Longitudinal Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness of Patients With Type 2 Diabetes

Lim, Hyung Bin; Shin, Yong Il; Lee, Min Woo; Park, Gi Seok; Kim, Jung‐Yeul

doi:10.1001/jamaophthalmol.2019.2537

Cited by 61 publications

(66 citation statements)

References 43 publications

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“…The results of this study were similar to our previous study, which studied pRNFL thickness using a similar study design 35 . The previous study determined that diabetic eyes had a significantly greater decrease in pRNFL over 3 years than normal eyes regardless of mild DR progression.…”

Section: Discussionsupporting

confidence: 90%

Ganglion Cell – Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study

Lim

Shin

Lee

et al. 2020

Sci Rep

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Diabetes is expected to accelerate age-related ganglion cell-inner plexiform layer (GC-IPL) loss, but there is limited information on the rate of reduction in GC-IPL thicknesses. We aimed to evaluate the reduction rate of GC-IPL thickness in diabetic patients, and to compare the rates between patients without and with diabetic retinopathy (DR). We included 112 eyes of 112 patients with diabetes [49 eyes without DR (no-DR group) and 63 eyes with mild to moderate non-proliferative DR (NPDR group)] and 63 eyes of 63 normal controls (control group) in this study. Macular GC-IPL thickness in all participants was measured for 3 years at 1-year intervals. The reduction rates of GC-IPL thickness were determined by linear mixed models and compared among the three groups. The estimated reduction rates of the average GC-IPL thickness in the no-DR (−0.627 μm/year) and NPDR (−0.987 μm/year) groups were 2.26-fold (p = 0.010) and 3.56-fold (p = 0.001) faster, respectively, than the control group (−0.277 μm/year). Age, duration of diabetes, and baseline average GC-IPL thickness were associated with longitudinal changes in average GC-IPL thickness. The GC-IPL reduction rate was significantly faster in diabetic patients, with and without DR. Physicians should therefore be aware that GC-IPL damage continues even if there is no DR. Diabetic retinopathy (DR), the most common complication of diabetes, is the leading cause of preventable visual impairment 1,2. In general, DR is clinically defined based on the observation of abnormal fundus vascular lesions, such as microaneurysms, hemorrhages, hard exudates, and cotton wool spots. However, experimental and clinical studies have shown that neurodegenerative changes, including loss of ganglion cells and glial reactivity, are also early events in the pathogenesis of DR 3-5. The loss of ganglion cells affects retinal ganglion cell layer and retinal nerve fiber layer (RNFL) thickness, and reduced thickness of these layers has been detected in clinical and animal studies 3,6-8. Optical coherence tomography (OCT) is a reliable method for quantitative structural evaluation of inner retinal layers, including of the thickness of the peripapillary RNFL (pRNFL) and macular ganglion cell-inner plexiform layer (GC-IPL), where such parameters could be useful for evaluating various conditions, such as retinal neuro-ophthalmic disease and glaucoma 9-11. Progressive changes in GC-IPL thickness can be identified by serial analysis of OCT measurements, and this trend-based analysis could be useful to understand the pathogenesis of certain conditions. Although microvascular abnormalities represent the classic hallmarks of DR, recent studies have reported that diabetic retinal neurodegeneration (DRN) occurs in patients without DR and DRN, which antecedes DR 12-15. The presence of age-related loss of retinal ganglion cells has been demonstrated histologically, and a progressive reduction in GC-IPL thickness, as measured by OCT, has also been reported 16. Abnormal systemic and eye conditions may accelerate th...

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Section: Discussionsupporting

confidence: 90%

Ganglion Cell – Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study

Lim

Shin

Lee

et al. 2020

Sci Rep

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“…Although one study showed there was no signi cant changes of average or sectoral RNFL thicknesses in no-DR [30] , some other studies found RNFL loss may occur in no-DR [31,32].Our study showed that the temporal RNFL thickness in diabetic patients was signi cantly thinner than that in the normal group. Further analysis revealed that the temporal RNFL thickness in the no-DR group was signi cantly smaller than that in the normal group.…”

Section: Discussioncontrasting

confidence: 70%

Early Neurovascular Changes in the Retina in Preclinical Diabetic Retinopathy and Relation to Blood Glucose

Zheng

et al. 2020

Preprint

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Aim: To investigate the changes of retinal optic disc nerve fiber layer thickness and macular blood flow density in preclinical stage of diabetic retinopathy and their relationship with blood glucose. Methods: In this cross-sectional study,97 diabetic patients(total 188 eyes,144 eyes in no diabetic retinopathy group, 44 eyes in mild diabetic non-proliferative retinopathy group ) and 35 healthy people (70 eyes) were enrolled, All the subjects were divided into different group by HbA1c , and underwent ocular examination by optical coherence tomography angiography. We compare optical coherence tomography angiography parameter and retinal nerve fiber layer thickness among different glucose group.Results: The parafoveal vessel density and the temporal retinal nerve fiber layer thickness were lower (P < 0.05) in the diabetic group than in the normal group. The diabetic group showed a higher acircularity index as compared with the normal group. From the normal group to no diabetic retinopathy group and then to mild non-proliferative retinopathy group, vessel density decreased and acircularity index increased (P < 0.001). Foveal vascular density and parafoveal vessel density decreased with the increase of HbA1c. There was a negative correlation between parafoveal vessel density of the deep retinal vascular layer and FBG (P<0.01). The temporal retinal nerve fiber layer thickness decreased among different HbA1c levels groups and was positively correlated with the parafoveal vessel density in superficial retinal vascular layer(P<0.05).Conclusions: This study shows retinal microvasculopathy and neuropathy has been present during no retinopathy. The vessel density of the deep retinal vascular layer was negatively correlated with fasting blood glucose, and the temporal RNFL thickness was positively correlated with the vessel density of superficial retinal vascular layer. These indicators are helpful for endocrinologists and ophthalmologists to detect early diabetic retinal pathological lesions.

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“…In addition, glutamate accumulation induced by DRN increases the secretion of vascular endothelial growth factor, which leads to damage to the BRB. 28 Considering these mechanisms, DRN is a crucial factor in the development of DR, and it could explain the findings of the present and a previous study 13 of significant pRNFL loss in patients without DR.…”

Section: Figuresupporting

confidence: 60%

“…8 The most important characteristics of DRN involve reactive gliosis and neuronal apoptosis, which may predominantly affect the inner retinal layer. 9 Several studies have reported inner retinal injury associated with DRN, 8,[10][11][12] and we also reported progressive pRNFL thinning in diabetic patients with or without DR. 13 Because the prevalence of diabetes and myopia is increasing worldwide, 3,14 the number of diabetic patients with myopia is expected to increase in the future. Myopia causes pRNFL reduction, which may accelerate pRNFL loss in diabetic patients, but the effects of myopia on pRNFL thickness in diabetic patients have not been definitively evaluated.…”

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confidence: 99%

Association of Myopia with Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Patients Without Diabetic Retinopathy

Lim

Shin

Lee

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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To investigate the association between myopia and peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetic patients without diabetic retinopathy (DR). METHODS. A total of 271 eyes of 271 participants were included. They were divided into four groups according to the presence of myopia (≤-3 diopters [D]) and diabetes without DR: (1) control group (n = 76), (2) myopia group (n = 57), (3) diabetes group (n = 82), and (4) diabetes + myopia group (n = 56). The peripapillary average and sector RNFL thicknesses were measured and compared among the four groups to determine the effects of myopia and diabetes. Covariates were adjusted using analyses of covariance. Linear regression analyses were fitted to evaluate the factors associated with pRNFL. RESULTS. Spherical equivalents were 0.12 ± 1.31 D in the control group,-4.00 ± 1.47 D in the myopia group, 0.00 ± 1.05 D in the diabetes group, and-4.33 ± 1.70 D in the diabetes + myopia group (P < 0.001). The respective axial lengths (ALs) were 23.91 ± 0.99 mm, 25.16 ± 0.94 mm, 23.68 ± 0.77 mm, and 25.34 ± 1.33 mm (P < 0.001). The average pRNFL showed a progressive decrease from the control group (97.16 ± 8.73 μm) to the myopia group (94.04 ± 9.13 μm) to the diabetes group (93.33 ± 9.07 μm) to the diabetes + myopia group (91.25 ± 9.72 μm) (P = 0.009). Age, diabetes, hypertension, and AL were significantly correlated with the pRNFL. The rate of reduction of pRNFL with increasing age was higher in the diabetes + myopia group than in the other groups, and pRNFL in the diabetes groups decreased more steeply with increasing AL compared to the non-diabetic groups. CONCLUSIONS. Myopia and diabetes are important factors affecting pRNFL thickness, and the simultaneous presence of diabetes and myopia results in greater pRNFL damage than observed with either pathology alone.

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Longitudinal Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness of Patients With Type 2 Diabetes

Cited by 61 publications

References 43 publications

Ganglion Cell – Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study

Ganglion Cell – Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study

Early Neurovascular Changes in the Retina in Preclinical Diabetic Retinopathy and Relation to Blood Glucose

Association of Myopia with Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Patients Without Diabetic Retinopathy

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