara hemoglobin glikat, NTBUT dan kehilangan kelenjar. Kesimpulannya, ia didapati bahawa pesakit dengan tempoh penyakit kurang daripada 10 tahun di bawah kawalan diabetes mempunyai permukaan mata yang serupa dengan subjek normal.  
Kata Kunci : Air mata, diabetes melitus, kelopak mata, permukaan okular, teknik diagnostik oftalmologi,

Correspondance Address
Zeynep Eylul Ercan. Yıldırım Beyazıt University Yenimahalle Education and Training Hospital Department of Ophthalmology, Ankara, 06900, Turkey. Tel: +90 (312) 587 20 00 Email: eylulercan@doctor.com

References
Craig, J.P., Nichols, K.K., Akpek, E.K., Caffery, B., Dua, H.S., Joo, C.K., Liu, Z., Nelson, J.D., Nichols, J.J., Tsubota, K., Stapleton, F. 2017. TFOS DEWS II definition and classification report. Ocul Surf 15(3): 276-83.

Derakhshan, A., Abrishami, M., Khajedaluee, M., Omidtabrizi, A., Moghaddam, S.G. 2019 Comparison between tear film osmolar cocentration and other tear film function parameters in patients with diabetes mellitus. Korean J Ophthalmol 33: 326-32.

Fan, F., Li,X., Li, K., Jia, Z. 2021. To find out the relationship between levels of glycosylated hemoglobin with meibomian gland dysfunction in patients with type 2 diabetes. Ther Clin Risk Manag 17: 797-807.

Gulmez Sevim, D., Gumus, K., Unlu, M. 2020. Reliable, noncontact imaging tool for the evaluation of meibomian gland function: Sirius meibography. Eye Contact Lens 46(Suppl 2): S135-40.

Kamel, S., Mohammed, T., Zankalony, Y.E., Saad, A. 2017. Prevalence of dry eye in diabetics. J Egypt Ophthalmol Soc 110: 77-82.

Kesarwani, D., Rizvi, S.W.A., Khan, A.A., Amitava, A.K., Vasenwala, S.M., Siddiqui, Z. 2017. Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population. Indian J Ophthalmol 65(4): 301-4.

Lyu, Y., Zeng, X., Li, F., Zhao, S. 2019. The effect of the duration of diabetes on dry eye and corneal nerves. Cont Lens Anterior Eye 42(4): 380-5.

Manjula, T.R., Gahana, K., Harsha, R. 2019. A clinical study on meibomian gland dysfunction and dry eye in patients with type 2 diabetes mellitus. J Med Sci Health 5(3): 7-12.

Meşen, A., Yavuzer, K. 2021. Comparison of tear film breaking time measured using new generation and traditional methods. Turk Klin J Ophthalmol 30.

Najafi, L., Malek, M., Valojerdi, A.E., Khamseh, M.E., Aghaei, H. 2015. Dry eye disease in type 2 diabetes mellitus; comparison of the tear osmolarity test with other common diagnostic tests: A diagnostic accuracy study using STARD standard. J Diabetes Metab Disord 14: 39.

Sağdık, H.M., Ugurbas, S.H., Can, M., Tetikoğlu, M., Ugurbas, E., Uğurbaş, S.C., Alpay, A., Uçar, F. 2013. Tear film osmolarity in patients with diabetes mellitus. Ophthalmic Res 50(1): 1-5.

Taheri, A.R., Allahyari, E. 2021. Dry eye and meibomian glands in vitiligo. Turk J Ophthalmol 51(2): 70-4.

Yıldız, E., Zibandeh, N. 2020. Effects of type 2 diabetes mellitus on gene expressions of mouse meibomian glands. Curr Eye Res 45: 72-80.

Yu, T., Han, X.G., Gao, Y., Song, A.P., Dang, G.F. 2019. Morphological and cytological changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 12: 1415-9.

Yu, T., Shi, W.Y., Song, A.P., Gao, Y., Dang, G.F., Ding, G. 2016. Changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 9: 1740-1744.
Correspondance Address

Craig, J.P., Nichols, K.K., Akpek, E.K., Caffery, B., Dua, H.S., Joo, C.K., Liu, Z., Nelson, J.D., Nichols, J.J., Tsubota, K., Stapleton, F. 2017. TFOS DEWS II definition and classification report. Ocul Surf 15(3): 276-83.

Derakhshan, A., Abrishami, M., Khajedaluee, M., Omidtabrizi, A., Moghaddam, S.G. 2019 Comparison between tear film osmolar cocentration and other tear film function parameters in patients with diabetes mellitus. Korean J Ophthalmol 33: 326-32.

Fan, F., Li,X., Li, K., Jia, Z. 2021. To find out the relationship between levels of glycosylated hemoglobin with meibomian gland dysfunction in patients with type 2 diabetes. Ther Clin Risk Manag 17: 797-807.

Gulmez Sevim, D., Gumus, K., Unlu, M. 2020. Reliable, noncontact imaging tool for the evaluation of meibomian gland function: Sirius meibography. Eye Contact Lens 46(Suppl 2): S135-40.

Kamel, S., Mohammed, T., Zankalony, Y.E., Saad, A. 2017. Prevalence of dry eye in diabetics. J Egypt Ophthalmol Soc 110: 77-82.

Kesarwani, D., Rizvi, S.W.A., Khan, A.A., Amitava, A.K., Vasenwala, S.M., Siddiqui, Z. 2017. Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population. Indian J Ophthalmol 65(4): 301-4.

Lyu, Y., Zeng, X., Li, F., Zhao, S. 2019. The effect of the duration of diabetes on dry eye and corneal nerves. Cont Lens Anterior Eye 42(4): 380-5.

Manjula, T.R., Gahana, K., Harsha, R. 2019. A clinical study on meibomian gland dysfunction and dry eye in patients with type 2 diabetes mellitus. J Med Sci Health 5(3): 7-12.

Meşen, A., Yavuzer, K. 2021. Comparison of tear film breaking time measured using new generation and traditional methods. Turk Klin J Ophthalmol 30.

Najafi, L., Malek, M., Valojerdi, A.E., Khamseh, M.E., Aghaei, H. 2015. Dry eye disease in type 2 diabetes mellitus; comparison of the tear osmolarity test with other common diagnostic tests: A diagnostic accuracy study using STARD standard. J Diabetes Metab Disord 14: 39.

Sağdık, H.M., Ugurbas, S.H., Can, M., Tetikoğlu, M., Ugurbas, E., Uğurbaş, S.C., Alpay, A., Uçar, F. 2013. Tear film osmolarity in patients with diabetes mellitus. Ophthalmic Res 50(1): 1-5.

Taheri, A.R., Allahyari, E. 2021. Dry eye and meibomian glands in vitiligo. Turk J Ophthalmol 51(2): 70-4.

Yıldız, E., Zibandeh, N. 2020. Effects of type 2 diabetes mellitus on gene expressions of mouse meibomian glands. Curr Eye Res 45: 72-80.

Yu, T., Han, X.G., Gao, Y., Song, A.P., Dang, G.F. 2019. Morphological and cytological changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 12: 1415-9.

Yu, T., Shi, W.Y., Song, A.P., Gao, Y., Dang, G.F., Ding, G. 2016. Changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 9: 1740-1744.



Craig, J.P., Nichols, K.K., Akpek, E.K., Caffery, B., Dua, H.S., Joo, C.K., Liu, Z., Nelson, J.D., Nichols, J.J., Tsubota, K., Stapleton, F. 2017. TFOS DEWS II definition and classification report. Ocul Surf 15(3): 276-83.

Derakhshan, A., Abrishami, M., Khajedaluee, M., Omidtabrizi, A., Moghaddam, S.G. 2019 Comparison between tear film osmolar cocentration and other tear film function parameters in patients with diabetes mellitus. Korean J Ophthalmol 33: 326-32.

Fan, F., Li,X., Li, K., Jia, Z. 2021. To find out the relationship between levels of glycosylated hemoglobin with meibomian gland dysfunction in patients with type 2 diabetes. Ther Clin Risk Manag 17: 797-807.

Gulmez Sevim, D., Gumus, K., Unlu, M. 2020. Reliable, noncontact imaging tool for the evaluation of meibomian gland function: Sirius meibography. Eye Contact Lens 46(Suppl 2): S135-40.

Kamel, S., Mohammed, T., Zankalony, Y.E., Saad, A. 2017. Prevalence of dry eye in diabetics. J Egypt Ophthalmol Soc 110: 77-82.

Kesarwani, D., Rizvi, S.W.A., Khan, A.A., Amitava, A.K., Vasenwala, S.M., Siddiqui, Z. 2017. Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population. Indian J Ophthalmol 65(4): 301-4.

Lyu, Y., Zeng, X., Li, F., Zhao, S. 2019. The effect of the duration of diabetes on dry eye and corneal nerves. Cont Lens Anterior Eye 42(4): 380-5.

Manjula, T.R., Gahana, K., Harsha, R. 2019. A clinical study on meibomian gland dysfunction and dry eye in patients with type 2 diabetes mellitus. J Med Sci Health 5(3): 7-12.

Meşen, A., Yavuzer, K. 2021. Comparison of tear film breaking time measured using new generation and traditional methods. Turk Klin J Ophthalmol 30.

Najafi, L., Malek, M., Valojerdi, A.E., Khamseh, M.E., Aghaei, H. 2015. Dry eye disease in type 2 diabetes mellitus; comparison of the tear osmolarity test with other common diagnostic tests: A diagnostic accuracy study using STARD standard. J Diabetes Metab Disord 14: 39.

Sağdık, H.M., Ugurbas, S.H., Can, M., Tetikoğlu, M., Ugurbas, E., Uğurbaş, S.C., Alpay, A., Uçar, F. 2013. Tear film osmolarity in patients with diabetes mellitus. Ophthalmic Res 50(1): 1-5.

Taheri, A.R., Allahyari, E. 2021. Dry eye and meibomian glands in vitiligo. Turk J Ophthalmol 51(2): 70-4.

Yıldız, E., Zibandeh, N. 2020. Effects of type 2 diabetes mellitus on gene expressions of mouse meibomian glands. Curr Eye Res 45: 72-80.

Yu, T., Han, X.G., Gao, Y., Song, A.P., Dang, G.F. 2019. Morphological and cytological changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 12: 1415-9.

Yu, T., Shi, W.Y., Song, A.P., Gao, Y., Dang, G.F., Ding, G. 2016. Changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 9: 1740-1744.