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Time to fellow eye involvement in patients with unilateral diabetic macular oedema



To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO.


Retrospective cohort study.


One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021.


Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves.


Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert.


Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.

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Fig. 1: Patient selection PRISMA.
Fig. 2: Forrest plot displaying hazard ratios from multivariate analysis.
Fig. 3: Analysis of conversion probability stratified by baseline criteria.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



PA was responsible for protocol design, data collection and analysis, and manuscript writing. MWR was responsible for data collection and analysis. VB, BLK, AKW, BJL, CCSV, CMX, and JCM were responsible for data collection. MK was responsible for manuscript writing and editing. RPS was responsible for designing the project and for providing feedback on the study.

Corresponding author

Correspondence to Rishi P. Singh.

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Competing interests

RPS reports personal fees from Genentech/Roche, Alcon/Novartis, Zeiss, Bausch+Lomb, Regeneron Pharmaceuticals, Inc, Gyroscope and Asceplix and grants from Apellis and Graybug. Other authors have no financial disclosures to report.

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Alsaloum, P., Russell, M.W., Blaga, V. et al. Time to fellow eye involvement in patients with unilateral diabetic macular oedema. Eye (2023).

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