Refractive errors (including myopia

hyperopia

and astigmatism) and diabetes are two highly prevalent chronic diseases worldwide. Traditionally

refractive errors have been considered independent ocular refractive issues

while the primary focus of diabetes has been its microvascular complication-diabetic retinopathy (DR). However

increasing evidence in recent years indicates a complex and bidirectional interaction between the two. Hyperglycemia can induce transient refractive changes by altering the osmotic pressure and refractive index of the lens and aqueous humor

serving as an early sign of poorly controlled diabetes. More importantly

long-term diabetes is a significant risk factor for acquired refractive errors such as pathological myopia and complicated cataracts

and can significantly exacerbate the progression of pre-existing refractive errors. Conversely

the inherent fundus pathologies in high refractive errors (especially high myopia)

such as retinal thinning and insufficient choroidal blood perfusion

may increase susceptibility to ischemic and hypoxic damage caused by diabetes

potentially influencing the onset and progression of DR. This interaction exhibits different characteristics across countries and regions due to variations in population demographics

healthcare resources

and prevention strategies. This article systematically elaborates on the bidirectional impact between refractive errors and diabetes

analyzes differences in domestic and international research evidence and clinical practices

and delves into its significant clinical implications

offering new perspectives for early diabetes screening

complication monitoring

vision correction planning

and public health strategy optimization.