RETINAL DISORDERS Association of serum lipid levels with retinal hard exudate area in African Americans with type 2 diabetes Evangelia Papavasileiou 1 & Samaneh Davoudi 1 & Ramak Roohipoor 1,2 & Heeyoon Cho 1,3 & Shreyas Kudrimoti 1 & Heather Hancock 4 & James G. Wilson 5 & Christopher Andreoli 6 & Deeba Husain 1 & Maurice James 7 & Alan Penman 5,8 & Ching J. Chen 4 & Lucia Sobrin 1 Received: 31 May 2016 /Revised: 21 August 2016 /Accepted: 29 August 2016 /Published online: 15 September 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Purpose Previous studies have yielded conflicting results re- garding whether serum lipid levels are associated with retinal hard exudates in diabetic retinopathy. The majority of studies have assessed hard exudates only as a dichotomous trait (pres- ence vs. absence) and included limited numbers of African Americans (AA). The purpose of this study was to determine if there are any associations between serum lipid levels and hard exudates in AA with type 2 diabetes (T2D). Methods 890 AA participants with T2D were enrolled from 5 sites. Macular fundus photographs were graded by masked ophthalmologist investigators. Hard exudate areas were mea- sured using a semi-automated algorithm and ImageJ software. Multivariate regression models were used to determine the association between serum lipid levels and (1) presence of hard exudate and (2) area of hard exudate. Results Presence of hard exudates was associated with higher total cholesterol [(odds ratio (OR) = 1.08, 95 % confidence interval (CI) 1.03–1.13, P = 0.001)] and higher low-density lipoprotein (LDL) cholesterol (OR = 1.08, 95 % CI 1.03– 1.14, P = 0.005) in models controlling for other risk factors. Hard exudate area was also associated with both higher total and LDL cholesterol levels (P = 0.04 and 0.01, respectively) in multivariate models controlling for other risk factors. Conclusions Higher total and LDL cholesterol were associat- ed with the presence of hard exudates and a greater hard exu- date area in AA with T2D. This information can be used to counsel diabetic patients regarding the importance of lipid control to decrease the risk of macular hard exudates. Keywords Hard exudate area . Serum lipid levels . Type 2 diabetes . African Americans Introduction Diabetic macular edema (DME) is an important cause of cen- tral vision loss in patients w,ith diabetes. Macular hard exu- dates are often seen in patients with DME and the exudates themselves, particularly when located subfoveally, can be a cause of permanent vision loss even after DME resolves [1]. Eventual disappearance of hard exudates is also not necessar- ily followed by improvement in visual acuity [1]. The failure of visual acuity to improve when exudation disappears could This submission has not been published anywhere previously and is not simultaneously being considered for any other publication. Evangelia Papavasileiou and Samaneh Davoudi contributed equally to this work. * Lucia Sobrin Lucia_sobrin@meei.harvard.edu 1 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA 2 Department of Ophthalmology, Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran 3 Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea 4 Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA 5 Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA 6 Visual Services Department, Harvard Vanguard Medical Associates, Boston, MA, USA 7 Ophthalmology, St Dominic’ s Hospital, Jackson, MS, USA 8 Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA Graefes Arch Clin Exp Ophthalmol (2017) 255:509–517 DOI 10.1007/s00417-016-3493-9