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Fu X, Ren X, Chen W, Chen D. Reduced macular thickness and vascular density in abnormal glucose metabolism patients: A meta-analysis of optical coherence tomography (OCT) and OCT angiography studies. Chin Med J (Engl) 2024; 137:1054-1068. [PMID: 38563217 PMCID: PMC11062653 DOI: 10.1097/cm9.0000000000003052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Alterations in macular thickness and vascular density before clinically visible diabetic retinopathy (DR) remain inconclusive. This study aimed to determine whether retinal manifestations in abnormal glucose metabolism (AGM) patients differ from those in the healthy individuals. METHODS PubMed, Embase, and Web of Science were searched between 2000 and 2021. The eligibility criteria were AGM patients without DR. Primary and secondary outcomes measured by optical coherence tomography (OCT) and OCT angiography (OCTA) were analyzed and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). A random-effects model was used in the data synthesis. The potential publication bias for the variables was evaluated using Egger's test. RESULTS A total of 86 observational studies involving 13,773 participants and 15,416 eyes were included. OCT revealed that compared to healthy controls, the total macular thickness of AGM patients was thinner, including the thickness of fovea (-0.24, 95% CI [-0.39, -0.08]; P = 0.002, I2 = 87.7%), all regions of parafovea (-0.32, 95% CI [-0.54, -0.11]; P = 0.003; I2 = 71.7%) and the four quadrants of perifovea; the thickness of peripapillary retinal nerve fiber layer (pRNFL), macular retinal nerve fiber layer (mRNFL), and ganglion cell layer (GCL) also decreased. OCTA indicated that the superficial and deep vascular density decreased, the foveal avascular zone (FAZ) area enlarged, and the acircularity index (AI) reduced in AGM individuals. CONCLUSIONS Retinal thinning and microvascular lesions have occurred before the advent of clinically detectable DR; OCT and OCTA may have the potential to detect these preclinical changes. REGISTRATION PROSPERO; http://www.crd.york.ac.uk/prospero/ ; No. CRD42021269885.
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Affiliation(s)
- Xiangyu Fu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiang Ren
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenyue Chen
- Department of Ophthalmology, The People’s Hospital of Guizhou Province, Guiyang, Guizhou 550002, China
| | - Danian Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Rauscher FG, Elze T, Francke M, Martinez-Perez ME, Li Y, Wirkner K, Tönjes A, Engel C, Thiery J, Blüher M, Stumvoll M, Kirsten T, Loeffler M, Ebert T, Wang M. Glucose tolerance and insulin resistance/sensitivity associate with retinal layer characteristics: the LIFE-Adult-Study. Diabetologia 2024; 67:928-939. [PMID: 38431705 PMCID: PMC10954961 DOI: 10.1007/s00125-024-06093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/08/2023] [Indexed: 03/05/2024]
Abstract
AIMS/HYPOTHESIS As the prevalence of insulin resistance and glucose intolerance is increasing throughout the world, diabetes-induced eye diseases are a global health burden. We aim to identify distinct optical bands which are closely related to insulin and glucose metabolism, using non-invasive, high-resolution spectral domain optical coherence tomography (SD-OCT) in a large, population-based dataset. METHODS The LIFE-Adult-Study randomly selected 10,000 participants from the population registry of Leipzig, Germany. Cross-sectional, standardised phenotyping included the assessment of various metabolic risk markers and ocular imaging, such as SD-OCT-derived thicknesses of ten optical bands of the retina. Global and Early Treatment Diabetic Retinopathy Study (ETDRS) subfield-specific optical retinal layer thicknesses were investigated in 7384 healthy eyes of 7384 participants from the LIFE-Adult-Study stratified by normal glucose tolerance, prediabetes (impaired fasting glucose and/or impaired glucose tolerance and/or HbA1c 5.7-6.4% [39-47 mmol/mol]) and diabetes. The association of optical retinal band characteristics with different indices of glucose tolerance (e.g. fasting glucose, area under the glucose curve), insulin resistance (e.g. HOMA2-IR, triglyceride glucose index), or insulin sensitivity (e.g. estimated glucose disposal rate [eGDR], Stumvoll metabolic clearance rate) was determined using multivariable linear regression analyses for the individual markers adjusted for age, sex and refraction. Various sensitivity analyses were performed to validate the observed findings. RESULTS In the study cohort, nine out of ten optical bands of the retina showed significant sex- and glucose tolerance-dependent differences in band thicknesses. Multivariable linear regression analyses revealed a significant, independent, and inverse association between markers of glucose intolerance and insulin resistance (e.g. HOMA2-IR) with the thickness of the optical bands representing the anatomical retinal outer nuclear layer (ONL, standardised β=-0.096; p<0.001 for HOMA2-IR) and myoid zone (MZ; β=-0.096; p<0.001 for HOMA2-IR) of the photoreceptors. Conversely, markers of insulin sensitivity (e.g. eGDR) positively and independently associated with ONL (β=0.090; p<0.001 for eGDR) and MZ (β=0.133; p<0.001 for eGDR) band thicknesses. These global associations were confirmed in ETDRS subfield-specific analyses. Sensitivity analyses further validated our findings when physical activity, neuroanatomical cell/tissue types and ETDRS subfield categories were investigated after stratifying the cohort by glucose homeostasis. CONCLUSIONS/INTERPRETATION An impaired glucose homeostasis associates with a thinning of the optical bands of retinal ONL and photoreceptor MZ. Changes in ONL and MZ thicknesses might predict early metabolic retinal alterations in diabetes.
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Affiliation(s)
- Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
- Department of Medical Data Science, University of Leipzig Medical Center, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Mike Francke
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - M Elena Martinez-Perez
- Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Yangjiani Li
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Anke Tönjes
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Joachim Thiery
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Matthias Blüher
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Toralf Kirsten
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
- Department of Medical Data Science, University of Leipzig Medical Center, Leipzig, Germany
| | - Markus Loeffler
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Thomas Ebert
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.
| | - Mengyu Wang
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Riazi-Esfahani H, Jafari B, Azimi H, Rahimi M, Saeidian J, Pouya P, Faghihi H, Mirzaei A, Asadi Khameneh E, Khalili Pour E. Assessment of area and structural irregularity of retinal layers in diabetic retinopathy using machine learning and image processing techniques. Sci Rep 2024; 14:4013. [PMID: 38369610 PMCID: PMC10874958 DOI: 10.1038/s41598-024-54535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
Diabetes retinopathy prevention necessitates early detection, monitoring, and treatment. Non-invasive optical coherence tomography (OCT) shows structural changes in the retinal layer. OCT image evaluation necessitates retinal layer segmentation. The ability of our automated retinal layer segmentation to distinguish between normal, non-proliferative (NPDR), and proliferative diabetic retinopathy (PDR) was investigated in this study using quantifiable biomarkers such as retina layer smoothness index (SI) and area (S) in horizontal and vertical OCT images for each zone (fovea, superior, inferior, nasal, and temporal). This research includes 84 eyes from 57 individuals. The study shows a significant difference in the Area (S) of inner nuclear layer (INL) and outer nuclear layer (ONL) in the horizontal foveal zone across the three groups (p < 0.001). In the horizontal scan, there is a significant difference in the smoothness index (SI) of the inner plexiform layer (IPL) and the upper border of the outer plexiform layer (OPL) among three groups (p < 0.05). There is also a significant difference in the area (S) of the OPL in the foveal zone among the three groups (p = 0.003). The area (S) of the INL in the foveal region of horizontal slabs performed best for distinguishing diabetic patients (NPDR and PDR) from normal individuals, with an accuracy of 87.6%. The smoothness index (SI) of IPL in the nasal zone of horizontal foveal slabs was the most accurate at 97.2% in distinguishing PDR from NPDR. The smoothness index of the top border of the OPL in the nasal zone of horizontal slabs was 84.1% accurate in distinguishing NPDR from PDR. Smoothness index of IPL in the temporal zone of horizontal slabs was 89.8% accurate in identifying NPDR from PDR patients. In conclusion, optical coherence tomography can assess the smoothness index and irregularity of the inner and outer plexiform layers, particularly in the nasal and temporal regions of horizontal foveal slabs, to distinguish non-proliferative from proliferative diabetic retinopathy. The evolution of diabetic retinopathy throughout severity levels and its effects on retinal layer irregularity need more study.
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Affiliation(s)
- Hamid Riazi-Esfahani
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Behzad Jafari
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Hossein Azimi
- Faculty of Mathematical Sciences and Computer, Kharazmi University, No. 50, Taleghani Ave, Tehran, Iran
| | - Masoud Rahimi
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Jamshid Saeidian
- Faculty of Mathematical Sciences and Computer, Kharazmi University, No. 50, Taleghani Ave, Tehran, Iran
| | - Parnia Pouya
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hooshang Faghihi
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Arash Mirzaei
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Esmaeil Asadi Khameneh
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran
| | - Elias Khalili Pour
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, Iran.
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Li D, Jin X, Wang C, Zhang N, Jin D, Zhang H. Correlation Between Corneal Whorl-Like Nerve and Retinal Neurodegenerative Changes and Their Association With Microvessel Perfusion in Diabetes. Invest Ophthalmol Vis Sci 2023; 64:44. [PMID: 38019489 PMCID: PMC10691402 DOI: 10.1167/iovs.64.14.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose The purpose of this study was to compare the evolution of changes in the corneal nerves, retinal nerves, and cells and blood vessels at a single time point in early diabetic retinopathy (DR). Methods Eighty participants (60 with diabetes and 20 nondiabetic controls) were examined. DR was graded according to the International Classification of Diabetic Retinopathy. Inferior whorl length (IWL), spiral orientation, central nerve fiber length (CNFL), retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) layer thickness, global loss volume (GLV), focal loss volume (FLV) indices, superficial (sVD), and deep vessel densities (dVD) were examined. Results Compared with those of healthy controls, the IWL, CNFL, and FLV were decreased in the diabetic groups (P < 0.001). The IWL was significantly positively correlated with the RNFL and GCC thicknesses in the diabetic group (r = 0.248, P = 0.006 and r = 0.207, P = 0.023, respectively) and significantly negatively correlated with the FLV (r = -0.535, P < 0.001). The sVD was significantly positively correlated with the RNFL thickness (r = 0.314, P < 0.001) and negatively correlated with the GLV (r = -0.229, P = 0.012). Conclusions Our findings suggest a correlation between corneal whorl-like nerve plexus and retinal nerve changes in the early stages of DR and that the IWL of the cornea may be able to indicate the extent of DR. Retinal nerve changes are associated with retinal microvessel perfusion, and nerve changes may precede vessel lesions.
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Affiliation(s)
- Dongyu Li
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Chao Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Nan Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Di Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, China
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Arruabarrena C, Rodríguez-Miguel A, de Aragón-Gómez F, Escámez P, Rosado I, Teus MA. Normative Data for Macular Thickness and Volume for Optical Coherence Tomography in a Diabetic Population without Maculopathies. J Clin Med 2023; 12:5232. [PMID: 37629274 PMCID: PMC10455588 DOI: 10.3390/jcm12165232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE The purpose was to establish normative data for the macular thicknesses and volume using spectral-domain optical coherence tomography (SD-OCT) in a diabetic population without maculopathies for use as a reference in diabetic retinopathy (DR) and diabetic macular edema screening programs. METHODS This was an observational study nested in a cohort of diabetics from a telemedicine DR screening program. Each patient underwent SD-OCT centered on the fovea. Macular thickness and volume were described and compared using the built-in normative database of the device. Quantile regression models for the 97.5% percentile were fitted to evaluate the predictors of macular thickness and volume. RESULTS A total of 3410 eyes (mean age, 62.25 (SD, 0.22) years) were included. Mean (SD) central subfield thickness (CST) was 238.2 (23.7) µm, while center thickness (CT), average thickness (AT), and macular volume (MV) were 205.4 (31.6) µm, 263.9 (14.3) µm, and 7.46 (0.40) mm3, respectively. Para- and perifoveal thicknesses were clinically and statistically significantly thinner in our population than in the normative reference database. The 97.5% percentile of the thickness of all sectors was increased in males and in the para- and perifovea among those with DR. CONCLUSIONS All ETDRS sectors were thinner in patients with diabetes than in the reference population, except for the CST, which was the most stable parameter that only changed with sex. The upper cutoff limit to detect diabetic macular edema (DME) was different from that of the reference population and was influenced by conditions related to diabetes, such as DR. Therefore, specific normative data for diabetic patients should be used for the screening and diagnosis of DME using SD-OCT.
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Affiliation(s)
- Carolina Arruabarrena
- Retina Unit, Department of Ophthalmology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Department of Biomedical Sciences, University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Madrid, Spain
| | - Fernando de Aragón-Gómez
- Retina Unit, Department of Ophthalmology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Madrid, Spain
| | - Purificación Escámez
- Retina Unit, Department of Ophthalmology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Madrid, Spain
| | - Ingrid Rosado
- Retina Unit, Department of Ophthalmology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Madrid, Spain
| | - Miguel A. Teus
- Retina Unit, Department of Ophthalmology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Madrid, Spain
- Department of Medical Sciences (Ophthalmology), University of Alcalá, 28805 Alcalá de Henares, Madrid, Spain
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Koca S, Vural E, Sırakaya E, Kılıc D. Evaluation of the lamina cribrosa in different stages of diabetic retinopathy. Jpn J Ophthalmol 2023; 67:280-286. [PMID: 37039947 DOI: 10.1007/s10384-023-00987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the relationship of the peripapillary retina nerve fiber layer (RNFL) and lamina cribrosa (LC) with diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) cases. STUDY DESIGN Prospective comparative study. METHODS This study included 50 non-DR (Group 1), 55 non-proliferative diabetic retinopathy (NPDR) (Group 2), 28 DM cases with proliferative diabetic retinopathy (PDR) (Group 3) and 45 healthy volunteers (Group 4). All participants were evaluated with visual acuity, intraocular pressure (IOP) with Goldman applanation tonometry, anterior segment biomicroscopy, 24 - 2 visual field testing, and dilated fundus examination. Retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT) and anterior lamina cribrosa depth (ALCD) were examined by spectral-domain optical coherence tomography (OCT). RESULTS There was no difference between the groups in terms of age and gender. Visual acuity (p < 0.001) was significantly different between the groups, while IOP (p = 0.068) was similar. Mean (p = 0.010), superior-temporal (p = 0.024), and superior-nasal (p = 0.011) RNFL thickness decreased significantly in correlation with the stage of DR. LCT decreased significantly as the stage of DR progressed in both vertical and horizontal radial OCT scans (p < 0.001). ALCD was not different between groups (p = 0.954 for horizontal scan, p = 0.867 for vertical scan). CONCLUSION Peripapillary RNFL and LCT significantly decreases as the DR stage progresses. The biomechanical effects of the LC may also be responsible for diabetes-induced neurodegeneration.
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Affiliation(s)
- Semra Koca
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey.
| | - Esra Vural
- Department of Ophthalmology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Ender Sırakaya
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Deniz Kılıc
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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Huang Y, Zhang N, Bulloch G, Zhang S, Shang X, Chen Y, Liao H, Zhu Z, Wang W. Rates of Choroidal and Neurodegenerative Changes Over Time in Diabetic Patients Without Retinopathy: A 3-Year Prospective Study. Am J Ophthalmol 2023; 246:10-19. [PMID: 35870490 DOI: 10.1016/j.ajo.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the longitudinal changes of retinal neurodegeneration and choroidal thickness in diabetic patients with and without diabetic retinopathy (DR). DESIGN Prospective observational cohort study. METHODS This prospective observational cohort study recruited type 2 diabetic patients from a community registry in Guangzhou. All participants underwent annual ocular examinations via swept-source optical coherence tomography that obtained choroid thickness (CT), retinal thickness (RT), and ganglion cell-inner plexiform layer (GC-IPL) thickness. The changes in GC-IPL, CT, and RT between patients who developed incident DR (IDR) or remained non-DR (NDR) were compared during a 3-year follow-up. RESULTS Among 924 patients, 159 (17.2%) patients developed IDR within the 3-year follow-up. A reduction in GC-IPL, RT, and CT was observed in NDR and IDR; however, CT thinning in patients with IDR was significantly accelerated, with an average CT reduction of -6.98 (95% CI: -8.26, -5.71) μm/y in patients with IDR and -3.98 (95% CI: -4.60, -3.36) μm/y in NDR patients (P < .001). Reductions in average GC-IPL thickness over 3 years were -0.97 (95% CI: -1.24, -0.70) μm/y in patients with IDR and -0.76 (95% CI: -0.82, -0.70) μm/y in NDR patients (P = .025). After adjusting for confounding factors, the average CT and GC-IPL thinning were significantly faster in patients with IDR compared with those who remained NDR by 2.09 μm/y (95% CI: 1.01, 3.16; P = .004) and -0.29 μm/y (95% CI: -0.49, -0.09; P = .004), respectively. The RT in the IDR group increased, whereas the RT in the NDR group decreased over time, with the adjusted difference of 2.09 μm/y (95% CI: 1.01, 3.16; P < .001) for central field RT. CONCLUSIONS The rate of retinal neurodegeneration and CT thinning were significantly different between the eyes that developed IDR and remained NDR during the 3-year follow-up, but both groups observed thickness reduction. This indicates that GC-IPL and CTs may decrease before the clinical manifestations of DR.
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Affiliation(s)
- Yining Huang
- From the Nanshan School, Guangzhou Medical University (Y.H.), Guangzhou, China
| | - Nuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.)
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China
| | - Xianwen Shang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.)
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (Y.C.)
| | - Huan Liao
- and Epigenetics and Neural Plasticity Laboratory, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.L.)
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia (G.B., X.S., Z.Z.).
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China.
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Kim JT, Na YJ, Lee SC, Lee MW. Impact of high myopia on inner retinal layer thickness in type 2 diabetes patients. Sci Rep 2023; 13:268. [PMID: 36609673 PMCID: PMC9822899 DOI: 10.1038/s41598-023-27529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
To investigate the impact of the combination of type 2 diabetes (DM) and high myopia on inner retinal layer thickness of the macular area. The patients were divided into four groups: control (group 1), patients with DM without high myopia (group 2), patients with high myopia without DM (group 3), and patients with DM and high myopia (group 4). Ganglion cell complex (GCC) thickness was compared among the groups. Linear regression analysis was performed to identify factors associated with GCC thickness. A total of 194 eyes were enrolled: 59 in group 1, 52 in group 2, 49 in group 3, and 34 in group 4. The average parafovea GCC thicknesses were 113.9 ± 10.4, 112.4 ± 11.2, 112.2 ± 7.8, and 102.6 ± 15.1 μm (P < 0.001), and the average perifovea GCC thicknesses were 104.8 ± 13.2, 103.5 ± 10.8, 103.6 ± 8.8, and 93.9 ± 15.5 μm in groups 1, 2, 3 and 4, respectively (P = 0.001). In multivariate analyses, age (β = - 0.20, P = 0.007), DM duration (β = - 0.34, P = 0.023), and axial length (β = - 1.64, P < 0.001) were significantly associated with parafoveal GCC thickness. The GCC was significantly thinner when high myopia and DM were combined, compared to either condition alone. Additionally, age, DM duration, and axial length were significant factors associated with GCC thickness. The combination of mechanical stretching and neurodegeneration would accelerate neural damage to the retina, resulting in greater inner retinal layer thinning.
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Affiliation(s)
- Jung-Tae Kim
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-dong, Seo-gu, Daejeon, Republic of Korea
| | - Yong-Jin Na
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-dong, Seo-gu, Daejeon, Republic of Korea
| | - Sung-Chul Lee
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-dong, Seo-gu, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-dong, Seo-gu, Daejeon, Republic of Korea.
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9
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Piona C, Costantini S, Zusi C, Cozzini T, Pedrotti E, Marigliano M, Fornari E, Maguolo A, Morandi A, Maffeis C. Early marker of ocular neurodegeneration in children and adolescents with type 1 diabetes: the contributing role of polymorphisms in mir146a and mir128a genes. Acta Diabetol 2022; 59:1551-1561. [PMID: 36002591 PMCID: PMC9581843 DOI: 10.1007/s00592-022-01919-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early ocular neurodegenerative signs of diabetic neuropathy (DN) can be found in children and adolescents with type 1 diabetes (T1D). No data are available on the potential role of polymorphisms in miRNAs genes in predisposing T1D subjects to these signs. AIMS To determine whether MIR146A rs2910164 and MIR128A rs11888095 polymorphisms are associated with early retinal and corneal neurodegenerative changes in pediatric patients with T1D. METHODS A total of 140 T1D children/adolescents underwent spectral domain-optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM) with measurement of retinal and corneal nerve fiber parameters. Risk factors for diabetes complications (diabetes duration, blood pressure, HbA1c) were recorded. Genotyping of rs2910164 and rs1188095 SNPs and genotype-phenotype association analysis were performed. RESULTS The C allele of rs2910164 in MIR146A was associated with higher values of IVCM parameters and minimum rim width (MRW) of the peripapillary region of optic nerve head measured in the retina, whereas the T allele of rs1188095 in MIR128A was associated with a significant impairment of them. Multiple regression analysis showed that MIR146A and MIR128A polymorphisms were significantly associated with corneal nerve fiber length (beta = 0.225 and - 0.204, respectively) and other IVCM parameters, independently from age, diabetes duration, HbA1c and systolic blood pressure percentile. Similar results were found for MRW (beta = 0.213 and - 0.286, respectively). CONCLUSIONS These results provide new insight into the genetic predisposition to DN showing that two polymorphisms in MIR146A and MIR128A genes could significantly contribute to the development of early ocular preclinical signs of DN.
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Affiliation(s)
- Claudia Piona
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Silvia Costantini
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Chiara Zusi
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Tiziano Cozzini
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134, Verona, Italy
| | - Emilio Pedrotti
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134, Verona, Italy
| | - Marco Marigliano
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Elena Fornari
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Alice Maguolo
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Anita Morandi
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy.
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, P.le Stefani 1, 37126, Verona, Italy
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10
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van der Heide FCT, Foreman YD, Franken IWM, Henry RMA, Kroon AA, Dagnelie PC, Eussen SJPM, Berendschot TTJM, Schouten JSAG, Webers CAB, Schram MT, van der Kallen CJH, van Greevenbroek MMJ, Wesselius A, Schalkwijk CG, Schaper NC, Brouwers MCGJ, Stehouwer CDA. (Pre)diabetes, glycemia, and daily glucose variability are associated with retinal nerve fiber layer thickness in The Maastricht Study. Sci Rep 2022; 12:17750. [PMID: 36273238 PMCID: PMC9587985 DOI: 10.1038/s41598-022-22748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023] Open
Abstract
Retinopathy and neuropathy in type 2 diabetes are preceded by retinal nerve fibre layer (RNFL) thinning, an index of neurodegeneration. We investigated whether glucose metabolism status (GMS), measures of glycaemia, and daily glucose variability (GV) are associated with RNFL thickness over the entire range of glucose tolerance. We used cross-sectional data from The Maastricht Study (up to 5455 participants, 48.9% men, mean age 59.5 years and 22.7% with type 2 diabetes) to investigate the associations of GMS, measures of glycaemia (fasting plasma glucose [FPG], 2-h post-load glucose [2-h PG], HbA1c, advanced glycation endproducts [AGEs] assessed as skin autofluorescence [SAF]) and indices of daily GV (incremental glucose peak [IGP] and continuous glucose monitoring [CGM]-assessed standard deviation [SD]) with mean RNFL thickness. We used linear regression analyses and, for GMS, P for trend analyses. We adjusted associations for demographic, cardiovascular risk and lifestyle factors, and, only for measures of GV, for indices of mean glycaemia. After full adjustment, type 2 diabetes and prediabetes (versus normal glucose metabolism) were associated with lower RNFL thickness (standardized beta [95% CI], respectively - 0.16 [- 0.25; - 0.08]; - 0.05 [- 0.13; 0.03]; Ptrend = 0.001). Greater FPG, 2-h PG, HbA1c, SAF, IGP, but not CGM-assessed SD, were also associated with lower RNFL thickness (per SD, respectively - 0.05 [- 0.08; - 0.01]; - 0.06 [- 0.09; - 0.02]; - 0.05 [- 0.08; - 0.02]; - 0.04 [- 0.07; - 0.01]; - 0.06 [- 0.12; - 0.01]; and - 0.07 [- 0.21; 0.07]). In this population-based study, a more adverse GMS and, over the entire range of glucose tolerance, greater glycaemia and daily GV were associated with lower RNFL thickness. Hence, early identification of individuals with hyperglycaemia, early glucose-lowering treatment, and early monitoring of daily GV may contribute to the prevention of RNFL thinning, an index of neurodegeneration and precursor of retinopathy and neuropathy.
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Affiliation(s)
- Frank C. T. van der Heide
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Yuri D. Foreman
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Iris W. M. Franken
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Ronald M. A. Henry
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Abraham A. Kroon
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Pieter C. Dagnelie
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Simone J. P. M. Eussen
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Department of Epidemiology, UM, Maastricht, The Netherlands
| | - Tos T. J. M. Berendschot
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, MUMC+, Maastricht, The Netherlands
| | - Jan S. A. G. Schouten
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, MUMC+, Maastricht, The Netherlands ,grid.413327.00000 0004 0444 9008Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Carroll A. B. Webers
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, MUMC+, Maastricht, The Netherlands
| | - Miranda T. Schram
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Heart and Vascular Center, MUMC+ Maastricht, Maastricht, The Netherlands
| | - Carla J. H. van der Kallen
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Marleen M. J. van Greevenbroek
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Anke Wesselius
- grid.5012.60000 0001 0481 6099Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, UM, Maastricht, The Netherlands
| | - Casper G. Schalkwijk
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - Nicolaas C. Schaper
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099CAPHRI Care and Public Health Research Institute, UM, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Martijn C. G. J. Brouwers
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Coen D. A. Stehouwer
- grid.5012.60000 0001 0481 6099CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
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Matuszewska-Iwanicka A, Stratmann B, Stachs O, Allgeier S, Bartschat A, Winter K, Guthoff R, Tschoepe D, Hettlich HJ. Mosaic vs. Single Image Analysis with Confocal Microscopy of the Corneal Nerve Plexus for Diagnosis of Early Diabetic Peripheral Neuropathy. Ophthalmol Ther 2022; 11:2211-2223. [PMID: 36184730 DOI: 10.1007/s40123-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The assessment of the corneal nerve fibre plexus with corneal confocal microscopy (CCM) is an upcoming but still experimental method in the diagnosis of early stage diabetic peripheral neuropathy (DPN). Using an innovative imaging technique-Heidelberg Retina Tomograph equipped with the Rostock Cornea Module (HRT-RCM) and EyeGuidance module (EG)-we were able to look at greater areas of subbasal nerve plexus (SNP) in order to increase the diagnostic accuracy. The aim of our study was to evaluate the usefulness of EG instead of single image analysis in diagnosis of early stage DPN. METHODS This prospective study was performed on 60 patients with type 2 diabetes mellitus, classified equally into two subgroups based on neuropathy deficient score (NDS): patients without DPN (group 1) or with mild DPN (group 2). The following parameters were analysed in the two subgroups: corneal nerve fibre length (CNFL; mm/mm2), corneal nerve fibre density (CNFD; no./mm2), corneal nerve branch density (CNBD; no./mm2). Furthermore, we compared the data calculated with the novel mosaic, EG-based method with those received from single image analysis using different quantification tools. RESULTS Using EG we did not find a significant difference between group 1 and group 2: CNFL (16.81 ± 5.87 mm/mm2 vs. 17.19 ± 7.19 mm/mm2, p = 0.895), CNFD (254.05 ± 115.36 no./mm2 vs. 265.91 ± 161.63 no./mm2, p = 0.732) and CNBD (102.68 ± 62.28 no./mm2 vs. 115.38 ± 96.91 no./mm2, p = 0.541). No significant difference between the EG method of analysing the SNP and the single image analysis of 10 images per patient was detected. CONCLUSION On the basis of our results it was not possible to differentiate between early stages of large nerve fibre DPN in patients with type 2 diabetes mellitus via SNP analysis. To improve sensitivity and specificity of this method newer technologies are under current evaluation. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05326958.
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Affiliation(s)
- Aleksandra Matuszewska-Iwanicka
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany.
| | - Bernd Stratmann
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Allgeier
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas Bartschat
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Diethelm Tschoepe
- Herz- und Diabeteszentrum NRW, Diabeteszentrum, Ruhr Universität Bochum, Bad Oeynhausen, Germany
- Stiftung DHD (Der herzkranke Diabetiker) Stiftung in der Deutschen Diabetes-Stiftung, Bad Oeynhausen, Germany
| | - Hans-Joachim Hettlich
- Eye Clinic Johannes Wesling Hospital, Ruhr Universität Bochum, Augen-Praxisklinik Minden, Königstraße 120, 32427, Minden, Germany
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12
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Retinal Microvascular and Neuronal Changes Are Also Present, Even If Differently, in Adolescents with Type 1 Diabetes without Clinical Diabetic Retinopathy. J Clin Med 2022; 11:jcm11143982. [PMID: 35887746 PMCID: PMC9323684 DOI: 10.3390/jcm11143982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
The purpose of this study was to evaluate retinal changes in adolescents with childhood-onset, long-lasting type 1 diabetes mellitus (T1D). Patients and healthy controls (HC) underwent optical coherence tomography (OCT) and OCT-angiography (OCTA). Individual macular layers, peripapillary retinal nerve fiber layer (pRNFL), and vascular parameters (vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI)) of macular superficial vascular (SVP), intermediate (ICP), deep (DCP) and radial peripapillary capillary plexuses (RPCP) were quantified. Thirty-nine patients (5 with (DR group) and 34 without (noDR group) diabetic retinopathy) and 20 HC were enrolled. The pRNFL and ganglion cell layer (GCL) were thicker in noDR compared to HC and DR, reaching statistically significant values versus HC for some sectors. At the macular level, VAD and VLF were reduced in DR versus HC in all plexuses, and versus noDR in SVP (p < 0.005 for all). At the RPCP level, VAD and VDI were increased in noDR versus HC, significantly for VDI (p = 0.0067). Glycemic indices correlated to retinal parameters. In conclusion, in T1D adolescents, retinal capillary and neuronal changes are present after long-lasting disease, even in the absence of clinical DR. These changes modify when clinical retinopathy develops. The precocious identification of specific OCT and OCTA changes may be a hallmark of subsequent overt retinopathy.
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13
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Bussan KA, Stuard WL, Mussi N, Lee W, Whitson JT, Issioui Y, Rowe AA, Wert KJ, Robertson DM. Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer. PLoS One 2022; 17:e0266483. [PMID: 35771778 PMCID: PMC9246161 DOI: 10.1371/journal.pone.0266483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity. Design Single center cross-sectional study. Methods Sixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance. Results No significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping. Conclusions OSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.
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Affiliation(s)
- Katherine A. Bussan
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Whitney L. Stuard
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Natalia Mussi
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Won Lee
- Department of Internal Medicine, Clinical Center for Sleep and Breathing Disorders, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jess T. Whitson
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Yacine Issioui
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ashley A. Rowe
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Katherine J. Wert
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Danielle M. Robertson
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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14
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In Vivo Confocal Microscopy in Different Types of Dry Eye and Meibomian Gland Dysfunction. J Clin Med 2022; 11:jcm11092349. [PMID: 35566475 PMCID: PMC9099706 DOI: 10.3390/jcm11092349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
In vivo confocal microscopy (IVCM) imaging is increasingly popular in ocular surface disease diagnosis and management. We conducted a systematic review to update the use of IVCM in the diagnosis and treatment of dry eye and meibomian gland dysfunction (MGD). A literature review was conducted on IVCM studies in MGD, dry eye disease, systemic disease causing dry eye, dry eye in glaucoma patients, contact lens-associated ocular conditions, graft-versus-host disease, and Sjogren’s syndrome-related dry eye. The articles were identified through PubMed and a total number of 63 eligible publications were analyzed in detail. All primary research studies on confocal microscopy on dry eye and related conditions from 2017 onwards were included. The reports were reviewed for their contribution to the existing literature as well as potential biases and drawbacks. Despite limitations such as small field of view, lack of population-based norms, and lack of standardization of image acquisition, interpretation, and quantification, IVCM is useful as a complementary technique for clinical diagnosis in various ocular surface disorders related to dry eye. With advances in hardware and software in the near future, it has the potential for further practical impact.
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15
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Ciprés M, Satue M, Melchor I, Gil-Arribas L, Vilades E, Garcia-Martin E. Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:205-218. [PMID: 35523467 DOI: 10.1016/j.oftale.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/06/2021] [Indexed: 06/14/2023]
Abstract
In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers.
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Affiliation(s)
- M Ciprés
- Servicio de Oftalmologia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M Satue
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Grupo de investigación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - I Melchor
- Departamento de Endocrinología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L Gil-Arribas
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Grupo de investigación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - E Vilades
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Grupo de investigación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - E Garcia-Martin
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Grupo de investigación Miguel Servet Oftalmología (GIMSO), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
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16
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Schreur V, Larsen MB, Sobrin L, Bhavsar AR, Hollander AI, Klevering BJ, Hoyng CB, Jong EK, Grauslund J, Peto T. Imaging diabetic retinal disease: clinical imaging requirements. Acta Ophthalmol 2022; 100:752-762. [PMID: 35142031 DOI: 10.1111/aos.15110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/12/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Diabetic retinopathy (DR) is a sight-threatening complication of diabetes mellitus (DM) and it contributes substantially to the burden of disease globally. During the last decades, the development of multiple imaging modalities to evaluate DR, combined with emerging treatment possibilities, has led to the implementation of large-scale screening programmes resulting in improved prevention of vision loss. However, not all patients are able to participate in such programmes and not all are at equal risk of DR development and progression. In this review, we discuss the relevance of the currently available imaging modalities for the evaluation of DR: colour fundus photography (CFP), ultrawide-field photography (UWFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), OCT angiography (OCTA) and functional testing. Furthermore, we suggest where a particular imaging technique of DR may aid the evaluation of the disease in different clinical settings. Combining information from various imaging modalities may enable the design of more personalized care including the initiation of treatment and understanding the progression of disease more adequately.
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Affiliation(s)
- Vivian Schreur
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Morten B. Larsen
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School Massachusetts Eye and Ear Infirmary Boston USA
| | | | - Anneke I. Hollander
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - B. Jeroen Klevering
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Eiko K. Jong
- Department of Ophthalmology, Donders Institution for Brain, Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Jakob Grauslund
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Department of Ophthalmology Odense University Hospital Odense Denmark
| | - Tunde Peto
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
- Centre for Public Health Queen's University Belfast Belfast UK
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17
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Little K, Llorián-Salvador M, Scullion S, Hernández C, Simó-Servat O, Del Marco A, Bosma E, Vargas-Soria M, Carranza-Naval MJ, Van Bergen T, Galbiati S, Viganò I, Musi CA, Schlingemann R, Feyen J, Borsello T, Zerbini G, Klaassen I, Garcia-Alloza M, Simó R, Stitt AW. Common pathways in dementia and diabetic retinopathy: understanding the mechanisms of diabetes-related cognitive decline. Trends Endocrinol Metab 2022; 33:50-71. [PMID: 34794851 DOI: 10.1016/j.tem.2021.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/06/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
Type 2 diabetes (T2D) is associated with multiple comorbidities, including diabetic retinopathy (DR) and cognitive decline, and T2D patients have a significantly higher risk of developing Alzheimer's disease (AD). Both DR and AD are characterized by a number of pathological mechanisms that coalesce around the neurovascular unit, including neuroinflammation and degeneration, vascular degeneration, and glial activation. Chronic hyperglycemia and insulin resistance also play a significant role, leading to activation of pathological mechanisms such as increased oxidative stress and the accumulation of advanced glycation end-products (AGEs). Understanding these common pathways and the degree to which they occur simultaneously in the brain and retina during diabetes will provide avenues to identify T2D patients at risk of cognitive decline.
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Affiliation(s)
- Karis Little
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - María Llorián-Salvador
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Sarah Scullion
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Cristina Hernández
- Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Olga Simó-Servat
- Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Angel Del Marco
- Division of Physiology, School of Medicine, Instituto de Investigacion Biomedica de Cadiz (INIBICA), Universidad de Cadiz, Cadiz, Spain
| | - Esmeralda Bosma
- Ocular Angiogenesis Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Vargas-Soria
- Division of Physiology, School of Medicine, Instituto de Investigacion Biomedica de Cadiz (INIBICA), Universidad de Cadiz, Cadiz, Spain
| | - Maria Jose Carranza-Naval
- Division of Physiology, School of Medicine, Instituto de Investigacion Biomedica de Cadiz (INIBICA), Universidad de Cadiz, Cadiz, Spain
| | | | - Silvia Galbiati
- Complications of Diabetes Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ilaria Viganò
- Complications of Diabetes Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Clara Alice Musi
- Università Degli Studi di Milano and Istituto di Ricerche Farmacologiche Mario Negri- IRCCS, Milano, Italy
| | - Reiner Schlingemann
- Ocular Angiogenesis Group, University of Amsterdam, Amsterdam, The Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | | | - Tiziana Borsello
- Università Degli Studi di Milano and Istituto di Ricerche Farmacologiche Mario Negri- IRCCS, Milano, Italy
| | - Gianpaolo Zerbini
- Complications of Diabetes Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ingeborg Klaassen
- Ocular Angiogenesis Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Monica Garcia-Alloza
- Division of Physiology, School of Medicine, Instituto de Investigacion Biomedica de Cadiz (INIBICA), Universidad de Cadiz, Cadiz, Spain
| | - Rafael Simó
- Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain.
| | - Alan W Stitt
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
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18
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Fursova AZ, Derbeneva AS, Vasilyeva MV, Tarasov MS, Nikulich IF, Gamza YA. [Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease]. Vestn Oftalmol 2021; 137:99-108. [PMID: 34965075 DOI: 10.17116/oftalma202113706199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the main structural and microvascular changes in the retina and choroid in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD), and their relationship with impaired renal function. MATERIAL AND METHODS The study included 158 patients (304 eyes). The 1st group consisted of 50 patients with CKD (97 eyes); group 2 - 65 patients with DR (119 eyes), group 3 - 43 patients with CKD and DR (86 eyes). All study patients underwent complete ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular region. RESULTS The analysis of structural parameters in groups of patients showed a decrease in the thickness of the ganglion cell layer and the inner plexiform layer of the retina in patients with DR (70.85±14.49 μm), with the lowest value in the CKD+DR group (65.84±15.34 μm) in comparison with the CKD group (75.64±10.32 μm). In the groups of patients with CKD, the thickness of the choroid (207.3±40.36 μm) was significantly reduced in comparison with the group of patients with DR (258.8±26.63 μm) and correlated with the stage of the disease. Patients in the CKD+DR group had the lowest perfusion and vascular density in the macular region (31.23±10.91% and 13.15±2.73 mm), an increase in the area and perimeter of the foveal avascular zone (0.55±0.26 mm2, 3.30±0.84 mm). Pronounced correlations of decrease in choroidal thickness, vascular density, and perfusion volume with low glomerular filtration rate and CKD stage, as well as urea and creatinine levels were determined. An increase in the area of the foveal avascular zone correlated with lower retinal capillary density, decreased perfusion volume, and the stage of both DR and CKD. CONCLUSION Structural and hemodynamic disorders of the retina and choroid can be recognized as significant biomarkers for non-invasive diagnosis of microvascular complications of diabetes mellitus and impaired renal function.
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Affiliation(s)
- A Zh Fursova
- Novosibirsk State Region Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - A S Derbeneva
- Novosibirsk State Region Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M V Vasilyeva
- Novosibirsk State Region Hospital, Novosibirsk, Russia
| | - M S Tarasov
- Novosibirsk State Region Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - I F Nikulich
- Novosibirsk State Region Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - Yu A Gamza
- Novosibirsk State Region Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
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19
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Piona C, Ventrici C, Marcovecchio L, Chiarelli F, Maffeis C, Bonfanti R, Rabbone I. Long-term complications of type 1 diabetes: what do we know and what do we need to understand? Minerva Pediatr (Torino) 2021; 73:504-522. [PMID: 34530587 DOI: 10.23736/s2724-5276.21.06545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.
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Affiliation(s)
- Claudia Piona
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Claudia Ventrici
- Paediatric Unit, Hospital of Polistena, Polistena, Reggio Calabria, Italy
| | | | | | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, Regional Center for Paediatric Diabetes, University City Hospital of Verona, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy -
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20
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Rauscher FG, Wang M, Francke M, Wirkner K, Tönjes A, Engel C, Thiery J, Stenvinkel P, Stumvoll M, Loeffler M, Elze T, Ebert T. Renal function and lipid metabolism are major predictors of circumpapillary retinal nerve fiber layer thickness-the LIFE-Adult Study. BMC Med 2021; 19:202. [PMID: 34488766 PMCID: PMC8422631 DOI: 10.1186/s12916-021-02064-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Circumpapillary retinal nerve fiber layer thickness (cpRNFLT) as assessed by spectral domain optical coherence tomography (SD-OCT) is a new technique used for the detection and evaluation of glaucoma and other optic neuropathies. Before translating cpRNFLT into clinics, it is crucially important to investigate anthropometric, biochemical, and clinical parameters potentially affecting cpRNFLT in a large population-based dataset. METHODS The population-based LIFE-Adult Study randomly selected 10,000 participants from the population registry of Leipzig, Germany. All participants underwent standardized systemic assessment of various cardiometabolic risk markers and ocular imaging, including cpRNFLT measurement using SD-OCT (Spectralis, Heidelberg Engineering). After employing strict SD-OCT quality criteria, 8952 individuals were analyzed. Multivariable linear regression analyses were used to evaluate the independent associations of various cardiometabolic risk markers with sector-specific cpRNFLT. For significant markers, the relative strength of the observed associations was compared to each other to identify the most relevant factors influencing cpRNFLT. In all analyses, the false discovery rate method for multiple comparisons was applied. RESULTS In the entire cohort, female subjects had significantly thicker global and also sectoral cpRNFLT compared to male subjects (p < 0.05). Multivariable linear regression analyses revealed a significant and independent association between global and sectoral cpRNFLT with biomarkers of renal function and lipid profile. Thus, thinner cpRNFLT was associated with worse renal function as assessed by cystatin C and estimated glomerular filtration rate. Furthermore, an adverse lipid profile (i.e., low high-density lipoprotein (HDL) cholesterol, as well as high total, high non-HDL, high low-density lipoprotein cholesterol, and high apolipoprotein B) was independently and statistically significantly related to thicker cpRNFLT. In contrast, we do not observe a significant association between cpRNFLT and markers of inflammation, glucose homeostasis, liver function, blood pressure, or obesity in our sector-specific analysis and globally. CONCLUSIONS Markers of renal function and lipid metabolism are predictors of sectoral cpRNFLT in a large and deeply phenotyped population-based study independently of previously established covariates. Future studies on cpRNFLT should include these biomarkers and need to investigate whether incorporation will improve the diagnosis of early eye diseases based on cpRNFLT.
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Affiliation(s)
- Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Mengyu Wang
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Mike Francke
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Anke Tönjes
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Joachim Thiery
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Markus Loeffler
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Ebert
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.
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21
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Badian RA, Andréasson M, Svenningsson P, Utheim TP, Lagali N. The pattern of the inferocentral whorl region of the corneal subbasal nerve plexus is altered with age. Ocul Surf 2021; 22:204-212. [PMID: 34450219 DOI: 10.1016/j.jtos.2021.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To describe the pattern of the nerves in the inferocentral whorl region of the human corneal subbasal nerve plexus (SBNP) in health and diseases known to affect the subbasal nerves. METHODS Laser-scanning in vivo confocal microscopy (IVCM) was used to image the SBNP bilaterally in 91 healthy subjects, 39 subjects with type 2 diabetes mellitus (T2DM), and 43 subjects with Parkinson's disease (PD). Whorl regions were classified according to nerve orientation relative to age and health/disease status. RESULTS Of 346 examined eyes, 300 (86.7%) had an identifiable whorl pattern. In healthy subjects, a clockwise nerve orientation of the whorl was most common (67.9%), followed by non-rotatory or 'seam' morphology (21.4%), and counterclockwise (10.7%). The clockwise orientation was more prevalent in healthy subjects than in T2DM or PD (P < 0.001). Healthy individuals below 50 years of age had a predominantly clockwise orientation (93.8%) which was reduced to 51.9% in those over 50 years (P < 0.001). Age but not disease status explained whorl orientation in T2DM and PD groups. Moreover, whorl orientation is bilaterally clockwise in the young, but adopts other orientations and becomes asymmetric across eyes with age. Finally, we report reflective 'dot-like' features confined to the whorl region of the subbasal plexus, sometimes appearing in close association with subbasal nerves and present in 84-93% of examined eyes regardless of disease status, eye or sex. CONCLUSION Subbasal nerves in the inferocentral whorl region are predominantly clockwise in young, healthy corneas. With aging and conditions of T2DM and PD, counterclockwise and non-rotatory configurations increase in prevalence, and bilateral symmetry is lost. Mechanisms regulating these changes warrant further investigation.
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Affiliation(s)
- Reza A Badian
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
| | - Mattias Andréasson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Svenningsson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tor Paaske Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Neil Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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22
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Cozzini T, Piona C, Marchini G, Merz T, Brighenti T, Bonetto J, Marigliano M, Olivieri F, Maffeis C, Pedrotti E. In vivo confocal microscopy study of corneal nerve alterations in children and youths with Type 1 diabetes. Pediatr Diabetes 2021; 22:780-786. [PMID: 33934464 PMCID: PMC8360056 DOI: 10.1111/pedi.13219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/13/2021] [Accepted: 04/16/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine whether children and youths with Type 1 diabetes (T1D) have early alterations of the corneal subbasal nerve plexus detectable with in vivo confocal microscopy (IVCM) and to investigate the role of longitudinally measured major risk factors for diabetes complications associated with these alterations. METHODS One hundred and fifty children and youths with T1D and 51 age-matched controls were enrolled and underwent IVCM. Corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal fiber total branch density (CTBD), and corneal fiber fractal dimension (CNFrD) were measured. Risk factors for diabetes complications (blood pressure, BMI, HbA1c, lipoproteins, urinary albumin-creatinine ratio) were recorded at IVCM and longitudinally since T1D onset. Unpaired t-test was used to compare variables between the groups. Multiple regression models were calculated using IVCM parameters as dependent variables and risk factors as independent variables. RESULTS All IVCM parameters, except CTBD, were significantly lower in the T1D patients. Glycometabolic control (HbA1c, visit-to-visit HbA1c variability, and mean HbA1c), and blood pressure were inversely correlated with IVCM parameters. Multiple regression showed that part of the variability in CNFL, CNFD, CTBD, and CNFraD was explained by HbA1c, blood pressure percentiles and age at IVCM examination, independent of diabetes duration, BMI percentile and LDL cholesterol. Comparable results were obtained using the mean value of risk factors measured longitudinally since T1D onset. CONCLUSIONS Early signs of corneal nerve degeneration were found in children and youths with T1D. Glycometabolic control and blood pressure were the major risk factors for these alterations.
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Affiliation(s)
- Tiziano Cozzini
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Giorgio Marchini
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Tommaso Merz
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Tommaso Brighenti
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Jacopo Bonetto
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Francesca Olivieri
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric DiabetesUniversity City Hospital of VeronaVeronaItaly
| | - Emilio Pedrotti
- Department of Neuroscience, Biomedicine and Movement SciencesEye Clinic, University of VeronaVeronaItaly
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23
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Lin K, Hsih W, Lin Y, Wen C, Chang T. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig 2021; 12:1322-1325. [PMID: 33316144 PMCID: PMC8354492 DOI: 10.1111/jdi.13480] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022] Open
Abstract
Despite progress in the treatment of diabetic macular edema and diabetic retinopathy, the rate of lower fundus examination due to limitations of medical resources delays the diagnosis and treatment of diabetic retinopathy. Therefore, implementation of automated diabetic retinopathy screening program and the identification of more specific and sensitive biomarkers are important for facilitating the earlier detection of diabetic macular edema and diabetic retinopathy to decrease the prevalence of poor vision and blindness.
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Affiliation(s)
- Kuan‐Yu Lin
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Wen‐Hui Hsih
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yen‐Bo Lin
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chen‐Yu Wen
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Tien‐Jyun Chang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
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24
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Kreeke JA, Nguyen HT, Konijnenberg E, Tomassen J, Braber A, Kate M, Yaqub M, Berckel B, Lammertsma AA, Boomsma DI, Tan HS, Visser PJ, Verbraak FD. Longitudinal retinal layer changes in preclinical Alzheimer's disease. Acta Ophthalmol 2021; 99:538-544. [PMID: 33073531 PMCID: PMC8451744 DOI: 10.1111/aos.14640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/21/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
Purpose Several studies found reduced retinal thickness on optical coherence tomography (OCT) in Alzheimer’s disease (AD), even in preclinical stages, labelling this technique of interest as biomarker. In this study, we examine retinal thickness changes in preclinical AD, as defined by cognitively normal individuals with amyloid‐beta (Aβ) on positron emission tomography (PET). Methods For this monocentre study, 145 cognitively healthy monozygotic twins aged ≥ 60 were included from the Netherlands Twin Register taking part in the EMIF‐AD PreclinAD study. At baseline, participants underwent [18F] flutemetamol PET that was visually rated for cortical Aβ. Binding potential was calculated as continuous measure for Aβ. Optical coherence tomography (OCT) was performed at baseline and after 22 months to assess changes in total and individual inner retinal layer thickness in the macular region (ETDRS circles) and peripapillary retinal nerve fibre layer thickness. Differences in rate of change between amyloid‐beta positive and negative individuals and associations between binding potential and change in retinal thickness were evaluated. Results Sixteen participants (11%) were positive for Aβ. Change in retinal thickness did not differ in any region between Aβ+ and Aβ− individuals. A positive association between binding potential and change in inner plexiform layer thickness was observed in the inner macular ring (beta = 1.708, CI = 0.575 to 2.841, p = 0.003). Conclusion Aβ+ individuals did not differ in rate of change of any retinal layer compared to controls, but higher binding potential at baseline was associated with less IPL thinning over time. Optical coherence tomography (OCT) as a longitudinal screening tool for preclinical AD seems limited, but IPL changes offer leads for further research.
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Affiliation(s)
- Jacoba A. Kreeke
- Ophthalmology Dept. Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Hoang Ton Nguyen
- Ophthalmology Dept. Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Jori Tomassen
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Anouk Braber
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
- Dept. of Biological Psychology VU University Amsterdam Amsterdam The Netherlands
| | - Mara Kate
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Bart Berckel
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Adriaan A. Lammertsma
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Dorret I. Boomsma
- Dept. of Biological Psychology VU University Amsterdam Amsterdam The Netherlands
| | - H. Stevie Tan
- Ophthalmology Dept. Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Frank D. Verbraak
- Ophthalmology Dept. Amsterdam UMC, location VUmc Amsterdam The Netherlands
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Structural and functional findings in patients with moderate diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2021; 259:3625-3635. [PMID: 34264395 PMCID: PMC8589761 DOI: 10.1007/s00417-021-05277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate structural and functional ocular changes in patients with type 2 diabetes mellitus (DM2) and moderate diabetic retinopathy (DR) without apparent diabetic macular edema (DME) assessed by optical coherence tomography (OCT) and microperimetry. Methods This was a single-center cross-sectional descriptive study for which 75 healthy controls and 48 DM2 patients with moderate DR were included after applying exclusion criteria (one eye per patient was included). All eyes underwent a complete ophthalmic examination (axial length, macular imaging with swept-source OCT, and MAIA microperimetry). Macular thicknesses, ganglion cell complex (GCC) thicknesses, and central retinal sensitivity were compared between groups, and the relationships between the OCT and microperimetry parameters were evaluated. Results Macular thickness was similar in both groups (242.17 ± 35.0 in the DM2 group vs 260.64 ± 73.9 in the control group). There was a diminution in the parafoveal area thickness in the DM2 group in the GCC complex. Retinal sensitivity was reduced in all sectors in the DM2 group. The central global value was 24.01 ± 5.7 in the DM2 group and 27.31 ± 2.7 in the control group (p < 0.001). Macular integrity was 80.89 ± 26.4 vs 64.70 ± 28.3 (p < 0.001) and total mean threshold was 23.90 ± 4.9 vs 26.48 ± 2.6 (p < 0.001) in the DM2 and control group, respectively. Moderate correlations were detected between the central sector of MAIA microperimetry and retina total central thickness (− 0.347; p = 0.0035). Age, visual acuity, and hemoglobin A1c levels also correlated with retinal sensitivity. Conclusion Macular GCC thickness and central retinal sensitivity were reduced in patients with moderate DR without DME, suggesting the presence of macular neurodegeneration.
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Bondugulapati LNR, Narayen N. Corneal confocal microscopy: potential usage in the context of diabetes mellitus. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- LN Rao Bondugulapati
- Consultant Physician in Diabetes & Endocrinology, Endocrine Unit, Maelor Hospital, Wrexham, UK
| | - Nitesh Narayen
- Consultant Ophthalmologist, Cataract, Cornea and Refractive Surgeon, Director – Nvision Eye Care, Hyderabad, India
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Non-invasive detection of corneal sub-basal nerve plexus changes in multiple myeloma patients by confocal laser scanning microscopy. Biosci Rep 2021; 40:226598. [PMID: 33026069 PMCID: PMC7578619 DOI: 10.1042/bsr20193563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Confocal laser scanning microscopy (CLSM) is a non-invasive technique for cellular in vivo imaging of the human cornea. CLSM screening was evaluated for early detection of corneal nerve morphology changes and neuropathogenic events in different stage multiple myeloma (MM) patients. As MM patients show disease as well as therapy-related neuropathological symptoms, CLSM potentially provides a tool for non-invasive early detection of neuropathogenic events. CLSM findings were compared with the severity of peripheral neuropathic (PNP) symptoms. METHODS The study enrolled 25 MM patients in which bilateral ophthalmologic examination was performed including unilateral CLSM. Further peripheral nerve function was clinically evaluated using the conventional neuropathy symptom and neuropathy deficit scores (NDSs). RESULTS In 18/25 MM patients, CLSM detected atypical morphological appearance of bulb-like enlarged nerve endings in the corneal sub-basal nerve plexus. These neuromas were only found in patients showing moderate to severe PNP, in patients with mild or lacking PNP neuromas were absent. CONCLUSIONS CLSM provides a novel non-invasive diagnostic tool for identification of neuromas in cancer patients affected by therapy or disease-related neuropathologies, perspectival allowing early neuronal degenerative process detection and monitoring.
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Relationship between anthropometric and biochemical changes of metabolic syndrome with retinal nerve fiber layer and macular thickness. PLoS One 2021; 16:e0246830. [PMID: 33630879 PMCID: PMC7906412 DOI: 10.1371/journal.pone.0246830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/26/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the retinal nerve fiber layer (RNFL) and macular thicknesses and identify systemic risk factors for thinning of these layers in patients with metabolic syndrome (MetS). Methodology A cross-sectional observational study was performed on patients diagnosed with MetS and compared to normal controls. All patients underwent ophthalmic and anthropometric examination, serological and biochemical blood investigations; and ocular imaging using spectral-domain optical coherence tomography. Patients with ocular pathology were excluded. Unpaired t-test was used to compare mean thickness between the two groups. One-way ANOVA with Bonferroni correction for multiple comparisons was used to compare mean thickness between different tertiles of MetS parameters, and a generalized estimating equation was used to correct for inter-eye correlation and to assess association between mean thickness and covariates. Results Two hundred and forty-eight eyes from 124 participants (1:1 ratio of MetS patients to controls) were included. Age ranged between 30 to 50 years old, and mean age was 40 ± 6.6 years. RNFL thickness was lower globally (93.6 ± 9.9 μm vs 99.0 ± 9.3, p<0.001) and in the inferior (124.5 ± 17.5 μm vs 131.0 ± 16.4 μm, p = 0.002), superior (117.2 ± 16.0 μm vs 126.3 ± 14.4 μm, p<0.001) and temporal (65.5 ± 10.2 μm vs 69.5 ± 9.8, p = 0.002) sectors in MetS patients compared to controls. Only the central (237.0 ± 14.0 μm vs 243.6 ± 18.0 μm, p = 0.002) and inferior parafoveal (307.8 ± 20.9 vs 314.6 ± 14.6, p = 0.004) area of the macula was significantly thinner. The inferior RNFL sector had the most difference (mean difference = 9.1 μm). The Generalized Estimating Equation found that, after adjusting for age, diastolic blood pressure, BMI, HDL and obesity; the number of MetS components and elevated triglyceride levels were independent risk factors for reduced thickness in global RNFL (β = -4.4, 95% CI = -7.29 to -1.5, p = 0.003) and inferior parafovea (β = -6.85, 95% CI = -11.58 to -2.13, p = 0.004) thickness respectively. Conclusion RNFL thinning was seen more than macula thinning in MetS patients, suggesting RNFL susceptibility to neurodegeneration than the macula. A higher number of metabolic components and elevated triglyceride levels were independent risk factors for retinal thinning in this group of patients.
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Venkataraman AP, Andersson J, Fivelsdal L, Nilsson M, Domínguez-Vicent A. Impact of optical coherence tomography scan direction on the reliability of peripapillary retinal nerve fiber layer measurements. PLoS One 2021; 16:e0247670. [PMID: 33617580 PMCID: PMC7899366 DOI: 10.1371/journal.pone.0247670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the intradevice repeatability and agreement for peripapillary retinal nerve fiber layer (pRNFL) measurements in healthy eyes with two different scan directions and two different number of B scans. Methods pRNFL was measured with a spectral domain optical coherence tomography on 54 healthy participants. Three-dimensional optic disc scans (6 mm x 6 mm) were performed on the right eye of the participants. Two repeated scans were performed in four different settings: H1: Horizontal scan with 512 A-scans x 96 B-scans; H2: Horizontal scan with 512 A-scans x 128 B-scans; V1: Vertical scan with 512 A-scans x 96 B-scans; V2: Vertical scan with 512 A-scans x 128 B-scans. The pRNFL thickness was evaluated in twelve clock-hour sector in a circle of 3.45 mm diameter centred at the optic disc. Repeatability and agreement were assessed with within subject standard deviation (Sw) and Bland-Altman test respectively. Results The repeatability of pRNFL measurements varied depending on the scan direction and sectors. The repeatability for the horizontal sectors were better with H1 and H2, with sector 9 having the best Sw (< 3 μm). The repeatability for the vertical sectors were better with V1 and V2 with sector 5 and 9 having the best Sw (< 4 μm). The repeatability with vertical scan was more symmetric among the sectors than with horizontal scans. The repeatability metrics of the sectors did not vary much between H1 and H2 (difference < 2 μm) and between V1 and V2 (difference < 3.2 μm). Comparing horizontal and vertical scans, the vertical sectors had larger limits of agreement of about 45 μm. Conclusion The reliability of the pRNFL thickness measurements is dependent on the direction of the scan and independent on the numbers of B-scans. Vertical scans for pRNFL gives more homogeneous repeatability across the different sectors.
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Affiliation(s)
- Abinaya Priya Venkataraman
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Josefine Andersson
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lina Fivelsdal
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Nilsson
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Alberto Domínguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Aschauer J, Pollreisz A, Karst S, Hülsmann M, Hajdu D, Datlinger F, Egner B, Kriechbaum K, Pablik E, Schmidt-Erfurth UM. Longitudinal analysis of microvascular perfusion and neurodegenerative changes in early type 2 diabetic retinal disease. Br J Ophthalmol 2020; 106:528-533. [PMID: 33293271 DOI: 10.1136/bjophthalmol-2020-317322] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively monitor subclinical changes in capillary perfusion and retinal layer thickness in patients with type 2 diabetes and early diabetic retinal disease over 2 years. METHODS In this longitudinal study we performed biannual retinal vascular imaging using optical coherence tomography angiography (RTVue) to analyse the foveal avascular zone (FAZ) area, perimeter, acircularity index (AI) and parafoveal superficial/deep vessel density (VD). Spectral-domain optical coherence tomography (Spectralis) was used to measure the thickness of nine macular layers and the peripapillary nerve fibre layer. RESULTS Among 117 eyes (58 left) of 59 patients (21 female), 105 had no diabetic retinopathy (DR), 6 mild and 6 moderate non-proliferative DR at baseline. We found DR progression in 13 eyes at year 2. The FAZ area (+0.008±0.002 mm2/year, p<0.0001), perimeter (+0.036±0.010 mm/year, p=0.006) and AI (+0.005±0.002/year, p=0.0280) increased significantly. A pronounced decrease was found in the superficial (-1.425±0.290%/year, p<0.0001) but not the deep VD. Inner neuroretinal loss was confined to the ganglion cell (-0.539±0.150 µm/year, p=0.0004) and the inner plexiform layer (-0.361±0.127 µm/year, p=0.0045). In the outer retina, we observed a statistically significant decrease in thickness in the outer plexiform, photoreceptor layer and pigment epithelium of -0.921±0.161 µm/year, -0.325±0.139 µm/year and -0.385±0.084 µm/year, respectively. CONCLUSION Subclinical signs of microangiopathy and neurodegeneration appear in parallel and are highly progressive even in the earliest stages of diabetic retinal disease.Trial registration number EudraCT20156000239634.
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Affiliation(s)
- Julia Aschauer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Sonja Karst
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Wien, Wien, Austria
| | - Dorottya Hajdu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Berit Egner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Katharina Kriechbaum
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
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Bohn S, Stahnke T, Sperlich K, Linke SJ, Farrokhi S, Klemm M, Allgeier S, Köhler B, Reichert KM, Witt M, Stachs O, Guthoff RF. In vivo Histology of the Cornea - from the "Rostock Cornea Module" to the "Rostock Electronic Slit Lamp" - a Clinical "Proof of Concept" Study. Klin Monbl Augenheilkd 2020; 237:1442-1454. [PMID: 33231276 DOI: 10.1055/a-1297-4717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Confocal in vivo microscopy is an established method in ophthalmology research. As it requires contact coupling and calibration of the instruments is suboptimal, this method has been only rarely used in clinical routine work. As a result of close collaboration between physicists, information scientists and ophthalmologists, confocal laser scanning microscopy (CLSM) of the eye has been developed in recent years and a prototype can now be used in patients. The present study evaluates possible clinical uses of this method. MATERIAL AND METHODS The essential innovations in CLSM are (1) a newly designed coupling element with superficial adaptation to corneal curvature and (2) the use of a dual computerised piezo drive for rapid and precise focusing. In post-processing and after elastic imaging registration of the individual images parallel to the surface, it is also possible to produce sagittal sections resembling a split lamp and with resolution in the micrometer range. The concept was tested on enucleated pig bulbi and tested on normal volunteers and selected patients with diseases of the cornea. RESULTS Simultaneous imaging in planes parallel to the surface and in sagittal planes provided additional information that can help us to understand the processes of wound healing in all substructures of the cornea and the role of immune competent cells. Possible clinical uses were demonstrated in a volunteer with healthy eyes and several groups of patients (keratoconus after CXL, recurrent keratitis, status after PRK). These show that this new approach can be used in morphological studies at cellular level in any desired and appropriate test plane. CONCLUSIONS It could be shown that this new concept of CLSM can be used clinically. It can provide valuable and novel information to both preclinical researchers and to ophthalmologists interested in corneal disease, e.g. density of Langerhans cells and epithelial stratification in ocular surface diseases.
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Affiliation(s)
- Sebastian Bohn
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Thomas Stahnke
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Karsten Sperlich
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Stephan J Linke
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland.,Augenarztpraxis am UKE, Zentrumsehstärke, Hamburg, Deutschland
| | - Sanaz Farrokhi
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland
| | - Maren Klemm
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Deutschland
| | - Stephan Allgeier
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Bernd Köhler
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Klaus-Martin Reichert
- Institut für Automation und angewandte Informatik, Karlsruher Institut für Technologie (KIT), Eggenstein-Leopoldshafen, Deutschland
| | - Martin Witt
- Institut für Anatomie, Universitätsmedizin Rostock, Deutschland
| | - Oliver Stachs
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Rudolf F Guthoff
- Universitätsaugenklinik, Universitätsmedizin Rostock, Deutschland.,Department Leben, Licht & Materie, Universität Rostock, Deutschland
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Piona C, Cozzini T, Marchini G, Merz T, Brighenti T, Mazzo U, Marigliano M, Olivieri F, Pedrotti E, Maffeis C. Reduced minimum rim width of optic nerve head: a potential early marker of retinal neurodegeneration in children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2020; 169:108420. [PMID: 32891689 DOI: 10.1016/j.diabres.2020.108420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023]
Abstract
AIMS To determine whether early retinal neurodegenerative changes in pediatric patients with type 1 diabetes (T1D) can be detected by spectral domain-optical coherence tomography (SD-OCT) and whether such changes are associated with risk factors for T1D complications. METHODS A total of 147 T1D children/adolescents and 51 healthy controls underwent SD-OCT. Spherical refractive error (SRE), macular total retinal thickness (TRT), ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), minimum rim width (MRW), and Bruch's membrane opening area (BMOA) were measured. Clinical and biochemical parameters were recorded at the time of SD-OCT and starting at T1D onset. Multiple regression models were calculated using SD-OCT parameters as dependent and risk factors as independent variables. RESULTS MRW was significantly thinner in the T1D patients (global MRW:361.58vs386.33 µm; p = 0.009), while RNFL and macular parameters were similar for both groups. MRW was inversely correlated with mean HbA1c (r ≥ -0.180, p < 0.05). Multiple regression showed that part of the variability in MRW was explained by HbA1c and BMOA (R2 = 0.21; p < 0.001), independent of other cardiometabolic risk factors. CONCLUSIONS MRW reduction could be a potential early marker of retinal neurodegeneration detectable in pediatric patients with T1D. The association between MRW and mean HbA1c suggests that glucometabolic control may affect early retinal neurodegeneration starting in childhood.
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Affiliation(s)
- Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani 1, 37126 Verona, Italy.
| | - Tiziano Cozzini
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Giorgio Marchini
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Tommaso Merz
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Tommaso Brighenti
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Umberto Mazzo
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani 1, 37126 Verona, Italy
| | - Francesca Olivieri
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani 1, 37126 Verona, Italy
| | - Emilio Pedrotti
- Department of Neuroscience, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani 1, 37126 Verona, Italy.
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Corneal nerves in diabetes-The role of the in vivo corneal confocal microscopy of the subbasal nerve plexus in the assessment of peripheral small fiber neuropathy. Surv Ophthalmol 2020; 66:493-513. [PMID: 32961210 DOI: 10.1016/j.survophthal.2020.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
The cornea's intense innervation is responsible for corneal trophism and ocular surface hemostasis maintenance. Corneal diabetic neuropathy affects subbasal nerve plexus, with progressive alteration of nerves' morphology and density. The quantitative analysis of nerve fibers can be performed with in vivo corneal confocal microscopy considering the main parameters such as corneal nerve fibers length, corneal nerve fibers density, corneal nerve branching density, tortuosity coefficient, and beadings frequency. As the nerve examination permits the detection of early changes occurring in diabetes, the invivo corneal confocal microscopy becomes, over time, an important tool for diabetic polyneuropathy assessment and follow-up. In this review, we summarize the actual evidence about corneal nerve changes in diabetes and the relationship between the grade of alterations and the duration and severity of the disease. We aim at understanding how diabetes impacts corneal nerves and how it correlates with sensorimotor peripheral polyneuropathy and retinal complications. We also attempt to analyze the safety of the most common surgical procedures such as cataract and refractive surgery in diabetic patients and to highlight the specific risk factors. We believe that information about the corneal nerve fibers' condition obtained from the in vivo subbasal nerve plexus investigation may be crucial in monitoring peripheral small fiber polyneuropathy and that it will help with decision-making in ophthalmic surgery in diabetic patients.
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De Clerck EE, Schouten JS, Berendschot TT, Koolschijn RS, Nuijts RM, Schram MT, Schaper NC, Henry RM, Dagnelie PC, Ruggeri A, Guimarães P, Stehouwer CD, Webers CA. Reduced corneal nerve fibre length in prediabetes and type 2 diabetes: The Maastricht Study. Acta Ophthalmol 2020; 98:485-491. [PMID: 32017403 PMCID: PMC7496813 DOI: 10.1111/aos.14359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 01/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE In individuals with diabetes, injury to the corneal nerve fibres predisposes to delayed corneal epithelial healing, reduced corneal sensitivity and corneal erosion. We investigated to what extent a reduction in corneal nerve fibre length (CNFL) is present in individuals with prediabetes or type 2 diabetes (DM2) compared with individuals with normal glucose metabolism (NGM). METHODS Using composite images acquired by corneal confocal microscopy, we assessed total CNFL per mm2 in the subbasal nerve plexus of the cornea in 134 participants (mean age 59 ± 8 years, 49% men, 87 NGM, 20 prediabetes, 27 DM2). Multivariable linear regression was used to assess the association between CNFL and glucose metabolism status, adjusted for age and sex. RESULTS In individuals with type 2 diabetes, the mean CNFL was significantly reduced [β = -1.86 mm/mm2 (95% CI -3.64 to -0.08), p = 0.04], as compared with individuals with normal glucose metabolism after adjustment for age and sex. Part of the reduction was present in individuals with prediabetes [β = -0.96 mm/mm2 (95% CI -2.91 to 0.99), p = 0.34], with a linear trend of corneal nerve fibre reduction with severity of glucose metabolism status (p trend = 0.04). CONCLUSIONS A significant reduction in CNFL was found in individuals with DM2 compared with individuals with NGM. A trend of reduction in CNFL was observed between individuals with NGM and prediabetes. The reduction in corneal nerve fibre length could contribute to a delayed corneal healing and an increased risk for corneal complications after surgery.
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Affiliation(s)
- Eline E.B. De Clerck
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
| | - Jan S.A.G. Schouten
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
| | - Tos T.J.M. Berendschot
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
| | - Renée S. Koolschijn
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
| | - Rudy M.M.A. Nuijts
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
| | - Miranda T. Schram
- Department of Internal MedicineMaastricht University Medical Center +Maastrichtthe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands
| | - Nicolaas C. Schaper
- Department of Internal MedicineMaastricht University Medical Center +Maastrichtthe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Ronald M.A. Henry
- Department of Internal MedicineMaastricht University Medical Center +Maastrichtthe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands
| | - Pieter C. Dagnelie
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands,Department of EpidemiologyMaastricht UniversityMaastrichtthe Netherlands
| | - Alfredo Ruggeri
- Department of Information EngineeringUniversity of PaduaPaduaItaly
| | - Pedro Guimarães
- Department of Information EngineeringUniversity of PaduaPaduaItaly
| | - Coen D.A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Center +Maastrichtthe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtthe Netherlands
| | - Carroll A.B. Webers
- University Eye Clinic MaastrichtMaastricht University Medical Center +Maastrichtthe Netherlands
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Farrah TE, Dhillon B, Keane PA, Webb DJ, Dhaun N. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int 2020; 98:323-342. [PMID: 32471642 PMCID: PMC7397518 DOI: 10.1016/j.kint.2020.01.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.
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Affiliation(s)
- Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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36
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Badian RA, Utheim TP, Lagali N. Region of interest and directional analysis of subbasal nerves in wide-area corneal nerve plexus mosaics in type 2 diabetes mellitus. Sci Rep 2020; 10:10802. [PMID: 32612112 PMCID: PMC7329902 DOI: 10.1038/s41598-020-67737-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
In vivo confocal microscopy (IVCM) imaging of the corneal subbasal nerve plexus (SBNP) is a clinical imaging modality gaining popularity for the diagnosis and follow-up of corneal neuropathy in various conditions such as diabetes mellitus. There remain, however, major limitations to the method, hindering its widespread clinical use. Finding the same exact area of the central cornea to standardize image acquisition is difficult without a reference point. Alternatively, creating wide-area mosaics of the SBNP is resource-intensive and has not yet been developed for routine clinical use. Here, we investigated whether IVCM analysis of the corneal SBNP in a predetermined, anatomically standardized region of interest (ROI) could be applied as an equivalent substitution for wide-area SBNP mosaic generation and analysis. Furthermore, we investigated nerve patterns outside the central corneal region for a possible relationship to type 2 diabetes mellitus status using a publicly available dataset. We found that corneal nerve fibre length density (CNFL) based on the ROI underestimated the mosaic-based CNFL by an average of 34% in 90% of cases (150 eyes), and did not exhibit a significant reduction with diabetes, as seen in the full SBNP. Outside the central cornea, nerve orientation differed depending on the anatomic region (left, central or right superior plexus, P < 0.001). Moreover, in long-term type 2 diabetes mellitus (≥ 10 years, 28 subjects), nerve density in the left superior sector of the SBNP was decreased (P < 0.001) while that in the central superior SBNP increased (P = 0.01) relative to 35 age-matched healthy subjects with normal glucose tolerance. These results indicate that subbasal nerve degeneration in type 2 diabetes mellitus can vary according to anatomic location, and regions with potential diagnostic value outside the central SBNP may warrant further investigation.
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Affiliation(s)
- Reza A Badian
- Unit of Regenerative Medicine, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
| | - Tor Paaske Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Neil Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.,Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Eyeing the Extracellular Matrix in Vascular Development and Microvascular Diseases and Bridging the Divide between Vascular Mechanics and Function. Int J Mol Sci 2020; 21:ijms21103487. [PMID: 32429045 PMCID: PMC7278940 DOI: 10.3390/ijms21103487] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
The extracellular matrix (ECM) is critical in all aspects of vascular development and health: supporting cell anchorage, providing structure, organization and mechanical stability, and serving as a sink for growth factors and sustained survival signals. Abnormal changes in ECM protein expression, organization, and/or properties, and the ensuing changes in vascular compliance affect vasodilator responses, microvascular pressure transmission, and collateral perfusion. The changes in microvascular compliance are independent factors initiating, driving, and/or exacerbating a plethora of microvascular diseases of the eye including diabetic retinopathy (DR) and vitreoretinopathy, retinopathy of prematurity (ROP), wet age-related macular degeneration (AMD), and neovascular glaucoma. Congruently, one of the major challenges with most vascular regenerative therapies utilizing localized growth factor, endothelial progenitor, or genetically engineered cell delivery, is the regeneration of blood vessels with physiological compliance properties. Interestingly, vascular cells sense physical forces, including the stiffness of their ECM, through mechanosensitive integrins, their associated proteins and the actomyosin cytoskeleton, which generates biochemical signals that culminate in a rapid expression of matricellular proteins such as cellular communication network 1 (CCN1) and CCN2 (aka connective tissue growth factor or CTGF). Loss or gain of function of these proteins alters genetic programs of cell growth, ECM biosynthesis, and intercellular signaling, that culminate in changes in cell behavior, polarization, and barrier function. In particular, the function of the matricellular protein CCN2/CTGF is critical during retinal vessel development and regeneration wherein new blood vessels form and invest a preformed avascular neural retina following putative gradients of matrix stiffness. These observations underscore the need for further in-depth characterization of the ECM-derived cues that dictate structural and functional properties of the microvasculature, along with the development of new therapeutic strategies addressing the ECM-dependent regulation of pathophysiological stiffening of blood vessels in ischemic retinopathies.
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van de Kreeke JA, Legdeur N, Badissi M, Nguyen HT, Konijnenberg E, Tomassen J, Ten Kate M, den Braber A, Maier AB, Tan HS, Verbraak FD, Visser PJ. Ocular biomarkers for cognitive impairment in nonagenarians; a prospective cross-sectional study. BMC Geriatr 2020; 20:155. [PMID: 32345233 PMCID: PMC7189586 DOI: 10.1186/s12877-020-01556-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 04/13/2020] [Indexed: 12/03/2022] Open
Abstract
Background Ocular imaging receives much attention as a source of potential biomarkers for dementia. In the present study, we analyze these ocular biomarkers in cognitively impaired and healthy participants in a population aged over 90 years (= nonagenarian), and elucidate the effects of age on these biomarkers. Methods For this prospective cross-sectional study, we included individuals from the EMIF-AD 90+ study, consisting of a cognitively healthy (N = 67) and cognitively impaired group (N = 33), and the EMIF-AD PreclinAD study, consisting of cognitively healthy controls aged ≥60 (N = 198). Participants underwent Optical Coherence Tomography (OCT) and fundus photography of both eyes. OCT was used to asses total and individual inner retinal layer thickness in the macular region (Early Treatment Diabetic Retinopathy Study circles) as well as peripapillary retinal nerve fiber layer thickness, fundus images were analyzed with Singapore I Vessel Assessment to obtain 7 retinal vascular parameters. Values for both eyes were averaged. Differences in ocular biomarkers between the 2 nonagenarian groups were analyzed using linear regression, differences between the individual nonagenarian groups and controls were analyzed using generalized estimating equations. Results Ocular biomarkers did not differ between the healthy and cognitively impaired nonagenarian groups. 19 out of 22 ocular biomarkers assessed in this study differed between either nonagenarian group and the younger controls. Conclusion The ocular biomarkers assessed in this study were not associated with cognitive impairment in nonagenarians, making their use as a screening tool for dementing disorders in this group limited. However, ocular biomarkers were significantly associated with chronological age, which were very similar to those ascribed to occur in Alzheimer’s Disease.
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Affiliation(s)
- Jacoba A van de Kreeke
- Ophthalmology Department, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Nienke Legdeur
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maryam Badissi
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - H Ton Nguyen
- Ophthalmology Department, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jori Tomassen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mara Ten Kate
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anouk den Braber
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Stevie Tan
- Ophthalmology Department, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Frank D Verbraak
- Ophthalmology Department, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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EARLY MICROVASCULAR AND NEURAL CHANGES IN PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES MELLITUS WITHOUT CLINICAL SIGNS OF DIABETIC RETINOPATHY. Retina 2020; 39:435-445. [PMID: 29206758 DOI: 10.1097/iae.0000000000001990] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess and compare early modifications in inner retinal layer thickness and optical coherence tomography angiography parameters in patients with diabetes mellitus (DM) Types 1 and 2 without clinical signs of diabetic retinopathy. METHODS Ninety eyes of 90 subjects (24 Type 1 DM, 36 Type 2 DM, and 30 healthy controls) were prospectively evaluated with spectral domain OCT, swept-source OCT angiography, and color fundus photography (on the same day). Retinal nerve fiber layer, ganglion cell layer (GCL+), and nerve fiber layer + GCL+ (GCL++) thickness were automatically determined by the instrument in the 1, 3, and 6 central mm. On OCT angiography, the following parameters were evaluated: area of foveal avascular zone, number of focally dilated endings of the capillaries (detected only on OCT angiography), presence of regular/irregular foveal avascular zone, capillary loss, and capillary network irregularities in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS Ganglion cell layer+ (P = 0.0099) and GCL++ (P = 0.0367) were significantly thicker in DM Type 1 versus DM Type 2 in 1 central mm, after adjustment for age and DM duration. The area of foveal avascular zone was significantly larger in DM Type 1 versus controls in both SCP and DCP and in DM Type 1 versus Type 2 only in DCP (P < 0.05 for all); the number of focally dilated endings of the capillaries was higher in DM Type 1 versus controls in both SCP and DCP (P < 0.01 for all); and in DM Type 2 versus controls only in DCP (P = 0.007). Perifoveal capillary loss in SCP and inner retinal layer thickness had the highest correlation in both DM types. CONCLUSION There are specific neural and microvascular modifications even before clinical signs of diabetic retinopathy in DM Types 1 and 2. Perifoveal capillary loss in the SCP is highly correlated with inner retinal layer. These data may help in characterization of patients at the preclinical stage of diabetic retinopathy.
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van de Kreeke JA, Darma S, Chan Pin Yin JMPL, Tan HS, Abramoff MD, Twisk JWR, Verbraak FD. The spatial relation of diabetic retinal neurodegeneration with diabetic retinopathy. PLoS One 2020; 15:e0231552. [PMID: 32298369 PMCID: PMC7161968 DOI: 10.1371/journal.pone.0231552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Diabetic retinal neurodegeneration (DRN) has been demonstrated in eyes of patients with diabetes mellitus (DM), even in the absence of diabetic retinopathy (DR). However, no studies have looked at the rate of change in retinal layers and presence/development of DR over time per quadrant of the macula. In this longitudinal study, we aimed to clarify whether the rate of DRN is associated with the development/presence of DR within 4 different quadrants of the retina. Methods 80 eyes of 40 patients with type 1 DM and no/minimal DR were included. At 4 visits over 6 years, SD-OCT and fundus images were acquired. Thickness of the Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL) and Inner Plexiform Layer (IPL) was measured in a 1-6mm circle around the fovea overall and for each quadrant (superior, nasal, inferior, temporal). Fundus images were scored for the presence/absence of DR in these areas. Multilevel analyses were performed to determine the rate of change for each layer overall and per quadrant for eyes/quadrants without and with DR during the follow-up period. Results RNFL and GCL showed significant thinning over time, IPL significant thickening. These changes were more pronounced for GCL and IPL in eyes/quadrants with DR during the follow-up period. Conclusions RNFL and GCL both showed thinning over time, which was more pronounced in eyes with DR for GCL. This holds true even in regional parts of the retina, as quadrant analyses showed similar results, showing that structural DRN is associated with DR per quadrant independently.
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Affiliation(s)
- Jacoba A. van de Kreeke
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- * E-mail:
| | - Stanley Darma
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - H. Stevie Tan
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Michael D. Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospital & Clinics, Iowa City, Iowa, United States of America
- VA Medical Center, Iowa City, Iowa, United States of America
- IDx, Iowa City, Iowa, United States of America
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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Satue M, Cipres M, Melchor I, Gil-Arribas L, Vilades E, Garcia-Martin E. Ability of Swept source OCT technology to detect neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy. Jpn J Ophthalmol 2020; 64:367-377. [PMID: 32157484 DOI: 10.1007/s10384-020-00729-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate neurodegeneration in patients with type 2 Diabetes Mellitus (DM2) without diabetic retinopathy, and to assess the possible role of chronic systemic ischaemia and disease duration in retinal changes. STUDY DESIGN Observational cross sectional study. METHODS Sixty eyes of 60 patients with DM2 without signs of diabetic retinopathy (DR), and 60 eyes of 60 healthy controls underwent retinal (ganglion cell layer (GCL), and retinal nerve fiber layer (RNFL) and choroidal evaluation using Swept source Optical coherence tomography, which allows high quality analysis of the different retinal layers and the choroidal plexus. Comparison between patients with presence/absence of systemic vascular complications and different disease duration time was performed. RESULTS Macular GCL and RNFL were reduced in patients compared to controls (p < 0.001). In the peripapillary area, a reduction of the RNFL (p < 0.001) was observed in patients with DM2. There were no significant changes observed in the choroidal plexus of these patients. Patients with systemic ischaemia presented significant thinning of the choroid and further reduction of the temporal RNFL (p = 0.014) and GCL (p = 0.016) thickness. The GCL and the choroid were also thinner in patients with longer disease duration. CONCLUSIONS Patients with early DM2 present retinal neurodegeneration prior to the appearance of clinically observable vascular retinal changes. In these patients chronic systemic ischaemia caused reduction of the choroidal plexus and further damage to the retinal layers, adding new information on systemic chronic ischaemia and retinal neurodegeneration in patients with DM2 without DR.
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Affiliation(s)
- Maria Satue
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain. .,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain. .,C/ Padre Arrupe. Consultas Externas de Oftalmología, 50009, Zaragoza, Spain.
| | - Marta Cipres
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Isabel Melchor
- Endocrinology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Gil-Arribas
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Elisa Vilades
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
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Kreeke JA, Nguyen H, Haan J, Konijnenberg E, Tomassen J, Braber A, Kate M, Collij L, Yaqub M, Berckel B, Lammertsma AA, Boomsma DI, Tan HS, Verbraak FD, Visser PJ. Retinal layer thickness in preclinical Alzheimer's disease. Acta Ophthalmol 2019; 97:798-804. [PMID: 31058465 PMCID: PMC6900176 DOI: 10.1111/aos.14121] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022]
Abstract
Purpose There is urgent need for non‐invasive diagnostic biomarkers in the preclinical phase of Alzheimer's Disease (AD). Several studies suggest that retinal thickness is reduced in AD. Here, we aim to test the diagnostic value of retinal thickness in preclinical AD, as defined by cognitively normal individuals with amyloid pathology on PET. Methods One hundred and sixty five cognitively healthy monozygotic twins aged ≥ 60 were included from the Netherlands Twin Register taking part in the European Medical Information Framework for Alzheimer's Disease PreclinAD study. Participants underwent [18F] flutemetamol PET that was visually rated for presence or absence of cortical amyloid beta (Aβ). Binding potential (BPND) was calculated as continuous measure for Aβ. Spectral Domain OCT was used to asses total and individual inner retinal layer thickness in the macular region (ETDRS circles) as well as peripapillary retinal nerve fibre layer (pRNFL) thickness. Differences between Aβ+ and Aβ− individuals and associations between BPND and retinal thickness were analyzed. Results No differences were found in retinal layer thickness in the macula or pRNFL between Aβ+ and Aβ− individuals. A positive associations between BPND and macular total retinal thickness was observed in the inner ring (p = 0.018), but this was not statistically significant after correction for multiple testing (p = 0.144). Brain/eye parameters had moderate to high intra‐twin correlations (p < 0.001) except visual rating score of Aβ, which did not correlate (r = 0.21, p = 0.068). Conclusion Variation in retinal thickness likely reflects genetic differences between individuals, but cannot discriminate between healthy and preclinical AD cases, making its use as biomarker in these early stages limited.
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Affiliation(s)
- Jacoba A. Kreeke
- Ophthalmology Department Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Hoang‐Ton Nguyen
- Ophthalmology Department Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Jurre Haan
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Jori Tomassen
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Anouk Braber
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
- Department of Biological Psychology VU University Amsterdam Amsterdam The Netherlands
| | - Mara Kate
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Bart Berckel
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Adriaan A. Lammertsma
- Department of Radiology and Nuclear Medicine Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Dorret I. Boomsma
- Department of Biological Psychology VU University Amsterdam Amsterdam The Netherlands
| | - Hendra Stevie Tan
- Ophthalmology Department Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Frank D. Verbraak
- Ophthalmology Department Amsterdam UMC, location VUmc Amsterdam The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Neuroscience Amsterdam Amsterdam UMC, location VUmc Amsterdam The Netherlands
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Zimmerman M, Eeg-Olofsson K, Svensson AM, Åström M, Arner M, Dahlin L. Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries. BMJ Open 2019; 9:e030179. [PMID: 31488486 PMCID: PMC6731852 DOI: 10.1136/bmjopen-2019-030179] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To study patient-reported outcome after open carpal tunnel release (OCTR) for carpal tunnel syndrome (CTS) in patients with or without diabetes using national healthcare quality registries. DESIGN Retrospective cohort study. SETTING Data from the Swedish National Quality Registry for Hand Surgery (HAKIR; www.hakir.se) were linked to data from the Swedish National Diabetes Register (NDR; www.ndr.nu). PARTICIPANTS We identified 9049 patients (10 770 hands) operated for CTS during the inclusion period (2010-2016). PRIMARY OUTCOME MEASURES Patient-reported outcome measures were analysed before surgery and at 3 and 12 months postoperatively using the QuickDASH as well as the HAKIR questionnaire with eight questions on hand symptoms and disability. RESULTS Patients with diabetes (n=1508; 14%) scored higher in the QuickDASH both preoperatively and postoperatively than patients without diabetes, but the total score change between preoperative and postoperative QuickDASH was equal between patients with and without diabetes. The results did not differ between patients with type 1 or type 2 diabetes. Patients with diabetic retinopathy scored higher in QuickDASH at 3 months postoperatively than patients with diabetes without retinopathy. In the regression analysis, diabetes was associated with more residual symptoms at 3 and 12 months postoperatively. CONCLUSIONS Patients with diabetes experience more symptoms both before and after OCTR, but can expect the same relative improvement from surgery as patients without diabetes . Patients with retinopathy, as a proxy for neuropathy, may need longer time for symptoms to resolve after OCTR. Smoking, older age, higher HbA1c levels and receiving a diabetes diagnosis after surgery were associated with more residual symptoms following OCTR.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Katarina Eeg-Olofsson
- Department of Medicine, University of Gothenburg, Göteborg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Ann-Marie Svensson
- National Diabetes Register, Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Åström
- Department of Data Analytics and Register Centre, Region Skåne Hälso- och sjukvård, Lund, Sweden
| | - Marianne Arner
- HAKIR, National Registry for Hand Surgery, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Lars Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
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Neurodegeneration in Patients with Type 2 Diabetes Mellitus without Diabetic Retinopathy. J Ophthalmol 2019; 2019:1825819. [PMID: 31485340 PMCID: PMC6702840 DOI: 10.1155/2019/1825819] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To evaluate neurodegeneration in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy and to assess the possible role of systemic vascular complications in retinal changes. Methods Sixty eyes of 60 patients with DM2 and without any signs of diabetic retinopathy and 60 eyes of 60 healthy controls underwent retinal evaluation using Spectralis optical coherence tomography. Macular ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) were evaluated. Peripapillary RNFL thickness was assessed using Glaucoma and Axonal Analytics applications. Comparison between patients with the presence/absence of systemic vascular complications and different disease duration was made. Results Macular GCL was reduced in patients compared to controls (p < 0.001). Differences in the macular RNFL thickness were only observed in the outer inferior sector (p=0.033). A reduction in the peripapillary RNFL (average, inferior, and inferotemporal thickness, p < 0.05 for all three) was observed in patients using both applications. Patients with chronic systemic vascular complications presented a reduction in the temporal RNFL (p=0.019) compared to patients without complications. The superotemporal RNFL thickness was thinner in patients with longer disease duration. Conclusions Patients with type 2 DM without diabetic retinopathy and good metabolic control present neurodegeneration affecting neurons in the macular area and axons in different sectors of the optic disc. Systemic vascular complications contributed to further axonal damage in these patients, suggesting a possible role of subclinical ischaemia to retinal neurodegeneration in type 2 DM.
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Prakasam RK, Röhlig M, Fischer DC, Götze A, Jünemann A, Schumann H, Stachs O. Deviation Maps for Understanding Thickness Changes of Inner Retinal Layers in Children with Type 1 Diabetes Mellitus. Curr Eye Res 2019; 44:746-752. [DOI: 10.1080/02713683.2019.1591463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ruby Kala Prakasam
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Martin Röhlig
- Institute of Computer Science, University Rostock, Rostock, Germany
| | - Dagmar-C. Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Aline Götze
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Anselm Jünemann
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Heidrun Schumann
- Institute of Computer Science, University Rostock, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
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Dehghani C, Frost S, Jayasena R, Masters CL, Kanagasingam Y. Ocular Biomarkers of Alzheimer's Disease: The Role of Anterior Eye and Potential Future Directions. Invest Ophthalmol Vis Sci 2019; 59:3554-3563. [PMID: 30025102 DOI: 10.1167/iovs.18-24694] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Globally, Alzheimer's disease (AD) is a growing health and economic challenge that has no effective cure. Recent clinical trials indicate that preclinical treatment may be required but a routine screening tool for AD has been elusive. Hence, a simple, yet sensitive biomarker for preclinical AD, when the disease is most likely to be amenable to treatment, is lacking. Due to several features, the eye has been explored for this purpose and, among the ocular tissues, the retina has received the most attention. Currently, major works investigating the potential AD diagnosis by detecting amyloid-β (Aβ) signatures in the retinal tissue are underway, while the anterior eye is more accessible for in vivo imaging and examination. This report provides a concise review of current literature on the anterior eye components, including the crystalline lens, cornea, and aqueous humor, in AD. We also discuss the potential for assessment of the corneal nerve structure and regeneration as well as conjunctival tissue for AD-related alterations. The crystalline lens has received considerable attention, but further research is required to confirm whether Aβ accumulates in the lens and whether it mirrors brain neuropathologic changes, particularly in preclinical AD. The rich corneal neural network and conjunctival vasculature also merit exploration in future studies to shed light on their potential association with AD pathologic changes.
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Affiliation(s)
- Cirous Dehghani
- Australian e-Health Research Center, CSIRO, Parkville, Australia
| | - Shaun Frost
- Australian e-Health Research Center, CSIRO, Perth, Australia
| | - Rajiv Jayasena
- Australian e-Health Research Center, CSIRO, Parkville, Australia
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, Australia
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Schröder K, Szendroedi J, Benthin A, Gontscharuk V, Ackermann P, Völker M, Steingrube N, Nowotny B, Ziegler D, Müssig K, Geerling G, Kuß O, Roden M, Guthoff R. German Diabetes Study - Baseline data of retinal layer thickness measured by SD-OCT in early diabetes mellitus. Acta Ophthalmol 2019; 97:e303-e307. [PMID: 30238609 DOI: 10.1111/aos.13851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/20/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE Recent studies highlighted that early diabetic neurodegeneration is present before microvascular changes are visible. Retinal neurodegeneration can decrease retinal layer thickness. We aimed to determine whether decreased retinal layer thickness is present already in the early time course of disease. METHODS A cross-sectional analysis of patients and healthy adults from the German Diabetes Study (GDS, ClinicalTrials.gov Identifier number: CT01055093, https://clinicaltrials.gov/ct2/show/NCT01055093). Inclusion criteria were a diagnosis of diabetes mellitus (DM) within the last 12 months. Retinal layers thickness in the nasal pericentral segment was measured by spectral domain ocular coherence tomography (SD-OCT). For statistical analysis proc mixed (sas-version 9.4) was used. RESULTS One hundred and seventy-eight eyes of 89 patients with type 1 DM (58 males, age 36 ± 11 years, BMI 25.5 ± 4.2 kg/m²) and 242 eyes of 121 patients with type 2 DM (84 males, age 53 ± 10 years, BMI 31.9 ± 6.3 kg/m²) with a disease duration of less than 1 year were compared to 76 eyes of 38 controls (27 males, age 41 ± 16 years, BMI 27.3 ± 6.4 kg/m²). Analysis of retinal layer thickness and visual function did not reveal a significant difference between patients and controls. CONCLUSION In the early course of DM potential, neurodegeneration does not relate to measureable changes of retinal layer thickness.
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Affiliation(s)
- Katharina Schröder
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
- Division of Endocrinology and Diabetology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
| | - Anna Benthin
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Veronika Gontscharuk
- Institute of Medical Statistics Düsseldorf University Hospital and Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Philipp Ackermann
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Magdalena Völker
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Nadine Steingrube
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
- Division of Endocrinology and Diabetology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
- Division of Endocrinology and Diabetology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
- Division of Endocrinology and Diabetology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
| | - Gerd Geerling
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Oliver Kuß
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
- Institute of Medical Statistics Düsseldorf University Hospital and Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- Institute for Biometrics and Epidemiology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Michael Roden
- Institute for Clinical Diabetology German Diabetes Center Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany
- Division of Endocrinology and Diabetology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
- German Center of Diabetes Research (DZD e.V.) München‐Neuherberg Germany
| | - Rainer Guthoff
- Department of Ophthalmology Medical Faculty Heinrich Heine University Düsseldorf Düsseldorf Germany
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Burns SA, Elsner AE, Sapoznik KA, Warner RL, Gast TJ. Adaptive optics imaging of the human retina. Prog Retin Eye Res 2019; 68:1-30. [PMID: 30165239 PMCID: PMC6347528 DOI: 10.1016/j.preteyeres.2018.08.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022]
Abstract
Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From animal models to clinical patients, AO imaging is changing the way scientists are approaching the study of the retina. By providing cellular and subcellular details without the need for histology, it is now possible to perform large scale studies as well as to understand how an individual retina changes over time. Because AO retinal imaging is non-invasive and when performed with near-IR wavelengths both safe and easily tolerated by patients, it holds promise for being incorporated into clinical trials providing cell specific approaches to monitoring diseases and therapeutic interventions. AO is being used to enhance the ability of OCT, fluorescence imaging, and reflectance imaging. By incorporating imaging that is sensitive to differences in the scattering properties of retinal tissue, it is especially sensitive to disease, which can drastically impact retinal tissue properties. This review examines human AO retinal imaging with a concentration on the use of the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO). It first covers the background and the overall approaches to human AO retinal imaging, and the technology involved, and then concentrates on using AO retinal imaging to study the structure and function of the retina.
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Affiliation(s)
- Stephen A Burns
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States.
| | - Ann E Elsner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Kaitlyn A Sapoznik
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Raymond L Warner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Thomas J Gast
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
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Pemp B, Palkovits S, Howorka K, Pumprla J, Sacu S, Garhöfer G, Bayerle-Eder M, Schmetterer L, Schmidt-Erfurth U. Correlation of retinal neurodegeneration with measures of peripheral autonomic neuropathy in type 1 diabetes. Acta Ophthalmol 2018; 96:e804-e810. [PMID: 29504257 PMCID: PMC6282971 DOI: 10.1111/aos.13733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/21/2018] [Indexed: 12/21/2022]
Abstract
Purpose To evaluate the relationship of neuroretinal layer thickness with sensitive measures of cardiovascular autonomic neuropathy in diabetic patients with non‐proliferative diabetic retinopathy (NPDR). Methods Twenty‐seven eyes of 27 patients with type 1 diabetes presenting with mild‐to‐moderate NPDR were compared to 27 healthy control (HC) eyes matched for age and gender. The total macular volume (TMV) and the volumes of individual neurosensory layers in the macula were analysed from spectral domain optical coherence tomography using automated layer segmentation. Cardiovascular autonomic regulation was assessed by short‐term power spectrum analysis of heart rate variability (HRV) before, during and after an orthostatic challenge. Results The patients had an age of 46 ± 12 years and diabetes since 28 ± 9 years. Diastolic and mean arterial pressure was lower in the patients compared to HCs. TMV (r = 0.58, p = 0.002), inner plexiform layer volume (IPLV; r = 0.39, p = 0.047) and inner nuclear layer volume (INLV; r = 0.60, p = 0.001) were associated with reduced recovery of low‐frequency (LF) spectral power of HRV after orthostatic load in diabetic patients but not in HCs. The response of LF spectral power during the orthostatic manoeuvre was blunted in patients compared to HCs (p = 0.02). Diabetes duration was negatively associated with TMV and INLV, whereas IPLV was significantly reduced in eyes with moderate NPDR compared to HCs. Conclusion The results indicate a correlation between inner retinal tissue loss and diminished autonomic regulation in type 1 diabetic patients with mild‐to‐moderate NPDR. The observed changes can be interpreted as congruent early signs of retinal and systemic neuropathy in diabetes.
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Affiliation(s)
- Berthold Pemp
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Stefan Palkovits
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Kinga Howorka
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
| | - Jiri Pumprla
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | | | - Leopold Schmetterer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Biomedical Engineering and Physics; Medical University of Vienna; Vienna Austria
- Lee Kong Chian School of Medicine; Nanyang Technological University and Singapore Eye Research Institute; Singapore Singapore
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50
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Prakasam RK, Götze A, von Keyserlingk S, Jünemann A, Röhlig M, Stachs O, Fischer DC. Spectral-Domain Optical Coherence Tomography for Determination of Retinal Thickness in Pediatric Patients with Mild-To-Moderate Chronic Kidney Disease: A Cross-Sectional Study. Curr Eye Res 2018; 44:206-211. [DOI: 10.1080/02713683.2018.1522649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ruby K. Prakasam
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Aline Götze
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | | | - Anselm Jünemann
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Martin Röhlig
- Institute of Computer Science, University of Rostock, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Dagmar-C. Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
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