Bidirectional 5-year risks of diabetic retinopathy, glaucoma and/or ocular hypertension: Results from a national screening programme

Signe Sperling*, Lonny Stokholm, Anne Suhr Thykjær, Frederik Nørregaard Pedersen, Sören Möller, Caroline Schmidt Laugesen, Nis Andersen, Jens Andresen, Toke Bek, Morten la Cour, Javad Hajari, Steffen Heegaard, Kurt Højlund, Ryo Kawasaki, Miriam Kolko, Katja Christina Schielke, Katrine Hass Rubin, Anders Højslet Vestergaard, Jakob Grauslund

*Corresponding author for this work

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PURPOSE: We aimed to investigate if diabetic retinopathy (DR), glaucoma and/or ocular hypertension (OHT) are prospectively linked, as previous studies have proposed cross-sectional associations, but longitudinal data from larger cohorts are lacking.

METHODS: We performed a bidirectional 5 years prospective, registry-based cohort study. We extracted data from national registers, including the Danish Registry of Diabetic Retinopathy, the Danish Civil Registration System, the Danish National Patient Register and the Danish National Prescription Registry. DR level was defined by the highest level of the two eyes. Glaucoma and/or OHT was defined by diagnostic codes (H40*) or at least three redeemed prescriptions of glaucoma medication (S01E*) within 1 year. We included 205 970 persons with diabetes and 1 003 170 age- and gender-matched non-diabetes controls. Exposures were level-specific DR (i) and glaucoma and/or OHT (ii), and outcomes were hazard ratios (HRs) for 5 years incident glaucoma and/or OHT (i) and DR (ii).

RESULTS: Persons with diabetes were more likely to develop glaucoma and/or OHT (multivariable adjusted HR 1.11, 95% CI 1.06-1.15), but this did not depend on the level of DR. In persons with diabetes, those with glaucoma and/or OHT were more likely to develop DR (multivariable adjusted HR 1.12, 95% CI 1.03-1.23) within 5 years.

CONCLUSION: In a national cohort, diabetes associated with a little higher risk of upcoming glaucoma and/or OHT, and, inversely, the presence of the latter predicted a higher risk of incident DR. Nevertheless, our data do not seem to justify including glaucoma evaluation in the national Danish DR-screening programme.

Original languageEnglish
JournalActa Ophthamologica
Issue number4
Pages (from-to)384-391
Number of pages8
Publication statusPublished - Jun 2023

Bibliographical note

© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.


  • diabetes
  • diabetic retinopathy
  • epidemiology
  • glaucoma
  • ocular hypertension


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