Transient hyperopic refractive changes in newly diagnosed juvenile diabetes

To investigate transient hyperopic refractive changes in newly diagnosed juvenile diabetics and to evaluate their clinical course after starting intensive glycemic control of severe hyperglycaemia.

20 hyperopic adolescents with newly diagnosed and uncomplicated type 1 diabetes, selected for this prospective study, were enrolled for a baseline examination and, after starting intensive insulin treatment, followed every two weeks during a four-month follow up. Standardised automated refraction and A-mode ultrasonography were performed. Poor metabolic control was an inclusion criteria.

Refractive changes and hyperopic peaks preceded the start of the intensive insulin therapy in all diabetics and, thereafter, refraction decreased gradually with a maximum recovery time of 94 days. A statistically significant positive correlation between refractive changes and magnitude of plasma glucose concentrations as well as HbA1c percentages was observed (P <0.001). No significant modifications in the explored refractive components were recorded.

Transient hyperopic changes are highly dependent on the magnitude of plasma glucose concentrations and rapid correction of hyperglycemia is strictly correlated with complete recovery of refraction. To account for this phenomenon, the sorbitol production via the polyol pathway with overhydration of the lens remains the best pathophysiological hypothesis at this time.