Association Between Fuchs Endothelial Corneal Dystrophy, Diabetes Mellitus, and Multimorbidity

Author:

Nealon Cari L.1,Halladay Christopher W.2,Gorman Bryan R.34,Simpson Piana1,Roncone David P.1,Canania Rachael L.1,Anthony Scott A.1,Sawicki Rogers Lea R.5,Leber Jenna N.5,Dougherty Jacquelyn M.5,Cooke Bailey Jessica N.678,Crawford Dana C.678,Sullivan Jack M.5910,Galor Anat1112,Wu Wen-Chih13,Greenberg Paul B.1415,Lass Jonathan H.1617,Iyengar Sudha K.678,Peachey Neal S.81318,

Affiliation:

1. Eye Clinic, VA Northeast Ohio Healthcare System, Cleveland, OH;

2. Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI;

3. VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA;

4. Booz Allen Hamilton, McLean, VA;

5. Ophthalmology Section, VA Western NY Health Care System, Buffalo, NY;

6. Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH;

7. Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH;

8. Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH;

9. Research Service, VA Western NY Health Care System, Buffalo, NY;

10. Department of Ophthalmology (Ross Eye Institute), University at Buffalo-SUNY, Buffalo, NY;

11. Miami Veterans Affairs Medical Center, Miami, FL;

12. Bascom Palmer Eye Institute, University of Miami, Miami, FL;

13. Cardiology Section, Medical Service, Providence VA Medical Center, Providence, RI;

14. Ophthalmology Section, Providence VA Medical Center, Providence, RI;

15. Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI;

16. Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH;

17. University Hospitals Eye Institute, Cleveland, OH;

18. Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH; and

Abstract

Purpose:The aim of this study was to assess risk for demographic variables and other health conditions that are associated with Fuchs endothelial corneal dystrophy (FECD).Methods:We developed a FECD case–control algorithm based on structured electronic health record data and confirmed accuracy by individual review of charts at 3 Veterans Affairs (VA) Medical Centers. This algorithm was applied to the Department of VA Million Veteran Program cohort from whom sex, genetic ancestry, comorbidities, diagnostic phecodes, and laboratory values were extracted. Single-variable and multiple variable logistic regression models were used to determine the association of these risk factors with FECD diagnosis.Results:Being a FECD case was associated with female sex, European genetic ancestry, and a greater number of comorbidities. Of 1417 diagnostic phecodes evaluated, 213 had a significant association with FECD, falling in both ocular and nonocular conditions, including diabetes mellitus (DM). Five of 69 laboratory values were associated with FECD, with the direction of change for 4 being consistent with DM. Insulin dependency and type 1 DM raised risk to a greater degree than type 2 DM, like other microvascular diabetic complications.Conclusions:Female sex, European ancestry, and multimorbidity increased FECD risk. Endocrine/metabolic clinic encounter codes and altered patterns of laboratory values support DM increasing FECD risk. Our results evoke a threshold model in which the FECD phenotype is intensified by DM and potentially other health conditions that alter corneal physiology. Further studies to better understand the relationship between FECD and DM are indicated and may help identify opportunities for slowing FECD progression.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Ophthalmology

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