Associations of Peripapillary Atrophy and Fundus Tessellation with Diabetic Retinopathy

Purpose: There is a limited understanding of ocular risk factors for diabetic retinopathy (DR). Our aim therefore was to determine the relationship of 2 retinal signs related to axial myopia (peripapillary atrophy [PPA] and fundus tessellation) with DR. Design: Cross-sectional study. Methods: Of 3353 subjects (72.8% response rate) who participated in the population-based Singapore Chinese Eye Study, 592 participants had diabetes. Of these, 1010 eyes from 530 participants were included in our analyses after excluding participants without gradable retinal photographs or missing key variables. DR, PPA-beta (β), and fundus tessellation were graded from retinal photographs. The associations between PPA-β or fundus tessellation with DR were analyzed using logistic regression models with generalized estimating equations. Main Outcome Measures: Diabetic retinopathy. Results: Among the 530 participants, the mean (standard deviation) age was 62.8 (9.2) years, and 288 (54.3%) were male. PPA-β and fundus tessellation were both associated with longer axial length (AL). In multivariable analyses adjusting for potential confounders including AL, eyes with PPA-β or fundus tessellation were less likely to have any DR, with odds ratio (95% confidence interval) 0.58 (0.41–0.83) and 0.46 (0.25–0.87), respectively. These associations with DR were consistent in models adjusting for refractive status, and in a subanalysis that excluded eyes with high AL (>24.5 mm). Conclusions: Eyes with PPA-β or fundus tessellation were less likely to have DR, independent of diabetes risk factors, AL, or refractive status. The presence of these 2 ophthalmic features may indicate lower risk of DR.