Eye diseases prevalent among CKD patients in SG

Patients with chronic kidney disease (CKD) have a particularly high burden of eye diseases, including diabetic retinopathy (DR) and age-related macular degeneration (AMD), despite receiving regular medical follow-up, as shown in a study from Singapore.

In a cohort of 528 CKD patients (mean age 63.74 years, 64.0 percent male, 63.6 percent Chinese, 58.3 percent had diabetes) recruited from outpatient renal clinics at the National University Hospital, 35 percent had ocular conditions that necessitated a referral. [J Pers Med 2025;15:204]

Specifically, urgent referrals (same day or within 24 h) were given to six patients for conditions such as central retinal arterial occlusion, macular hole, proliferative DR (PDR), retinal detachment, or retinal emboli. Semi-urgent referrals (within 1−2 weeks) were given to 30 patients for PDR with maculopathy, late AMD, central retinal vein occlusion, central serous retinopathy, collaterals with impending occlusion/disc collaterals, or pseudo-hole due to epiretinal membrane.

In the remaining 151 patients, fast-track referrals (within 1–3 months) were given for conditions including cataracts, glaucoma suspect, late AMD, maculopathy, mild nonproliferative DR with maculopathy, moderate nonproliferative DR, or treated stable DR.

When stratified into CKD stages, referral rates among patients with an eGFR <60 mL/min/1.73 m² (n=284) increased with CKD progression, from 43 percent in stage G3 to 58 percent in G4 and 72 percent in G5.

In the subgroup of patients with diabetes, half (34.3 percent) of the 67.4 percent who were on annual follow-up still received fast-track referrals for serious conditions such as referable DR, glaucoma/glaucoma suspect, epiretinal membrane, or AMD, among others. In the subgroup of those without diabetes, 7.8 percent of the 31.2 percent on annual follow-up required fast-track referral.

“These findings underscore the high prevalence and severe nature of eye diseases in CKD patients, even those who are under regular annual follow-up,” according to the study authors. “The absence of eye screening guidelines for CKD patients is concerning, especially since many vision-threatening conditions are asymptomatic and may be present even in patients already receiving annual diabetic eye care.”

They emphasized that their study makes a substantial contribution to the development of personalized care strategies for CKD patients.

“Integrating retinal photography into nephrology care could support earlier detection and timely intervention, which aligns with personalized medicine by tailoring care based on CKD stages, diabetic status, and referral needs,” the authors pointed out.

“Additionally, eye screening may prove cost-effective by preventing advanced eye disease and promoting health equity through improved access to comprehensive care, ultimately supporting better visual outcomes for CKD patients,” they said.

In the study, professional graders assessed retinal photographs from each dilated eye for the presence of DR and other eye diseases. Patients with significant eye conditions were referred to ophthalmologists based on severity and urgency, categorized as urgent, semi-urgent, fast-track, or annual referrals.

Overall, 53.8 percent of the CKD population had an eye disease. Specifically, 19.3 percent of patients had any retinopathy, 18.4 percent had AMD, 16.1 percent had multiple lesions, 13.1 percent had cataracts, 7.2 percent had epiretinal membrane, 5.5 percent were glaucoma suspects, and 5.3 percent had other eye diseases such as retinal detachment, corneal diseases, or optic neuropathy.

Among CKD patients with diabetes, 11.4 percent had mild nonproliferative DR, 9.7 percent had moderate nonproliferative DR, 1.3 percent severe nonproliferative DR, and 5.5 percent had proliferative DR.