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Li RR, Yang Y, Zhang MG, Wang J, Chen H, Liu S, Miao H, Wang YC. Abnormalities of retinal function in type 2 diabetes mellitus patients without clinical diabetic retinopathy detected by multifocal electroretinogram. BMC Ophthalmol 2024; 24:71. [PMID: 38360630 PMCID: PMC10870650 DOI: 10.1186/s12886-024-03335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To study the changes of retinal function in type 2 diabetes mellitus(DM) patients without apparently diabetic retinopathy via multifocal electroretinogram. METHODS Thirty-six type 2 DM patients (72 eyes) without visible diabetic retinopathy were selected as the experimental group, and thirty-five healthy subjects (70 eyes) were selected as the control group. All subjects were underwent multifocal electroretinogram (mf- ERG). RESULTS Compared with the control group, the implicit time delay of the P1 wave in the first ring, third ring, fourth ring, and fifth ring of the experimental group was significant (t = -3.154, p = 0.004, t = -8.21, p = 0.000, t = -3.067, p = 0.004, t = -4.443, p = 0.000, respectively). The implicit time of the N1 wave in the fourth- and fifth-ring were also significantly delayed compared with the control group (t = -3.549, p = 0.001, t = 2.961, p = 0.005, respectively). Compared with the control group, the implicit time of the P1 wave and N1 wave in the temporal region of the experimental group were delayed (t = -2.148, p = 0.037, t = -2.834, p = 0.007, respectively). There were no significant difference between the experimental group and the control group of the temporal area in the amplitude density of P1 wave, N1 wave. There was no difference in the implicit time and amplitude density of the N1 and P1 waves in the nasal region between the experimental group and the control group. The multifocal electroretinogram complex parameters showed better specificity and sensitivity in the diagnosis of diabetic retinopathy. CONCLUSION The multifocal electroretinogram can detect abnormal changes in the retina of type 2 DM patients without visible diabetic retinopathy. The multifocal electroretinogram complex parameter is a potential indicator for the early diagnosis of diabetic retinopathy.
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Affiliation(s)
- Rong-Rong Li
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Yang Yang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Meng-Ge Zhang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Jie Wang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Hong Chen
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Shan Liu
- Beijing Yiran Changwu Cultural Creative Co., Ltd, Beijing, China
| | - Hui Miao
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China
| | - Yun-Chang Wang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Hebei Provincial Clinical Research Center for Eye Diseases, NO. 399 quan bei dong da jie, 054001, Xingtai, Hebei Province, China.
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Long CP, Ameri H. Effects of Smoothing and Adaptive Filtering in Multifocal Electroretinography (mfERG). J Clin Med 2023; 12:5286. [PMID: 37629328 PMCID: PMC10455984 DOI: 10.3390/jcm12165286] [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: 07/04/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: mfERG testing is used to study the function of cone photoreceptors in the central retina. Various filters including "smoothing" (Smooth) and "adaptive data filtering" (Adapt) are used to simplify raw data. This study will seek to characterize the effect of data modification on raw patient data. (2) Methods: This was a retrospective study of patients with mfERG results at our institution. For each patient, raw mfERG data without filtering, with smooth level 4 modifier applied, and with adapt level 4 applied were collected and compared. (4) Conclusions: In all patients, smoothing and adaptive filter modifiers create statistically significant differences in both P1 latency and P1 amplitude values when compared to raw data. The impacts of these filters demonstrated in this study should impact physicians' decision making when interpreting mfERG results.
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Affiliation(s)
| | - Hossein Ameri
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo St #4400, Los Angeles, CA 90033, USA;
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Yang Z, Tan TE, Shao Y, Wong TY, Li X. Classification of diabetic retinopathy: Past, present and future. Front Endocrinol (Lausanne) 2022; 13:1079217. [PMID: 36589807 PMCID: PMC9800497 DOI: 10.3389/fendo.2022.1079217] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of visual impairment and blindness worldwide. Since DR was first recognized as an important complication of diabetes, there have been many attempts to accurately classify the severity and stages of disease. These historical classification systems evolved as understanding of disease pathophysiology improved, methods of imaging and assessing DR changed, and effective treatments were developed. Current DR classification systems are effective, and have been the basis of major research trials and clinical management guidelines for decades. However, with further new developments such as recognition of diabetic retinal neurodegeneration, new imaging platforms such as optical coherence tomography and ultra wide-field retinal imaging, artificial intelligence and new treatments, our current classification systems have significant limitations that need to be addressed. In this paper, we provide a historical review of different classification systems for DR, and discuss the limitations of our current classification systems in the context of new developments. We also review the implications of new developments in the field, to see how they might feature in a future, updated classification.
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Affiliation(s)
- Zhengwei Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Ebrahimi M, Sivaprasad S, Thompson P, Perry G. Retinal Neurodegeneration in Euglycemic Hyperinsulinemia, Prediabetes, and Diabetes. Ophthalmic Res 2022; 66:385-397. [PMID: 36463857 DOI: 10.1159/000528503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2023]
Abstract
Diabetic retinopathy (DR) is a challenging public health problem mainly because of its growing prevalence and risk of blindness. In general, our current knowledge and practice have failed to prevent the onset or progression of DR to sight-threatening complications. While there are treatment options for sight-threatening complications of DR, it is crucial to pay more attention to the early stages of DR to decrease its prevalence. Growing evidence suggests many pathologic changes occur before clinical presentations of DR in euglycemic hyperinsulinemia, prediabetes, and diabetes. These pathological changes occur in retinal neurons, glia, and microvasculature. A new focus on these preclinical pathologies - especially on hyperinsulinemia - may provide further insight into disease mechanisms, endpoints for clinical trials, and druggable targets in early disease. Here, we review the current evidence on the pathophysiological changes reported in preclinical DR and appraise preventive and treatment options for DR.
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Affiliation(s)
- Moein Ebrahimi
- Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Paul Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - George Perry
- Department of Biology, University of Texas and San Antonio, San Antonio, Texas, USA
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Differences in Multifocal Electroretinogram Study in Two Populations of Type 1 and Type 2 Diabetes Mellitus Patients without Diabetic Retinopathy. J Clin Med 2022; 11:jcm11195824. [PMID: 36233694 PMCID: PMC9572303 DOI: 10.3390/jcm11195824] [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: 08/30/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Diabetic retinopathy (DR) is a diabetes mellitus (DM) complication where neurodegeneration plays a significant role. The aim of our study was to determine the differences between type 1 DM (T1DM) and 2 DM (T2DM) in the multifocal electroretinogram (mERG).; (2) Methods: A mERG study was performed in two groups, a T1DM group with 72 eyes of 36 patients compared with 72 eyes of 36 patients with T2DM, randomly selected from our DM databases, without DR. We studied how HbA1c and DM duration affects amplitude and implicit time of mERG; (3) Results: the study of DM duration shows patients with T1DM have lower amplitude values compared to T2DM patients, although implicit time increases in patients with T2DM. HbA1c over 7% only affects T1DM patients with an increase of implicit time; (4) Conclusions: the retinas of patients with T1DM seem more sensitive to changes in HbA1c levels than in patients with DMT2, although the duration of diabetes affects both types of DM patients.
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