Diabetic nephropathy may predict the retinal changes of patients with diabetes: An Indian population-based study

Purpose: This study aimed to study and correlate fundus changes in patients with Type 2 diabetes mellitus with different stages of nephropathy. Materials and Methods: It is a prospective, observational study involving 100 patients at a tertiary health-care institute. Type 2 diabetic patients with diabetic nephropathy (DN) were enrolled. Those with uncontrolled hypertension, history of other ocular diseases, or surgeries were excluded. DN was defined as – microalbuminuria, macroproteinuria, and massive proteinuria based on 24-h urine protein analyser values. Participants underwent complete ophthalmic examination with fundus examination, fundus fluorescein angiography, and optical coherence tomography and were graded into various stages of diabetic retinopathy. The influence of nephropathy on retinal changes was assessed using Pearson's correlation analysis. Results: The study population included those with a median age of 56 years (range 38–79 years). In the group with microalbuminuria, 10 (62%) eyes did not have any retinopathy changes. In the macroproteinuria group, 61 (53%) showed mild-to-moderate nonproliferative diabetic retinopathy (PDR). In addition, 30 eyes of patients (48%) with massive proteinuria had PDR which were all statistically significant. Also in 32 eyes (16%) of DN patients, clinically significant macular edema was present, most of which, i.e., 24 (75%), were in the macroproteinuria group. Conclusions: These findings indicated that the severity of proteinuria was significantly associated with fundus changes in Type 2 diabetic patients. Thus, we conclude that DN is a marker of retinopathy and timely ophthalmic evaluation of patients should be done.