Diabetic retinopathy as a potential risk factor for ptosis: A 13-year nationwide population-based cohort study in Taiwan

Chun-Ju Lin; Alan Y Hsu; Peng-Tai Tien; Cheng-Hsien Chang; Chun-Ting Lai; Ning-Yi Hsia; Yu-Cih Yang; Henry Bair; Huan-Sheng Chen; Wen-Lu Chen; Yi-Yu Tsai

doi:10.3389/fepid.2023.1093064

Diabetic retinopathy as a potential risk factor for ptosis: A 13-year nationwide population-based cohort study in Taiwan

Front Epidemiol. 2023 Mar 13:3:1093064. doi: 10.3389/fepid.2023.1093064. eCollection 2023.

Authors

Chun-Ju Lin^{1

2

3}, Alan Y Hsu^{1

4}, Peng-Tai Tien^{1

5}, Cheng-Hsien Chang^{1

6}, Chun-Ting Lai¹, Ning-Yi Hsia¹, Yu-Cih Yang^{7

8}, Henry Bair^{1

9}, Huan-Sheng Chen¹⁰, Wen-Lu Chen¹, Yi-Yu Tsai^{1

2

3}

Affiliations

¹ Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
² School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Optometry, Asia University, Taichung, Taiwan.
⁴ Department of General Medicine, China Medical University Hospital, Taichung, Taiwan.
⁵ Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
⁶ Department of Ophthalmology, Changhua Hospital, Changhua, Taiwan.
⁷ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁸ College of Medicine, China Medical University, Taichung, Taiwan.
⁹ Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States.
¹⁰ An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan.

Abstract

Purpose: To determine the risk of ptosis among diabetic retinopathy (DR) patients.

Methods: This is a population-based, retrospective, matched-cohort study where DR patients were recruited from the Taiwan National Health Insurance Research Database (NHIRD) to investigate the risk of developing ptosis. Preexisting co-factors of interest included smoking status and medical comorbidities of hyperlipidemia and hypertension. Statistical analysis was performed using T-test, Cox-proportional hazard ratios adjusted for comorbidities (aHR), Wilcoxon rank sum test, Kaplan-Meier estimators, and log rank tests.

Results: Follow-up data of 9,494 patients with DR and 37,976 matched control cohort (non-DR) from 2000 to 2012 were analyzed. DR patients were found to have significantly increased risk of developing ptosis (adjusted hazard ratio (HR) [95% CI]: 2.76 [1.74-4.38], p < 0.001) when compared to the control cohort. From analysis in different strata, adult age and non-smokers were shown to have higher risk for ptosis development among DR patients. Furthermore, DR patients was also found to have increased risk of developing ptosis when compared to matched controls, regardless of whether they had medical comorbidities of lipid metabolism disorders or hypertension.

Conclusions: In this large-scale study using real-world data, our results showed that DR patients were found to have increased risk of developing ptosis. Female gender, adult age, and non-smokers were also shown to increase the risk of ptosis among DR patients. This has implications towards the care of diabetic patients, complications such as ptosis should be properly screened for when encountering such patients. Before ptosis surgery, the possibility of underlying diabetes or DR should be also scrutinized and treated properly to avoid undesirable postoperative dissension.

Keywords: age; diabetic retinopathy; gender; hypertension; lipid disorders; ptosis; smoking.

Grants and funding

This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (grant no. MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (grant no. BM10501010037), NRPB Stroke Clinical Trial Consortium (grant no. MOST 104-2325-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.