Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy

Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. HbA1c at the follow-up was significantly lower in the bariatric surgery group (6.4 vs 8.5; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group ( P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusion: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden after bariatric surgery, which may have a significant impact on quality of life for patients with DR.