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Hartnett ME, Fickweiler W, Adamis AP, Brownlee M, Das A, Duh EJ, Feener EP, King G, Kowluru R, Luhmann UF, Storti F, Wykoff CC, Aiello LP. Rationale of Basic and Cellular Mechanisms Considered in Updating the Staging System for Diabetic Retinal Disease. OPHTHALMOLOGY SCIENCE 2024; 4:100521. [PMID: 39006804 PMCID: PMC11245984 DOI: 10.1016/j.xops.2024.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 07/16/2024]
Abstract
Purpose Hyperglycemia is a major risk factor for early lesions of diabetic retinal disease (DRD). Updating the DRD staging system to incorporate relevant basic and cellular mechanisms pertinent to DRD is necessary to better address early disease, disease progression, the use of therapeutic interventions, and treatment effectiveness. Design We sought to review preclinical and clinical evidence on basic and cellular mechanisms potentially pertinent to DRD that might eventually be relevant to update the DRD staging system. Participants Not applicable. Methods The Basic and Cellular Mechanisms Working Group (BCM-WG) of the Mary Tyler Moore Vision Initiative carefully and extensively reviewed available preclinical and clinical evidence through multiple iterations and classified these. Main Outcome Measures Classification was made into evidence grids, level of supporting evidence, and anticipated future relevance to DRD. Results A total of 40 identified targets based on pathophysiology and other parameters for DRD were grouped into concepts or evaluated as specific candidates. VEGFA, peroxisome proliferator-activated receptor-alpha related pathways, plasma kallikrein, and angiopoietin 2 had strong agreement as promising for use as biomarkers in diagnostic, monitoring, predictive, prognostic, and pharmacodynamic responses as well as for susceptibility/risk biomarkers that could underlie new assessments and eventually be considered within an updated DRD staging system or treatment, based on the evidence and need for research that would fit within a 2-year timeline. The BCM-WG found there was strong reason also to pursue the following important concepts regarding scientific research of DRD acknowledging their regulation by hyperglycemia: inflammatory/cytokines, oxidative signaling, vasoprotection, neuroprotection, mitophagy, and nutrients/microbiome. Conclusion Promising targets that might eventually be considered within an updated DRD staging system or treatment were identified. Although the BCM-WG recognizes that at this stage little can be incorporated into a new DRD staging system, numerous potential targets and important concepts deserve continued support and research, as they may eventually serve as biomarkers and/or therapeutic targets with measurable benefits to patients with diabetes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- M. Elizabeth Hartnett
- Department of Ophthalmology, Byers Eye Institute of Stanford University, Palo Alto, California
| | - Ward Fickweiler
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Anthony P. Adamis
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michael Brownlee
- Departments of Medicine and Pathology, Einstein Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York
| | - Arup Das
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Elia J. Duh
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward P. Feener
- Research Division, KalVista Pharmaceuticals, Inc, Cambridge, Massachusetts
| | - George King
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Renu Kowluru
- Department of Ophthalmology, Visual & Anatomical Sciences, Wayne State University, Detroit, Michigan
| | - Ulrich F.O. Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Basel, Switzerland
| | - Federica Storti
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Basel, Switzerland
| | - Charles C. Wykoff
- Ophthalmology, Retina Consultants of Texas, Houston, Texas
- Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Lloyd Paul Aiello
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Zhang Z, Deng C, Paulus YM. Advances in Structural and Functional Retinal Imaging and Biomarkers for Early Detection of Diabetic Retinopathy. Biomedicines 2024; 12:1405. [PMID: 39061979 PMCID: PMC11274328 DOI: 10.3390/biomedicines12071405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetic retinopathy (DR), a vision-threatening microvascular complication of diabetes mellitus (DM), is a leading cause of blindness worldwide that requires early detection and intervention. However, diagnosing DR early remains challenging due to the subtle nature of initial pathological changes. This review explores developments in multimodal imaging and functional tests for early DR detection. Where conventional color fundus photography is limited in the field of view and resolution, advanced quantitative analysis of retinal vessel traits such as retinal microvascular caliber, tortuosity, and fractal dimension (FD) can provide additional prognostic value. Optical coherence tomography (OCT) has also emerged as a reliable structural imaging tool for assessing retinal and choroidal neurodegenerative changes, which show potential as early DR biomarkers. Optical coherence tomography angiography (OCTA) enables the evaluation of vascular perfusion and the contours of the foveal avascular zone (FAZ), providing valuable insights into early retinal and choroidal vascular changes. Functional tests, including multifocal electroretinography (mfERG), visual evoked potential (VEP), multifocal pupillographic objective perimetry (mfPOP), microperimetry, and contrast sensitivity (CS), offer complementary data on early functional deficits in DR. More importantly, combining structural and functional imaging data may facilitate earlier detection of DR and targeted management strategies based on disease progression. Artificial intelligence (AI) techniques show promise for automated lesion detection, risk stratification, and biomarker discovery from various imaging data. Additionally, hematological parameters, such as neutrophil-lymphocyte ratio (NLR) and neutrophil extracellular traps (NETs), may be useful in predicting DR risk and progression. Although current methods can detect early DR, there is still a need for further research and development of reliable, cost-effective methods for large-scale screening and monitoring of individuals with DM.
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Affiliation(s)
- Zhengwei Zhang
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi 214002, China;
- Department of Ophthalmology, Wuxi No.2 People’s Hospital, Wuxi Clinical College, Nantong University, Wuxi 214002, China
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Callie Deng
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
- Department of Biomedical Engineering, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA
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Dong W, Imdad L, Xu S, Wang Y, Liu C, Song S, Li Z, Kong Y, Kong L, Ren X. O-GlcNAc Modification Is a Promising Therapeutic Target for Diabetic Retinopathy. Int J Mol Sci 2024; 25:6286. [PMID: 38892474 PMCID: PMC11173153 DOI: 10.3390/ijms25116286] [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: 03/27/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diabetic retinopathy (DR) is a very serious diabetes complication. Changes in the O-linked N-acetylglucosamine (O-GlcNAc) modification are associated with many diseases. However, its role in DR is not fully understood. In this research, we explored the effect of O-GlcNAc modification regulation by activating AMP-activated protein kinase (AMPK) in DR, providing some evidence for clinical DR treatment in the future. Bioinformatics was used to make predictions from the database, which were validated using the serum samples of diabetic patients. As an in vivo model, diabetic mice were induced using streptozotocin (STZ) injection with/without an AMPK agonist (metformin) or an AMPK inhibitor (compound C) treatment. Electroretinogram (ERG) and H&E staining were used to evaluate the retinal functional and morphological changes. In vitro, 661 w cells were exposed to high-glucose conditions, with or without metformin treatment. Apoptosis was evaluated using TUNEL staining. The protein expression was detected using Western blot and immunofluorescence staining. The angiogenesis ability was detected using a tube formation assay. The levels of O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA) in the serum changed in the DR patients in the clinic. In the diabetic mice, the ERG wave amplitude and retinal thickness decreased. In vitro, the apoptotic cell percentage and Bax expression were increased, and Bcl2 expression was decreased in the 661 w cells under high-glucose conditions. The O-GlcNAc modification was increased in DR. In addition, the expression of GFAT/TXNIP O-GlcNAc was also increased in the 661 w cells after the high-glucose treatment. Additionally, the Co-immunoprecipitation(CO-IP) results show that TXNIP interacted with the O-GlcNAc modification. However, AMPK activation ameliorated this effect. We also found that silencing the AMPKα1 subunit reversed this process. In addition, the conditioned medium of the 661 w cells may have affected the tube formation in vitro. Taken together, O-GlcNAc modification was increased in DR with photoreceptor cell degeneration and neovascularization; however, it was reversed after activating AMPK. The underlying mechanism is linked to the GFAT/TXNIP-O-GlcNAc modification signaling axis. Therefore, the AMPKα1 subunit plays a vital role in the process.
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Affiliation(s)
- Wenkang Dong
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Laraib Imdad
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Shengnan Xu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Yinli Wang
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Chengzhi Liu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Shiyu Song
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Zechuan Li
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Ying Kong
- Key Laboratory of Reproductive and Developmental Biology, Dalian Medical University, Dalian 116044, China
- Core Laboratory of Glycobiology and Glycoengineering, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Li Kong
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
| | - Xiang Ren
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian 116044, China; (W.D.); (L.I.); (S.X.); (Y.W.); (C.L.); (S.S.); (Z.L.); (L.K.)
- Key Laboratory of Reproductive and Developmental Biology, Dalian Medical University, Dalian 116044, China
- Core Laboratory of Glycobiology and Glycoengineering, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
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Chen S, Xu Y, Chen B, Lin S, Lu L, Cheng M, Wang Y, Yang Q, Ling S, Zhou D, Shi Y, Zou H, Ma Y. Remnant cholesterol is correlated with retinal vascular morphology and diabetic retinopathy in type 2 diabetes mellitus: a cross-sectional study. Lipids Health Dis 2024; 23:75. [PMID: 38468242 PMCID: PMC10926603 DOI: 10.1186/s12944-024-02064-6] [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: 01/12/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The association between remnant cholesterol (RC) and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) remains unclear. Morphological changes in retinal vessels have been reported to predict vascular complications of diabetes, including DR. METHODS This cross-sectional study included 6535 individuals with T2DM. The RC value was calculated using the recognized formula. The retinal vascular parameters were measured using fundus photography. The independent relationship between RC and DR was analyzed using binary logistic regression models. Multiple linear regression and subgroup analyses were employed to investigate the link between RC and vascular parameters, including the retinal arteriolar diameter (CRAE), venular diameter (CRVE), and fractal dimension (Df). Mediation analysis was performed to assess whether the vascular morphology could explain the association between RC and DR. RESULTS RC was independently associated with DR in patients with a longer duration of T2DM (> 7 years). Patients with the highest quartile RC levels had larger CRAE (5.559 [4.093, 7.025] μm), CRVE (7.620 [5.298, 9.941] μm) and Df (0.013 [0.009, 0.017]) compared with patients with the lowest quartile RC levels. Results were robust across different subgroups. The association between RC and DR was mediated by CRVE (0.020 ± 0.005; 95% confidence interval: 0.012-0.032). CONCLUSIONS RC may be a risk factor for DR among those who have had T2DM for a longer period of time. Higher RC levels were correlated with wider retinal arterioles and venules as well as higher Df, and it may contribute to DR through the dilation of retinal venules.
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Affiliation(s)
- Shuli Chen
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Yi Xu
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Bo Chen
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai, China
| | - Senlin Lin
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
| | - Lina Lu
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Minna Cheng
- Department of Chronic Non-Communicable Diseases and Injury, Shanghai Municipal Center for Disease Control & Prevention, No. 1380, West Zhongshan Road, Shanghai, China
| | - Yuheng Wang
- Department of Chronic Non-Communicable Diseases and Injury, Shanghai Municipal Center for Disease Control & Prevention, No. 1380, West Zhongshan Road, Shanghai, China
| | - Qinping Yang
- Department of Chronic Non-Communicable Diseases and Injury, Shanghai Municipal Center for Disease Control & Prevention, No. 1380, West Zhongshan Road, Shanghai, China
| | - Saiguang Ling
- EVision technology (Beijing) co. LTD, Beijing, 100085, China
| | - Dengji Zhou
- EVision technology (Beijing) co. LTD, Beijing, 100085, China
| | - Yan Shi
- Department of Chronic Non-Communicable Diseases and Injury, Shanghai Municipal Center for Disease Control & Prevention, No. 1380, West Zhongshan Road, Shanghai, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, No. 12, Middle Wulumuqi Road, Shanghai, China.
| | - Haidong Zou
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
| | - Yingyan Ma
- Department of Eye Disease Control and Prevention, Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, School of Medicine, Tongji University, No. 1440, Hongqiao Road, Shanghai, 200336, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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Pradhana D, Priya NS, Manayath GJ, Kulkarni S, Behera UC, Agarwal T, Agarwal M, Shah S, Giridhar A, Surya J, Ramasamy K, Vignesh TP, Shoba S, Bhende M, Raman R. Natural course of non-center-involving diabetic macular edema progression in patients under initial observation. Indian J Ophthalmol 2024; 72:236-239. [PMID: 38153973 PMCID: PMC10941951 DOI: 10.4103/ijo.ijo_2182_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE We aim to report the natural course of non-center involving diabetic macular edema (NCIDME) progression to center involving diabetic macular edema (CIDME) and associated risk factors. METHODS This is a multicenter retrospective comparative study. Data was collected from electronic medical records from 8 centers in India covering. We included patients with type 2 diabetes above 18 years of age with treatment-naïve NCIDME on OCT and best-corrected visual acuity at baseline of 6/12 or better who were under observation for NCIDME and had 2 years follow-up data. RESULTS Out of 72 patients with NCIDME, 26.38% patients progressed to CI DME by 2 years, and the visit wise proportion was 11.11% at 6 months, 7% at 1st year and 8.3% at 2 years. The change in CST was statistically significant at 2 years in patients who developed CIDME, the mean difference was 137.73 ± 48.56 microns p = 0.045. Duration of diabetes mellitus > 10 years was the only risk factor for conversion to CIDME. CONCLUSION A quarter of eyes with NCIDME developed CIDME and 15% progressed from NPDR to PDR by 2 years, highlighting the disease burden in these patients with NCIDME.
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Affiliation(s)
- Divya Pradhana
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - N Swathi Priya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - George J Manayath
- Department of Vitreo Retina, Aravind Eye Hospital and Post Graduate Institute, Coimbatore, Tamil Nadu, India
| | - Sucheta Kulkarni
- Department of Vitreo Retina, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Umesh C Behera
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Tushar Agarwal
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Manisha Agarwal
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - Shalin Shah
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - A Giridhar
- Department of Vitreo Retina, Giridhar Eye Institute, Kerala, India
| | - Janani Surya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - TP Vignesh
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sivaprasad Shoba
- Department of Vitreo Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Kalaw FGP, Sharma P, Kako RN, Walker E, Borooah S. Peripheral retinal vessel whitening in patients with diabetes mellitus. Sci Rep 2023; 13:7981. [PMID: 37198200 DOI: 10.1038/s41598-023-35124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023] Open
Abstract
This study aimed to identify retinal vessel whitening outside the standard Early Treatment Diabetic Retinopathy Study (ETDRS) fields and to correlate the findings with vision and severity of diabetic retinopathy. Patients with diabetes mellitus who were seen in the retinal clinic to assess diabetic retinopathy status were included. Retinal vessel whitening was identified using ultra-widefield imaging. Four hundred and forty-five eyes of 260 patients were included. Thirty-five eyes in 24 patients (7.9%) were noted to have peripheral retinal vessel whitening. Thirty-one eyes with peripheral retinal vessel whitening did not have vessel whitening within the standard 7 ETDRS fields (p < 0.001). The proportion of whitening increased as DR severity increased, from 4.0% for patients with no DR (OR 0.249) to 33.3% for those with severe NPDR and PDR (OR 6.430 and 7.232, respectively). In addition, patients with peripheral retinal vessel whitening had worse visual acuity (logMAR = 0.34) compared to those without (logMAR = 0.15) (p < 0.001). In conclusion, we found an association between peripheral retinal vessel whitening in diabetic patients which correlated with diabetic retinopathy severity. Additionally, we found an association between vessel whitening and reduced vision, suggesting that vessel whitening identified using ultra-widefield imaging may be a prognostic indicator of vision in diabetic retinopathy.
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Affiliation(s)
- Fritz Gerald P Kalaw
- Jacobs Retina Center, University of California San Diego, San Diego, CA, 92093, USA
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr, La Jolla, San Diego, CA, 92093, USA
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, San Diego, CA, 92093, USA
| | - Paripoorna Sharma
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr, La Jolla, San Diego, CA, 92093, USA
| | - Rasha Nabil Kako
- Jacobs Retina Center, University of California San Diego, San Diego, CA, 92093, USA
| | - Evan Walker
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr, La Jolla, San Diego, CA, 92093, USA
| | - Shyamanga Borooah
- Jacobs Retina Center, University of California San Diego, San Diego, CA, 92093, USA.
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr, La Jolla, San Diego, CA, 92093, USA.
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7
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Srinivasan S, Sobha Sivaprasad, Rajalakshmi R, Anjana RM, Malik RA, Kulothungan V, Raman R, Muna Bhende. Retinal structure-function correlation in type 2 diabetes. Eye (Lond) 2022; 36:1865-1871. [PMID: 34462581 PMCID: PMC9500073 DOI: 10.1038/s41433-021-01761-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/16/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To examine the relationship of visual function as assessed by visual acuity, contrast sensitivity, and multifocal electroretinography (mfERG) to macular structural and microvascular measures on optical coherence tomography (OCT) and angiography (OCTA) in individuals with diabetes. METHODS This is a prospective observational study conducted at a tertiary eye care centre in India. Right eyes of 121 adults with type 2 diabetes with no diabetic retinopathy (DR), mild or moderate nonproliferative DR (NPDR) were examined. Severe NPDR, proliferative DR and diabetic macular oedema were excluded. Participants underwent assessment of glycated haemoglobin (HbA1C), blood pressure, best corrected visual acuity (LogMAR), contrast sensitivity (CS), mfERG, ultrawide field fundus photography, OCT and OCTA. Correlations were assessed by Spearman's rank correlation (rho). RESULTS Of the total of 121 eyes, 89 had No DR, 32 had mild to moderate NPDR. In the No DR group, the LogMAR acuity was significantly and negatively correlated to central subfoveal thickness (CST) (rho = -0.420), macular vessel density (rho = -0.270) and perfusion (rho = -0.270). (ii) Contrast sensitivity correlated to foveal avascular zone circularity (rho = 0.297); (iii) mfERG P1 response densities were better with higher macular perfusion index (rho = 0.240). In the NPDR group, the LogMAR acuity also showed a significant negative correlation to CST (rho = -0.379). Other correlations were not significant. CONCLUSION Retinal and visual functional changes are evident in diabetic patients with No DR and are correlated to subclinical retinal structural changes detectable using multimodal imaging.
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Affiliation(s)
| | | | | | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
| | - Vaitheeswaran Kulothungan
- National Centre for Disease Informatics and Research (NCDIR) & Indian Council of Medical Research (ICMR), Bangalore, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, SankaraNethralaya, Chennai, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, SankaraNethralaya, Chennai, India.
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8
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Yu Q, Xiao Y, Lin Q, Xiang Z, Cui L, Chen Z, Sun J, Li S, Qin X, Yang C, Zou H. Two-year longitudinal study on changes in thickness of the retinal nerve fiber layer and ganglion cell layer in children with type 1 diabetes mellitus without visual impairment or diabetic retinopathy. Curr Eye Res 2022; 47:1218-1225. [PMID: 35642554 DOI: 10.1080/02713683.2022.2079142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To study changes in the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) in children with type 1 diabetes mellitus (T1DM) without visual impairment or diabetic retinopathy (DR) after 2 years of follow-up and analyze the associated factors. METHODS Thirty-seven children with T1DM were enrolled in this study. All children underwent a complete ophthalmologic evaluation that included swept-source optical coherence tomography at baseline and follow-up. Changes in RNFL and GCL thickness were compared among the children at baseline and follow-up. RESULTS The peripapillary RNFL thickness was greater in the temporal (inner, p = 0.015; outer, p = 0.004) and inner superior (p = 0.043) sectors in the follow-up group than in the baseline group. The macular RNFL thickness in the fovea, inner nasal sector, inner inferior sector, and outer ring and the average thickness (all p < 0.05) were greater in the follow-up group than in the baseline group. The peripapillary GCL thickness decreased in the temporal sector (inner, p = 0.049; outer, p = 0.041) and increased in the inner nasal sector (p = 0.006) in the follow-up group compared with the baseline group, and the thickness of the inner temporal, inner superior, inner inferior, outer nasal, and outer inferior sectors and average thickness in the macula were lower in the follow-up group than in the baseline group (all p < 0.05). The total retinal thickness around optic disc in the follow-up group increased in the inner superior sectors (p = 0.006). The total retinal thickness of the macula decreased in inner temporal sector, inner superior sector and outer nasal sector, and increased in outer superior sector (all p < 0.05). CONCLUSIONS Retinal neurodegenerative changes preceded microvascular changes in children with T1DM in the early stage. Peripapillary RNFL thickness in the nasal sector may be lower in children with T1DM without visual impairment or other ocular pathologies.
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Affiliation(s)
- Qian Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Xiao
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Qiurong Lin
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyu Xiang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lipu Cui
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhangling Chen
- Department of Ophthalmology, Shanghai General Hospital Affiliated Nanjing Medical University, Shanghai, China.,Department of Ophthalmology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Jiaqi Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sicong Li
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinran Qin
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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9
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Yang N, Li MX, Peng XY. Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study. BMC Ophthalmol 2022; 22:187. [PMID: 35459162 PMCID: PMC9034536 DOI: 10.1186/s12886-022-02397-9] [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: 01/21/2022] [Accepted: 04/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background We examined the retinal microvascular changes and associated factors in type 2 diabetes mellitus (T2DM) before and after intensive insulin therapy. Methods This prospective observational study recruited patients with T2DM and divided them into intensive insulin therapy and oral hypoglycemic agent groups. All patients enrolled in this study had diabetes without retinopathy or non-proliferative diabetic retinopathy. Optical coherence tomography angiography (OCTA) was used in all patients before treatment and at 1, 3, and 6 months after treatment. Vessel density (VD) and thickness changes in the macular and optic disc areas were assessed. Results The study included 36 eyes in the intensive insulin therapy group and 36 in the oral hypoglycemic agent group. One month after treatment, VD in the deep capillary plexus (DCP) and peripapillary capillary VD (ppVD) were significantly decreased by intensification (P = 0.009, 0.000). At three months after treatment, decreases in VD induced by intensification were found in the superficial capillary plexus (SCP), DCP, foveal density in a 300-μm-wide region around the foveal avascular area (FD-300), and ppVD (P = 0.032, 0.000, 0.039, 0.000). Six months after treatment, decreases in VD by intensification were observed in the DCP and ppVD groups (P = 0.000, 0.000). Vessel density showed no significant change in the oral hypoglycemic agent group after treatment. The amount of DCP-VD reduction was correlated with macular thickening (r = 0.348, P = 0.038; r = 0.693, P = 0.000 and r = 0.417, P = 0.011, respectively) after intensive insulin therapy. Conclusions Insulin-intensive treatment caused a transient reduction in vessel density in the macular and optic disc areas. DCP-VD and ppVD were more susceptible at an earlier stage. Retinal microvasculature monitoring using OCTA is vital for patients with type 2 diabetes receiving intensive insulin therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02397-9.
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Affiliation(s)
- Ning Yang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, No.17 Hougou Lane, Chongnei Street, Beijing, 100005, China.,Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, 99 West Huaihai RdJiangsu, Xuzhou, 221002, China
| | - Ming-Xin Li
- Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, 99 West Huaihai RdJiangsu, Xuzhou, 221002, China
| | - Xiao-Yan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, No.17 Hougou Lane, Chongnei Street, Beijing, 100005, China.
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10
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Quinn N, Januszewski AS, Brazionis L, O'Connell R, Aryal N, O'Day J, Scott R, Mitchell P, Jenkins AJ, Keech AC. Fenofibrate, which reduces risk of sight-threatening diabetic retinopathy in type 2 diabetes, is associated with early narrowing of retinal venules: a FIELD trial substudy. Intern Med J 2022; 52:676-679. [PMID: 35419960 DOI: 10.1111/imj.15733] [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: 09/15/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Retinal vessel calibre metrics were evaluated at baseline and 2 years in a FIELD substudy (n = 208). Central retinal venule calibre was significantly reduced by fenofibrate and unchanged by placebo. Arteriole metrics did not change. Larger studies relating retinal vessel calibre to future diabetes complications and response to therapy are merited.
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Affiliation(s)
- Nicola Quinn
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrzej S Januszewski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine (St. Vincent's Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Laima Brazionis
- Department of Medicine (St. Vincent's Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nanda Aryal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin O'Day
- Department of Ophthalmology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Russell Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Mitchell
- Clinical Ophthalmology and Eye Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine (St. Vincent's Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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11
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Understanding Neurodegeneration from a Clinical and Therapeutic Perspective in Early Diabetic Retinopathy. Nutrients 2022; 14:nu14040792. [PMID: 35215442 PMCID: PMC8877033 DOI: 10.3390/nu14040792] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Recent evidence indicates that neurodegeneration is a critical element of diabetic retinopathy (DR) pathogenesis. The neuronal cells’ apoptosis contributes to microvascular impairment and blood–retinal barrier breakdown. Therefore, neurodegeneration represents an early intervention target to slow and prevent the development of microvascular alterations visible on clinical examination. Multimodal imaging features and functional assessment can permit the identification of neuronal damage in a subclinical stage before the recognition of DR signs. Clinical features of neurodegeneration are crucial in identifying patients at high risk of developing a vascular impairment and, thus, serve as outcome measures to understand the efficacy of supplementation. The optimal approach for targeting neurodegeneration contemplates the use of topical compounds that possibly act on different elements of the pathogenic cascade. To date, clinical trials available on humans tested three different topical agents, including brimonidine, somatostatin, and citicoline, with promising results.
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12
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Wang M, Zhou X, Liu DN, Chen J, Zheng Z, Ling S. Development and validation of a predictive risk model based on retinal geometry for an early assessment of diabetic retinopathy. Front Endocrinol (Lausanne) 2022; 13:1033611. [PMID: 36479215 PMCID: PMC9719996 DOI: 10.3389/fendo.2022.1033611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS This study aimed to develop and validate a risk nomogram prediction model based on the retinal geometry of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) and to investigate its clinical application value. METHODS In this study, we collected the clinical data of 410 patients with T2DM in the Second Affiliated Hospital of Chongqing Medical University between October 2020 and March 2022. Firstly, the patients were randomly divided into a development cohort and a validation cohort in a ratio of 7:3. Then, the modeling factors were selected using the least absolute shrinkage and selection operator (LASSO). Subsequently, a nomogram prediction model was built with these identified risk factors. Two other models were constructed with only retinal vascular traits or only clinical traits to confirm the performance advantage of this nomogram model. Finally, the model performances were assessed using the area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). RESULTS Five predictive variables for DR among patients with T2DM were selected by LASSO regression from 33 variables, including fractal dimension, arterial tortuosity, venular caliber, duration of diabetes mellitus (DM), and insulin dosage (P< 0.05). A predictive nomogram model based on these selected clinical and retinal vascular factors presented good discrimination with an AUC of 0.909 in the training cohort and 0.876 in the validation cohort. By comparing the models, the retinal vascular parameters were proven to have a predictive value and could improve diagnostic sensitivity and specificity when combined with clinical characteristics. The calibration curve displayed high consistency between predicted and actual probability in both training and validation cohorts. The DCA demonstrated that this nomogram model led to net benefits in a wide range of threshold probability and could be adapted for clinical decision-making. CONCLUSION This study presented a predictive nomogram that might facilitate the risk stratification and early detection of DR among patients with T2DM.
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Affiliation(s)
- Minglan Wang
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiyuan Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xiyuan Zhou, ;;
| | - Dan Ning Liu
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jieru Chen
- School of Computer Science and Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Zheng Zheng
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Saiguang Ling
- Institute of EVision Computing, EVision technology (Beijing) co. LTD, Beijing, China
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13
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Malyutina SK, Direev AO, Munz IV, Palekhina YY, Ryabikov AN. [Relationship of retinal vascular caliber with age and cardiometabolic diseases in the population over 50 years of age]. Vestn Oftalmol 2022; 138:14-21. [PMID: 36288413 DOI: 10.17116/oftalma202213805114] [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] [Indexed: 06/16/2023]
Abstract
UNLABELLED In an aging society, age-dependent diseases with high mortality, including cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM2), occupy a special place. There is only limited population-based data on the relationship between cardiometabolic diseases and target-organ damage, including ocular microvasculature. PURPOSE To explore the associations between the caliber of retinal vessels and cardiometabolic diseases in a population sample of men and women from middle-aged to elderly (Novosibirsk). MATERIAL AND METHODS The subjects were participants of the Russian cohort - part of the international project HAPIEE, and were initially examined in 2003-2005 (n=9360, aged 45-69 years, Novosibirsk). At the third survey in 2015-2017, a random sub-sample of men and women (n=1011) was formed for an in-depth evaluation. We performed a calibrometric analysis involving measurement of central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and CRAE-to-CRVE ratio (AVR). RESULTS In a population sample of men and women aged 55-84 years, age increment is accompanied by a decrease in the calibers of retinal arterioles and venules (p<0.001). Arterial hypertension (AH) was accompanied by a decrease in CRAE, CRVE (p=0.001) and AVR (p<0.001); the associations between AH, CRAE and AVR were independent from other factors. Multivariate analysis showed that CRAE and CRVE were inversely associated with the presence of DM2 (p=0.026). Carotid atherosclerosis was accompanied by an increase in CRVE (p<0.002); this relationship was mainly attributed to age and metabolic factors. There were no associations between carotid atherosclerosis and either CRAE or AVR. The multivariate analysis identified the weak positive associations of CRAE and AVR with the presence of ischemic heart disease and CVD. CONCLUSION In the examined population sample aged 55-84 years, a number of associations were detected between retinal vascular caliber and cardiometabolic diseases. The observed changes in the microvascular bed of the retina may be important for prognosis of the course of common cardiometabolic diseases.
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Affiliation(s)
- S K Malyutina
- Novosibirsk State Medical University, Novosibirsk, Russia
- Federal Research Center Institute of Cytology and Genetics - Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - A O Direev
- Novosibirsk State Medical University, Novosibirsk, Russia
- Federal Research Center Institute of Cytology and Genetics - Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - I V Munz
- Novosibirsk State Medical University, Novosibirsk, Russia
- Federal Research Center Institute of Cytology and Genetics - Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Yu Yu Palekhina
- Federal Research Center Institute of Cytology and Genetics - Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - A N Ryabikov
- Novosibirsk State Medical University, Novosibirsk, Russia
- Federal Research Center Institute of Cytology and Genetics - Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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14
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Damian I, Nicoară SD. Correlations between Retinal Arterial Morphometric Parameters and Neurodegeneration in Patients with Type 2 Diabetes Mellitus with No or Mild Diabetic Retinopathy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:244. [PMID: 33807881 PMCID: PMC8002138 DOI: 10.3390/medicina57030244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022]
Abstract
Background and Objectives: In patients with diabetes mellitus (DM), the neural retina is starting to degenerate before the development of vascular lesions. Our purpose was to investigate the correlation between the retinal arterial morphometric parameters and structural neurodegeneration in patients with type 2 DM with no or mild diabetic retinopathy (DR). Materials and Methods: This is a prospective study including 53 eyes of patients with type 2 DM and 32 eyes of healthy controls. Based on SD-OCT (spectral domain-optical coherence tomography) images, using a micro-densitometry method, we measured the outer and luminal diameter of retinal arteries and calculated the AWT (arterial wall thickness), WLR (wall-to-lumen ratio), and WCSA (wall cross-sectional area). GCL (ganglion cell layer) and RNFL (retinal nerve fiber layer) thickness were analyzed in correlation with the retinal arterial morphometric parameters mentioned above. Results: GCL was thinner in the inner quadrants in the NDR (no DR) group compared to controls (p < 0.05). RAOD (retinal artery outer diameter), RALD (retinal artery lumen diameter), AWT, WLR, and WCSA were similar between groups. A regression model considering age, gender, duration of DM, and HbA1C was carried out. Central GCL thickness was correlated positively with RAOD (coefficient 0.360 per µm, p = 0.011), RALD (coefficient 0.283 per µm, p = 0.050), AWT (coefficient 0.304 per µm, p = 0.029), and WCSA (coefficient 3.90 per µm, p = 0.005). Duration of DM was positively correlated with WCSA (coefficient 0.311 per one year duration of diabetes, p = 0.043). Conclusions: Significant GCL thinning in the inner quadrants preceded the morphological retinal arterial morphometric changes, supporting the neurodegeneration as primary pathogenic mechanism in DR.
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Affiliation(s)
- Ioana Damian
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania;
- Medical Doctoral School, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
| | - Simona Delia Nicoară
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania;
- Department of Ophthalmology, Emergency County Hospital Cluj, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania
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15
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Frizziero L, Midena G, Longhin E, Berton M, Torresin T, Parrozzani R, Pilotto E. Early Retinal Changes by OCT Angiography and Multifocal Electroretinography in Diabetes. J Clin Med 2020; 9:jcm9113514. [PMID: 33143008 PMCID: PMC7692230 DOI: 10.3390/jcm9113514] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background: To evaluate the earliest retinal morphological and functional changes in diabetic eyes without or with early signs of diabetic retinopathy (DR). Methods: Twenty-two eyes with no DR (noDR group), 22 eyes with mild DR (DR group), and 18 healthy nondiabetic eyes (controls) were enrolled. All eyes were studied by means of spectral domain optical coherence tomography (OCT), OCT angiography (OCTA), and multifocal electroretinogram (mfERG). Results: A significantly higher number of OCT hyperreflective intraretinal foci (HRF) was found in both noDR and DR groups versus controls, but not between DR groups. The OCTA parameters of the superficial vascular plexus (SVP) were significantly reduced in the noDR group both versus controls and DR group (p < 0.05). The OCTA parameters of the intermediate capillary plexus (ICP) were significantly reduced in the DR group versus controls. An increased number of altered hexagons on mfERG was found in the noDR versus the DR group (p = 0.0192). Conclusions: Retinal vascular and functional parameters are differently involved in diabetic eyes; major vascular changes in the SVP and functional alterations of the mfERG are present in diabetic eyes with no clinical microvascular signs of DR, while ICP is mainly involved when early ophthalmoscopic signs of DR are present. The integrated use of mfERG and OCTA provides new significant insights into the pathogenesis of diabetic related retinal disease.
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Affiliation(s)
- Luisa Frizziero
- IRCCS—Fondazione Bietti, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-049-821-2110
| | - Giulia Midena
- Institute of Ophthalmology, Policlinico Gemelli, IRCCS, 00168 Rome, Italy;
| | - Evelyn Longhin
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | | | - Tommaso Torresin
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | - Raffaele Parrozzani
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
| | - Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (E.L.); (T.T.); (R.P.); (E.P.)
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16
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Hernández C, Porta M, Bandello F, Grauslund J, Harding SP, Aldington SJ, Egan C, Frydkjaer-Olsen U, García-Arumí J, Gibson J, Lang GE, Lattanzio R, Massin P, Midena E, Ponsati B, Ribeiro L, Scanlon P, Cunha-Vaz J, Simó R. The Usefulness of Serum Biomarkers in the Early Stages of Diabetic Retinopathy: Results of the EUROCONDOR Clinical Trial. J Clin Med 2020; 9:jcm9041233. [PMID: 32344735 PMCID: PMC7231127 DOI: 10.3390/jcm9041233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/22/2022] Open
Abstract
The main aim of this study was to evaluate the ability of serum biomarkers to predict the worsening of retinal neurodysfunction in subjects with type 2 diabetes. For this purpose, we measured selected molecules (N-epsilon-carboxy methyl lysine (CML), laminin P1 (Lam-P1), and asymmetric dimethylarginine (ADMA)) in the serum of 341 participants of the EUROCONDOR study at baseline, 24, and 48 weeks. Retinal neurodysfunction was assessed by measuring implicit time (IT) using multifocal electroretinography, and structural changes were examined by spectral domain–optical coherence tomography. The values of IT at baseline were directly correlated with baseline serum concentrations of CML (r = 0.135, p = 0.013). Furthermore, in the placebo group, increase in CML concentration throughout follow-up correlated with the IT (r = 0.20; p = 0.03). Baseline serum levels of CML also correlated with macular retinal thickness (RT) (r = 0.231; p < 0.001). Baseline Lam-P1 levels correlated with the increase of the RT at the end of follow-up in the placebo group (r = 0.22; p = 0.016). We provide evidence that CML may be a biomarker of both retinal neurodysfunction and RT, whereas Lam-P1 was associated with RT only. Therefore, circulating levels of these molecules could provide a complementary tool for monitoring the early changes of diabetic retinopathy (DR).
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Affiliation(s)
- Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d’Hebron Research Institute, 08035 Barcelona, Spain;
- Correspondence:
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, 20132 Milano, Italy; (F.B.); (R.L.)
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (J.G.); (U.F.-O.)
| | - Simon P. Harding
- Department of Eye & Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, and St. Pauls’ Eye Unit. Liverpool University Hospitals, members of Liverpool Health Partners, Liverpool L69 7ZX, UK;
| | - Stephen J. Aldington
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham GL53 7AG, UK; (S.J.A.); (P.S.)
| | - Catherine Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, Institute of Ophthalmology/University College London, London EC1V 2PD, UK;
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (J.G.); (U.F.-O.)
| | - José García-Arumí
- Department of Ophthalmology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Jonathan Gibson
- Department of Vision Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Gabriele E. Lang
- Department of Ophthalmology, University of Ulm, 89081 Ulm, Germany;
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, 20132 Milano, Italy; (F.B.); (R.L.)
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, 75004 Paris, France;
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, 35122 Padova, Italy;
| | | | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal; (L.R.); (J.C.-V.)
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham GL53 7AG, UK; (S.J.A.); (P.S.)
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal; (L.R.); (J.C.-V.)
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d’Hebron Research Institute, 08035 Barcelona, Spain;
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17
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Grauslund J, Frydkjaer-Olsen U, Peto T, Fernández-Carneado J, Ponsati B, Hernández C, Cunha-Vaz J, Simó R. Topical Treatment With Brimonidine and Somatostatin Causes Retinal Vascular Dilation in Patients With Early Diabetic Retinopathy From the EUROCONDOR. Invest Ophthalmol Vis Sci 2019; 60:2257-2262. [PMID: 31112610 DOI: 10.1167/iovs.18-26487] [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
Purpose Structural retinal microvascular changes have been identified as risk markers of diabetic retinopathy (DR). In order to estimate the retinal response of neuroprotective eye drops, we aimed to evaluate the effect of topical retinal neuroprotection on retinal microvascular changes in early DR. Methods Patients with type 2 diabetes with no or early DR were randomized 1:1:1 to topical treatment with placebo, brimonidine, or somatostatin in a 96-week prospective, phase II to III, European multicenter trial. Retinal vascular calibers were measured semiautomatically in digital fundus images by certified graders at baseline and follow-up and summarized as central retinal arteriolar and venular equivalent (CRAE and CRVE). Results Of 449 patients originally included, 297 completed the study with gradable retinal images. Median age and duration of diabetes was 64.5 and 9.9 years, and 65.7% were male. At baseline, Early Treatment Diabetic Retinopathy Study levels were 10 (no DR, 42.8%), 20 (minimal DR, 28.3%), and 35 (mild DR, 29.0%), and CRAE and CRVE did not differ between groups. As opposed to patients with no or minimal DR at baseline, patients with mild DR in the active groups developed a larger retinal arteriolar (brimonidine: +6.2 μm, P = 0.006; somatostatin: +7.2 μm, P = 0.006) and venular (brimonidine: +13.9 μm, P = 0.01; somatostatin: +14.3 μm, P = 0.0001) caliber in contrast to those in the placebo group. Conclusions Topical treatment with brimonidine and somatostatin causes retinal arteriolar and venular dilation in patients with type 2 diabetes and preexisting early DR. Upcoming studies should elaborate on the potential of these findings in arresting early DR.
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Affiliation(s)
- Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ulrik Frydkjaer-Olsen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), and University of Coimbra, Coimbra, Portugal
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain
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18
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Zhou L, Yang Y, Yang L, Cao W, Jing H, Xu Y, Jiang X, Xu D, Xiao Q, Jiang C, Bo L. Point-of-care ultrasound defines gastric content in elective surgical patients with type 2 diabetes mellitus: a prospective cohort study. BMC Anesthesiol 2019; 19:179. [PMID: 31601180 PMCID: PMC6785890 DOI: 10.1186/s12871-019-0848-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Delayed gastric emptying and the resultant "full stomach" is the most important risk factor for perioperative pulmonary aspiration. Using point-of-care gastric sonography, we aimed to investigate the prevalence of full stomach and its risk factors in elective surgical patients with type 2 diabetes. METHODS Type 2 diabetic and non-diabetic elective surgical patients were included from July 2017 to April 2018 in a 1:1 ratio. The study was retrospectively registered at July 2017, after enrollment of the first participant. Gastric ultrasound was performed 2 h after ingesting clear fluid or 6 h after a light meal. Full stomach was defined by the presence of gastric content in both semi-recumbent and right lateral decubitus positions. For patients with full or intermediate stomach, consecutive ultrasound scan was performed until empty stomach was detected. Logistic regression analyses were used to identify risk factors associated with full stomach. RESULTS Fifty-two type 2 diabetic and fifty non-diabetic patients were analyzed. The prevalence of full stomach was 48.1% (25/52) in diabetic patients, with 44.0% for 2-h fast after clear fluid and 51.9% for 6-h fast after a light meal, significantly higher than 8% (4/50) in non-diabetic patients (P = 0.000). The average time to empty stomach in diabetic patients was 146.50 ± 40.91 mins for clear liquid and 426.50 ± 45.25 mins for light meal, respectively. Further analysis indicated that presence of diabetes-related eye disease was an independent risk factor of full stomach in diabetic patients (OR = 4.83, P = 0.010). CONCLUSIONS Almost half of type 2 diabetic patients have a full stomach following the current preoperative fasting guideline. Preoperative ultrasound assessment of gastric content in type 2 diabetic patients is suggested, especially for those with diabetes -related eye disease. TRIAL REGISTRATION The trial was registered at www.clinicaltrials.gov with registration number NCT03217630 . Retrospectively registered on 14th July 2017.
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Affiliation(s)
- Li Zhou
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yi Yang
- Department of Anesthesiology, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, 610000, Sichuan, China
| | - Lei Yang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Cao
- Department of Anesthesiology, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, 610000, Sichuan, China
| | - Heng Jing
- Department of Anesthesiology, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, 610000, Sichuan, China
| | - Yan Xu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaojuan Jiang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Danfeng Xu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qianhui Xiao
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chunling Jiang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Lulong Bo
- Faculty of Anaesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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19
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Hafner J, Karst S, Sacu S, Scholda C, Pablik E, Schmidt‐Erfurth U. Correlation between corneal and retinal neurodegenerative changes and their association with microvascular perfusion in type II diabetes. Acta Ophthalmol 2019; 97:e545-e550. [PMID: 30311432 DOI: 10.1111/aos.13938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/14/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The pathophysiology of diabetic neurodegeneration and microvasculopathy remains controversial. Neurosensory layer thickness and corneal nerve fibre loss represent potential biomarkers of neuropathy. The purpose of this cross-sectional study was to determine the correlation between these neurodegenerative features and their association with retinal microvascular integrity in patients with type II diabetes without retinopathy. METHODS Nerve fibre length (NFL), density (NFD) and branch density (NBD) were assessed using corneal confocal microscopy. Spectralis optical coherence tomography (OCT) was used for peripapillary retinal nerve fibre layer (RNFL), and macular RNFL, ganglion cell (GCL), inner plexiform (IPL) and inner nuclear layer (INL) thicknesses. Parafoveal vessel density (PVD) was determined using OCT angiography. RESULTS We analysed 118 eyes of 61 patients. Peripapillary RNFL, macular RNFL, GCL, IPL and INL were 101 ± 8, 29 ± 3, 43 ± 4, 36 ± 3 and 36 ± 3 μm. NFL, NFD and NBD were 12.3 ± 4.4 mm/mm2 , 17.8 ± 7.4/mm2 and 26.7 ± 15.2/mm2 . Corneal nerve fibre variables were neither associated with inner retinal thicknesses nor PVD. A significant positive correlation was found between macular GCL, IPL and peripapillary RNFL with deep capillary plexus PVD (p ≤ 0.05). CONCLUSION Our results indicate that corneal and retinal neurodegeneration are independent changes early in type II diabetes and that distinct retinal, but not corneal neurodegenerative features, are associated with retinal microvascular perfusion.
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Affiliation(s)
- Julia Hafner
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Sonja Karst
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
- Vienna Clinical Trial Center Medical University of Vienna Vienna Austria
| | - Christoph Scholda
- Department of Ophthalmology and Optometry Medical University of Vienna Vienna Austria
| | - Eleonore Pablik
- CeMSIIS Institute for Medical Statistics Medical University of Vienna Vienna Austria
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20
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McKay GJ, Paterson EN, Maxwell AP, Cardwell CC, Wang R, Hogg S, MacGillivray TJ, Trucco E, Doney AS. Retinal microvascular parameters are not associated with reduced renal function in a study of individuals with type 2 diabetes. Sci Rep 2018; 8:3931. [PMID: 29500396 PMCID: PMC5834527 DOI: 10.1038/s41598-018-22360-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/22/2018] [Indexed: 01/22/2023] Open
Abstract
The eye provides an opportunistic "window" to view the microcirculation. There is published evidence of an association between retinal microvascular calibre and renal function measured by estimated glomerular filtration rate (eGFR) in individuals with diabetes mellitus. Beyond vascular calibre, few studies have considered other microvascular geometrical features. Here we report novel null findings for measures of vascular spread (vessel fractal dimension), tortuosity, and branching patterns and their relationship with renal function in type 2 diabetes over a mean of 3 years. We performed a nested case-control comparison of multiple retinal vascular parameters between individuals with type 2 diabetes and stable (non-progressors) versus declining (progressors) eGFR across two time points within a subset of 1072 participants from the GoDARTS study cohort. Retinal microvascular were measured using VAMPIRE 3.1 software. In unadjusted analyses and following adjustment for age, gender, systolic blood pressure, HbA1C, and diabetic retinopathy, no associations between baseline retinal vascular parameters and risk of eGFR progression were observed. Cross-sectional analysis of follow-up data showed a significant association between retinal arteriolar diameter and eGFR, but this was not maintained following adjustment. These findings are consistent with a lack of predictive capacity for progressive loss of renal function in type 2 diabetes.
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Affiliation(s)
- Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Euan N Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Ruixuan Wang
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Stephen Hogg
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Thomas J MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Emanuele Trucco
- VAMPIRE project, Computer Vision and Image Processing Group, School of Science and Engineering (Computing), University of Dundee, Dundee, United Kingdom
| | - Alexander S Doney
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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21
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A Comparative Study Towards the Establishment of an Automatic Retinal Vessel Width Measurement Technique. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-67561-9_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Santos AR, Ribeiro L, Bandello F, Lattanzio R, Egan C, Frydkjaer-Olsen U, García-Arumí J, Gibson J, Grauslund J, Harding SP, Lang GE, Massin P, Midena E, Scanlon P, Aldington SJ, Simão S, Schwartz C, Ponsati B, Porta M, Costa MÂ, Hernández C, Cunha-Vaz J, Simó R. Functional and Structural Findings of Neurodegeneration in Early Stages of Diabetic Retinopathy: Cross-sectional Analyses of Baseline Data of the EUROCONDOR Project. Diabetes 2017; 66:2503-2510. [PMID: 28663190 DOI: 10.2337/db16-1453] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/19/2017] [Indexed: 11/13/2022]
Abstract
This cross-sectional study evaluated the relationship between 1) functional and structural measurements of neurodegeneration in the initial stages of diabetic retinopathy (DR) and 2) the presence of neurodegeneration and early microvascular impairment. We analyzed baseline data of 449 patients with type 2 diabetes enrolled in the European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR) study (NCT01726075). Functional studies by multifocal electroretinography (mfERG) evaluated neurodysfunction, and structural measurements using spectral domain optical coherence tomography (SD-OCT) evaluated neurodegeneration. The mfERG P1 amplitude was more sensitive than the P1 implicit time and was lower in patients with Early Treatment of Diabetic Retinopathy Study (ETDRS) level 20-35 than in patients with ETDRS level <20 (P = 0.005). In 58% of patients, mfERG abnormalities were present in the absence of visible retinopathy. Correspondence between SD-OCT thinning and mfERG abnormalities was shown in 67% of the eyes with ETDRS <20 and in 83% of the eyes with ETDRS level 20-35. Notably, 32% of patients with ETDRS 20-35 presented no abnormalities in mfERG or SD-OCT. We conclude that there is a link between mfERG and SD-OCT measurements that increases with the presence of microvascular impairment. However, a significant proportion of patients in our particular study population (ETDRS ≤35) had normal ganglion cell-inner plexiform layer thickness and normal mfERG findings. We raise the hypothesis that neurodegeneration may play a role in the pathogenesis of DR in many but not in all patients with type 2 diabetes.
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Affiliation(s)
- Ana Rita Santos
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Superior School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Catherine Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, Institute of Ophthalmology/University College London, London, U.K
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - José García-Arumí
- Department of Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jonathan Gibson
- Department of Vision Sciences, Aston University, Birmingham, U.K
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon P Harding
- Department of Eye & Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, U.K
| | - Gabriele E Lang
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Paris, France
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Stephen J Aldington
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Sílvia Simão
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Christian Schwartz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | | | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Miguel Ângelo Costa
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
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23
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Abstract
PURPOSE OF REVIEW The diameter of retinal vessels is an important source of information about retinal blood flow and metabolism. The purpose of the present study is to review how diameter changes of retinal vessels contribute to the development of diabetic retinopathy and may be a marker of the prognosis of the disease. RECENT FINDINGS The early stages of diabetic retinopathy are accompanied with dilatation of the diameter of retinal vessels and reduced autoregulation. Diabetic retinopathy also shows regional differences in the macular area and the retinal periphery and accompanying differences in vascular reactivity in these areas. These differences may potentially become an important source of insight into the pathophysiology of the disease in the future. Diabetic retinopathy is accompanied with changes in the diameter regulation of retinal vessels. The potential of newly developed techniques for assessing retinal blood flow and metabolism, such as Doppler techniques, adaptive optics, and retinal oximetry, is promising and may potentially contribute to significant advances in our understanding of diabetic retinopathy which remains a major cause of visual impairment.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, 8000, Aarhus C, Denmark.
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24
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Trento M, Durando O, Lavecchia S, Charrier L, Cavallo F, Costa MA, Hernández C, Simó R, Porta M. Vision related quality of life in patients with type 2 diabetes in the EUROCONDOR trial. Endocrine 2017; 57:83-88. [PMID: 27628581 DOI: 10.1007/s12020-016-1097-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022]
Abstract
To evaluate vision related quality of life in the patients enrolled in The European Consortium for the Early Treatment of Diabetic Retinopathy, a clinical trial on prevention of diabetic retinopathy. Four-hundred-forty-nine patients, 153 women, with type 2 Diabetes and no or mild diabetic retinopathy were enrolled in a 2-year multicenter randomized controlled trial. The 25-item National Eye Institute Visual Functioning Questionnaire was used to explore 12 subscales of vision related quality of life. The patients were 62.8 ± 6.7 years old and had 11.1 ± 5.6 years known disease duration. Diabetic retinopathy was absent in 193 (43.0 %) and mild in 256 (57.0 %). Patients without diabetic retinopathy were older, had shorter diabetes duration and used less insulin and glucose-lowering agents but did not differ by gender, best corrected visual acuity or any subscale, except vision specific mental health and vision specific role difficulties. Patients with reduced retinal thickness at the ganglion cell layer (n = 36) did not differ for diabetic retinopathy but were older, had lower best corrected visual acuity and worse scores for ocular pain, color vision and peripheral vision. On multivariable analysis, worse scores for general vision remained associated with reduced retinal thickness, diabetes duration and best corrected visual acuity, and scores for visual specific mental health with diabetic retinopathy and lower best corrected visual acuity. Visual specific role difficulties were only associated with reduced best corrected visual acuity. Scores for driving decreased among females, with worsening of Hemoglobin A1c and best corrected visual acuity. Color vision depended only on reduced retinal thickness, and peripheral vision on both reduced thickness and best corrected visual acuity. The National Eye Institute Visual Functioning Questionnaire could detect subtle changes in patients' perception of visual function, despite absent/minimal diabetic retinopathy.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sonia Lavecchia
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Miguel Angelo Costa
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Hernández
- Vall d' Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Rafael Simó
- Vall d' Hebron Research Institute and CIBERDEM (ISCIII), Barcelona, Spain
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
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25
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Wu HQ, Wu H, Shi LL, Yu LY, Wang LY, Chen YL, Geng JS, Shi J, Jiang K, Dong JC. The association between retinal vasculature changes and stroke: a literature review and Meta-analysis. Int J Ophthalmol 2017; 10:109-114. [PMID: 28149786 DOI: 10.18240/ijo.2017.01.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/05/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the association between retinal vasculature changes and stroke. METHODS MEDLINE and EMBASE were searched for relevant human studies to September 2015 that investigated the association between retinal vasculature changes and the prevalence or incidence of stroke; the studies were independently examined for their qualities. Data on clinical characteristics and calculated summary odds ratios (ORs) were extracted for associations between retinal microvascular abnormalities and stroke, including stroke subtypes where possible, and adjusted for key variables. RESULTS Nine cases were included in the study comprising 20 659 patients, 1178 of whom were stroke patients. The retinal microvascular morphological markers used were hemorrhage, microaneurysm, vessel caliber, arteriovenous nicking, and fractal dimension. OR of retinal arteriole narrowing and retinal arteriovenous nicking and stroke was 1.42 and 1.91, respectively, indicating that a small-caliber retinal arteriole and retinal arteriovenous nicking were associated with stroke. OR of retinal hemorrhage and retinal microaneurysm and stroke was 3.21 and 3.83, respectively, indicating that retinal microvascular lesions were highly associated with stroke. Results also showed that retinal fractal dimension reduction was associated with stroke (OR: 2.28 for arteriole network, OR: 1.80 for venular network). CONCLUSION Retinal vasculature changes have a specific relationship to stroke, which is promising evidence for the prediction of stroke using computerized retinal vessel analysis.
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Affiliation(s)
- Hui-Qun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Huan Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Li Shi
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Yuan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Yuan Wang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Ya-Lan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jin-Song Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jian Shi
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jian-Cheng Dong
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
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