1453 Open Access J Pak Med Assoc Introduction Diabetes mellitus (DM) is a global problem affecting approximately 537 million adults aged 20-79 years in 2021, and is likely to reach 634 million by 2030. 1 Pakistan with a population of more than 220 million and a prevalence of diabetes at 26.3% is facing a DM epidemic. 2 DM is known for its complications, including eye–related complications. Some of these ophthalmic complications, like retinopathy, are the result of poor glycaemic control. 3 Other eye diseases, like cataract, glaucoma and ocular surface diseases, have also been found in higher frequency among diabetics at a younger age. 4 Ever increasing DM prevalence demands periodic evaluation of distribution and determinants of its complications. There has been some work done to evaluate the association of DM with multiple ocular complications internationally 5 but most of the work has been focussed around diabetic retinopathy (DR) 6-8 and sustainable blindness (SB). 9 DM prevalence and its associated complications in all ages are causing signifcant morbidities, but data from Pakistan is still lacking in certain areas. Association of different factors of diabetes, such as sugar level and lipid profle, have been explored with DR, 10,11 but not much work has been done with co-ocular morbidities, such as cataract and glaucoma. Considering the overall burden of the disease and its co- morbidities, it is highly essential to evaluate not only the frequencies of the ocular co-morbidities, but the overall risk of SB associated with DR and its risk with systemic factors, such as lipid profle and glycated haemoglobin (HbA1c). The current study was planned to evaluate the frequencies of ocular comorbidities among patients with type II DM (T2DM), and the association with multiple systemic factors. Materials and Methods The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic (DEC) data from April 2014 to February 2022, under the project “Strengthening Pakistan’s response to Diabetic Retinopathy”. After approval from the institutional ethics review committee, data was retrieved using non-probability purposive sampling technique. Data of all individuals who attended DEC during the stipulated period was included, while incomplete data was excluded. Systemic factors had been documented by the diabetologist (general physician), while ocular assessments RESEARCH ARTICLE Ocular complications associated with diabetes and the risk of sustainable blindness: A real world analysis Tauseef Mahmood 1 , Muhammad Faisal Fahim 2 , Shahid Ahsan 3 , Umair Qidwai 4 , Muhammad Saleh Memon 5 Abstract Objective: To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. Method: The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic fndings of the patients were recorded. Ocular fndings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. Results: Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision-threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were signifcantly associated with advanced diabetic eye disease and clinically signifcant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated signifcantly with diabetic retinopathy and suspected glaucoma (p<0.05). Conclusion: Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications. Keywords: Cataract, Glaucoma, Diabetic retinopathy. (JPMA 73: 1453; 2022) DOI: https://doi.org/10.47391/JPMA.8001 Submission completion date: 07-10-2022- Acceptance date: 01-04-2023 1,4,5 Al Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi, Pakistan; 2 Bahria University Medical and Dental College, Karachi, Pakistan; 3 Jinnah Medical and Dental College, Karachi, Pakistan. Correspondence: Muhammad Saleh Memon. e-mail: salehmemon@yahoo.com ORCID ID. 0009-0001-7852-1207