Introduction and Objective: To compare clinical and biochemical characteristics associated with the presence of age-related macular degeneration (AMD) versus diabetic retinopathy (DR) severity in people diagnosed with type 1 and type 2 diabetes. Methods: Retinal images were examined for the presence of AMD, diabetic macular edema (DME), and DR severity in age comparable individuals with type 1 (N=1,413) and type 2 diabetes (N=3,923) from the Beetham Eye Institute (BEI) and in people with over 50 years of insulin-dependent diabetes (N=1,019, Medalists) at Joslin Diabetes Center (Boston, MA). Retinol-Binding Protein 3 (RBP3) and Vascular Endothelial Growth Factor (VEGF) concentrations were measured in ELISA assays. Results: The presence of DME was more frequent in eyes without AMD in type 1 (no AMD 16.7% vs AMD 7.6%, P0.01) and type 2 diabetes (no AMD 23.8% vs 13.9% AMD, P0.01). In type 1 diabetes, AMD was associated with less severe DR (Medalist: 41.1% no-mild DR, 32.6% moderate-severe DR and 18.2% proliferative DR, P0.001; BEI: no-mild DR 14.5%, moderate-severe DR 8.2%, proliferative DR 3.0%, P0.001). This remained significantly associated in multivariable models adjusting for factors associated with AMD and DR (P0.001). In type 2 diabetes, prevalence of AMD was lower and this was even lower with increasing DR severity (no-mild DR 3.1%, moderate-severe DR 2.1%, proliferative DR 1.2%, P0.05), but not in multivariable models. Vitreous VEGF concentration was positively associated with DR severity, but inversely associated with dry AMD. Vitreous RBP3 concentration was negatively correlated with DR severity, but positively with dry AMD (P0.05, all). Conclusion: DME and other DR associated clinical and biochemical factors are inversely associated with the presence of AMD, especially in type 1 diabetes. Further studies are needed to clarify the interactions between AMD and DR and possible difference in type 1 and type 2 diabetes in order to optimal approaches for glycemic control to prevent AMD and DR progression. Disclosure W. Fickweiler: None. V. Douglas: None. S. Jangolla: None. M. Kang: None. J. Gauthier: None. I. Wu: None. M. Yu: None. H. Shah: None. J.D. Cavallerano: None. P.S. Silva: Research Support; Current; Optos plc. Consultant; Current; AbbVie Inc., Roche Pharmaceuticals, Bayer AG. Research Support; Current; Boehringer Ingelheim International GmbH. L.P. Aiello: Advisory Panel; Current; Optos plc. Research Support; Current; Boehringer Ingelheim International GmbH. Consultant; Current; Ceramedix. J. Sun: Research Support; Current; Adaptive Sensory Technology. Other - Research support and food at meeting; Current; Boehringer Ingelheim International GmbH. Research Support; Current; Roche Pharmaceuticals. Research Support; Ended; Genentech, Inc. Research Support; Current; LKC Technologies, Konan. Other - Research support and food at meeting; Current; Novo Nordisk. Research Support; Current; Optovue, Incorporated. Research Support; Ended; Physical Sciences, Inc. Other - Food at meeting; Ended; Alcon. G.L. King: None. Funding NIH T32 DK007260-48, NEI (R01EYE26080-01), NIDDK (DP3- DK-094333-01); JDRF (17-2013-310); the Dianne Nunnally Hoppes Fund; the Beatson Pledge Fund
FICKWEILER et al. (Fri,) studied this question.