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News
Poor diabetes control raises surgical eye risks. A large retrospective study found that higher preoperative hemoglobin A1c levels significantly increase the risk of cystoid macular edema (CME) after cataract surgery, with incidence jumping from 4.2% in well-controlled patients to 6.9% in those with A1c ≥8%. A separate study also linked high A1c to nearly double the infection risk after glaucoma tube-shunt surgery.
Two new studies presented at the American Academy of Ophthalmology (AAO) annual meeting reveal that elevated preoperative hemoglobin A1c (A1c) levels are a meaningful risk factor for serious complications after both cataract and glaucoma surgeries — adding urgency to pre-surgical diabetes counseling and management.
In a large VA Health System analysis (2010–2022) of over 127,000 patients, researchers found a direct correlation between A1c levels and the incidence of cystoid macular edema (CME) — the most common vision-threatening complication of cataract surgery. Preoperative diabetic retinopathy was the strongest predictor of CME, but A1c was an independent, additive risk factor. A second study using the TriNetX network found that patients with A1c >8.4% before tube-shunt glaucoma surgery had nearly double the 5-year risk of serious eye infections compared to those with normal A1c levels.
By the Numbers
Why it matters: These findings push clinicians to consider A1c optimization before elective eye surgery — not just as a general health measure, but as a targeted strategy to reduce vision-threatening and infection-related complications.
