Ward Fickweiler, MD, PhD: Diabetic Retinopathy Inversely Associated with AMD

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An analysis at ADA 2023 presents novel findings on the inverse association between clinical and biochemical factors in diabetic retinopathy and age-related macular degeneration.

New research suggests diabetic retinopathy is inversely associated with age-related macular degeneration (AMD), with clinical and biochemical factors inversely correlated between the ocular diseases.

The data, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), suggest that the inverse risk of diabetic retinopathy and AMD is likely not due to similar pathogenic mechanisms and aging factors.

“We found that the presence of advanced diabetic retinopathy was associated with protection against AMD,” presenting investigator Ward Fickweiler, MD, PhD, a clinical research fellow at Joslin Diabetes Center, Harvard Medical School told HCPLive. “The presence of AMD was less common in advanced diabetic retinopathy. Additionally, we found that the progression of AMD and diabetic retinopathy seem to be inversely associated.”

The number of people affected by diabetic retinopathy is expected to reach nearly 16 million by 2050 in the United States, with AMD expected to affect more than 20 million people in the same period.2 Although DR and AMD are the 2 most common sight-threatening conditions in the elderly population, there is limited understanding of the associated risks between the diseases.

In the current analysis, Fickweiler and colleagues examined the association between AMD and diabetic retinopathy in people with type 1 and type 2 diabetes from the Joslin 50-Year Medalist Study of individuals who have had insulin-dependent diabetes for ≥50 years, and in the Beetham Eye Institute.1

The analysis revealed an inverse association between diabetic retinopathy severity and the presence of AMD in the Medalists study (n = 1163). The association in eyes with AMD was 23.4% for no-mild, 18.6% for moderate-severe, and 7.9% for proliferative diabetic retinopathy (P <.0001). Meanwhile, the presence of AMD was associated with milder diabetic retinopathy in the Beetham Eye Institute cohort (n = 58; P = .004).

Investigators observed no eyes with neovascular AMD. They indicated the presence of AMD was associated with older age (P = .03), increased diabetes duration (P <.0001), less severe diabetic retinopathy (P <.0001), and the absence of neuropathy (P = .003). On the other hand, younger age (P = .02) and the presence of neuropathy (P <.0001) were associated with the presence of proliferative diabetic retinopathy.

The analysis showed higher vitreous retinol-binding protein 3 to vascular endothelial growth factor (VEGF) ratios was associated with AMD and less severe diabetic retinopathy in both postmortem Medalist and surgical Beetham Eye Institute samples (n = 187; P <.05 for all).

The presence of milder diabetic retinopathy was associated with an increased risk of AMD development (24.8%, 10.0%, 5.0% for no-mild, moderate-severe, and proliferative diabetic retinopathy, respectively, P = .047), according to the analysis. Meanwhile, the risk of diabetic retinopathy progression was decreased in eyes with versus without AMD (P = .04) in a subset of Medalist patients with longitudinal follow-up (22.9%).

The investigative team noted further studies will be required to clarify the interactions between AMD that ultimately may provide new treatment pathways to target their development.

For more insight into this analysis and takeaways from the data, watch the full interview with Fickweiler at ADA 2023 below:

Fickweiler reports no relevant disclosures.


  1. Fickweiler W, Jacoba CM, Jangolla SVT, Gauthier J, Ziemniak NA, Wu I, Cavallerano JD, Aiello LP, Sun J, King GL. Clinical and Biochemical Factors Are Inversely Correlated in Diabetic Retinopathy and Age-Related Macular Degeneration. Oral presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023.
  2. Saaddine JB, Honeycutt AA, Narayan KMV, Zhang X, Klein R, Boyle JP. Projection of Diabetic Retinopathy and Other Major Eye Diseases Among People With Diabetes Mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126(12):1740–1747. doi:10.1001/archopht.126.12.1740