Findings from a recent study published in Eye & Contact Lens: Science & Clinical Practice tracked ulcerative keratitis (UK) incidence across the United States over 7 years while measuring the impact of diabetes mellitus (DM) on its development.
Give me some background first.
Some context: UK is corneal inflammation and ulceration that can scar the cornea and threaten sight.
And while diabetes has long been suspected of undermining corneal health, investigators in this recent study noted the lack of population-level data available on exactly how much it raises the risk for UK.
Why that matters: The authors set out to quantify both the trend in UK incidence and the specific contribution of diabetes, including whether glycemic control changed the picture.
Now, talk about the study.
Investigators ran a retrospective analysis using the TriNetX platform, pulling records from U.S. health care organizations to calculate UK incidence rates from 2017 to 2024.
Then: They identified patients with and without DM and compared their risk of developing UK after propensity score matching for baseline demographic characteristics.
Who was included in the study?
Patients came from U.S. health care organizations represented in the TriNetX database. Two cohorts, one with diabetes and one without, were matched on baseline demographics and followed for 1 year.
Worth noting: The abstract did not report exact cohort sizes or a full demographic breakdown.
And the findings?
UK incidence fluctuated across the study window but generally rose, peaking at 30.06 cases per 100,000 person-years in 2024.
The headline comparison: Patients with diabetes had a 60% greater risk of developing UK than those without, within 1 year of follow-up (relative risk [RR] 1.601; 95% confidence interval [CI], 1.239 to 2.069).
Tell me more.
Glycemic control mattered.
Among patients with diabetes, those with recorded hemoglobin A1c (HbA1c) values above 8% had a higher risk of UK than those with values below 8% (RR 1.14; 95% CI, 1.058 to 1.228).
The authors' read: The pathophysiology of diabetes can degrade corneal health through impaired wound healing, altered corneal innervation, reduced corneal sensitivity and tear production, and weakened epithelial barrier function, all of which raise susceptibility to infection and inflammation.
Any limitations?
The retrospective design and reliance on electronic health record data limited the ability to assess disease severity and establish causality.
That said: The matched-cohort approach and the higher risk seen with elevated HbA1c strengthen the case that diabetes, especially when poorly controlled, is a real contributor rather than a coincidental association.
Expert opinion?
No outside expert commentary was included in the study.
The authors concluded that the findings underscore diabetes, particularly uncontrolled diabetes, as a meaningful risk factor for UK and emphasize systemic disease management as part of preserving corneal health.
Anything else?
The trajectory is worth flagging: Incidence didn't plateau over the study window—it landed at its high point in the final year on record, which points to UK becoming more common over time.
But one open question: Whether that climb reflects more diabetes in the population or simply better detection and coding is something this dataset can't separate out.
Take home.
For clinicians: Patients with diabetes, especially those with an HbA1c above 8%, warrant closer attention to corneal health, and tighter glycemic control may be one lever for protecting the ocular surface.