Dyschromatopsia in Diabetes Mellitus and its Relation to Metabolic Control

Abstract

In 102 insulin-dependent diabetic patients without retinopathy and with visual acuity 20/20, the Farnsworth-Munsell 100-Hue test was performed, and glycosylated hemoglobin (GlHb) levels were determined. In 70% of the patients, a dyschromatopsia in the yellow-blue axis (tritanopia) was found. No correlation existed between duration of diabetes and tritanopia. On the other hand, the degree of this visual defect was positively correlated with GlHb levels. Thus, dyschromatopsia might be associated with poor metabolic control. It is suggested that dyschromatopsia is a consequence of hypoxia at the neuroepithelial level. The high levels of GlHb could be a contributory cause of hypoxia by reduction of both oxygen release capacity and erythrocyte deformability.

Seeing Beyond Retinopathy in Diabetes: Electrophysiological and Psychophysical Abnormalities and Alterations in Vision

“…Poor glycemic control (as measured by HbA1c) was shown to correlate significantly (r ϭ 0.24; r ϭ 0.3) with deterioration in color vision in two studies (52,94). This finding, however, was not replicated in four other studies that examined this association (80,83,86,88).…”

“…Four groups did not find a significant association (52,83,86,88). By contrast, two studies (80,93) noted that poorer performance in the 100-Hue Test was associated with longer duration of diabetes.…”

“…With the exception of one study (88), the results all confirm a significant deterioration in color vision (mainly assessed by the 100-Hue Test) in diabetic subjects without retinopathy compared with nondiabetic controls. More specifically, spectral losses of yellow-blue discrimination (tritanopia) have been observed in people with diabetes with varying frequency; 30% (87), 70% (52,80) and 80% (83). As a congenital finding, tritanopia is very rare but has been reported in several different pathological conditions including diabetes, (52) all of which may be linked by neuronal hypoxia.…”

“…In view of the rapid rate of improvement, the authors proposed that the changes in P100 latency resulted from metabolic effects. By contrast, short-term hyperglycemia (of Ͻ3 h duration) does not significantly affect monocular VEPs in IDDM subjects, irrespective of the duration of diabetes or the presence of diabetic retinopathy (52). Many of the studies sought a correlation between longer term glycemic control (estimated by glycated hemoglobin) and P100 latency alterations.…”

A multifocal electroretinogram model predicting the development of diabetic retinopathy

“…We reported such S-cone pathway loss in the early 1980's (Adams, 1982;Adams, et al, 1987a;Zisman and Adams, 1982). Changes in this pathway are not only an early event in diabetic eye disease but, importantly, the severity of these color defects correlate with both glycemic control and severity of retinopathy and are greater when macular edema is present (Adams, 1982;Adams, et al, 1987a;Adams, et al, 1987b;Bresnick, et al, 1985;Daley, et al, 1987;Greenstein, et al, 1990;Kurtenbach, et al, 2002;Lutze and Bresnick, 1994;Muntoni, et al, 1982;Volbrecht, et al, 1994;Zisman and Adams, 1982).…”