The Impact of Refractive Errors on Diabetes and Its Clinical Significance

Refractive errors (including myopia, hyperopia, and astigmatism) and diabetes are two highly prevalent chronic diseases worldwide. Traditionally, refractive errors have been considered independent ocular refractive issues, while the primary focus of diabetes has been its microvascular complication-diabetic retinopathy (DR). However, increasing evidence in recent years indicates a complex and bidirectional interaction between the two. Hyperglycemia can induce transient refractive changes by altering the osmotic pressure and refractive index of the lens and aqueous humor, serving as an early sign of poorly controlled diabetes. More importantly, long-term diabetes is a significant risk factor for acquired refractive errors such as pathological myopia and complicated cataracts, and can significantly exacerbate the progression of pre-existing refractive errors. Conversely, the inherent fundus pathologies in high refractive errors (especially high myopia), such as retinal thinning and insufficient choroidal blood perfusion, may increase susceptibility to ischemic and hypoxic damage caused by diabetes, potentially influencing the onset and progression of DR. This interaction exhibits different characteristics across countries and regions due to variations in population demographics, healthcare resources, and prevention strategies. This article systematically elaborates on the bidirectional impact between refractive errors and diabetes, analyzes differences in domestic and international research evidence and clinical practices, and delves into its significant clinical implications, offering new perspectives for early diabetes screening, complication monitoring, vision correction planning, and public health strategy optimization.