Abstract
OBJECTIVE: This study investigated the relationship between estimated glucose disposal rate (eGDR) and the risk of age-related ocular diseases, including macular degeneration, glaucoma, cataracts, diabetic retinopathy (DR) and retinal detachment (RD), in individuals with stages 0-3 of cardiovascular-kidney-metabolic (CKM) syndrome. METHODS AND ANALYSIS: This prospective cohort study included 223 120 participants from the UK Biobank. The CKM stages were defined based on adiposity, metabolic risk factors and subclinical cardiovascular disease. Lower eGDR values indicate greater insulin resistance. Outcomes were incidences of macular degeneration, glaucoma, cataract, DR and RD. HRs and 95% CIs were estimated using Cox proportional hazards models. Non-linear relationships were explored using restricted cubic splines. RESULTS: The study showed that macular degeneration (HR 0.92, 95% CI 0.87 to 0.97, p=0.001) and glaucoma (HR 0.91, 95% CI 0.87 to 0.95, p<0.001) were linearly associated with eGDR. Cataracts exhibited a U-shaped association with eGDR (P non-linear=0.001) and DR exhibited an L-shaped association (P non-linear=0.018). Quartile stratification of eGDR significantly differentiated risk in DR (Q4 vs Q1: HR 0.15, 95% CI 0.04 to 0.52, p=0.003) and RD (Q4 vs Q1: HR 0.65, 95% CI 0.47 to 0.89, p=0.007). Stratified effects analysis revealed that these associations were more significant in advanced CKM syndrome stages. CONCLUSIONS: eGDR is associated with ocular diseases risk in CKM syndrome, especially in advanced stages. This finding suggests the potential use of eGDR for guiding ophthalmic screening in CKM management.