Association of Cataract Surgery With Risk of Diabetic Retinopathy Among Asian Participants in the Singapore Epidemiology of Eye Diseases Study

Question Is cataract surgery associated with an increased risk of diabetic retinopathy? Findings In this population-based cohort study of 972 participants with type 2 diabetes (1734 eyes), any prior cataract surgery was significantly associated with a higher risk of diabetic retinopathy after adjustment for confounding factors. Similar associations were observed in both Malay and Indian participants. Meaning These findings suggest that patients with diabetes may benefit from more frequent diabetic retinopathy screenings after cataract surgery. This population-based cohort study assesses the risk of developing diabetic retinopathy after cataract surgery among individuals with diabetes in Singapore. Importance Cataracts and diabetic retinopathy (DR) are the leading causes of acquired blindness worldwide. Although extraction is the standard treatment option for cataracts, it is also reported to increase the risk of developing DR among individuals with diabetes. Nevertheless, the association between cataract surgery and risk of DR is still not well understood, and there have been no prior population-based reports in this area. Objective To assess the risk of developing DR after cataract surgery among individuals with type 2 diabetes. Design, Setting, and Participants A population-based prospective cohort study was conducted among participants recruited from the Singapore Epidemiology of Eye Diseases Study. The baseline visit was conducted between June 1, 2004, and March 31, 2009, and the 6-year follow-up visit was conducted between June 1, 2011, and July 31, 2016. Statistical analysis was performed from October 1 to 31, 2019. Exposures Cataract surgery performed before a follow-up visit, determined based on slitlamp evaluation of lens status at baseline and follow-up visits. Main Outcomes and Measures Eyes with incidence of DR were defined as those with the presence of any DR (level >= 15 based on the modified Airlie House classification system, graded from retinal photographs) at 6-year follow-up with no DR at baseline. The association between cataract surgery and incidence of DR was evaluated using a multivariable Poisson regression model with a generalized estimating equation to account for correlation between both eyes. Results A total of 1734 eyes from 972 participants with diabetes (392 Malay individuals and 580 Indian individuals; 495 men; mean [SD] age, 58.7 [9.1] years) were included in the analysis. A total of 163 study eyes had already undergone cataract surgery at baseline, and a total of 187 eyes (originally phakic at baseline) underwent cataract surgery any time during the follow-up period. Of these 350 eyes, 77 (22.0%) developed DR. Among the 1384 eyes that never underwent cataract surgery, 195 (14.1%) developed DR. After adjustments for age, sex, race/ethnicity, baseline hemoglobin A(1c)level, duration of diabetes, random blood glucose level, antidiabetic medication use, hypertension, body mass index, and smoking status, multivariable regression analysis showed that any prior cataract surgery was associated with incidence of DR (relative risk, 1.70; 95% CI, 1.26-2.30; P = .001). Subgroup analyses by race/ethnicity showed similar associations in both Malay individuals (relative risk, 1.73; 95% CI, 1.13-2.69; P = .02) and Indian individuals (relative risk, 1.93; 95% CI, 1.33-2.80; P < .001). Conclusions and Relevance The findings of this population-based cohort study suggest that prior cataract surgery was associated with a higher risk of developing DR among individuals with diabetes. Further validation is warranted to confirm this association.