Comparison of the nerve fiber layer of type 2 diabetic patients without glaucoma with normal subjects of the same age and sex (original) (raw)
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Assessment of nerve fiber layer in diabetic patients with scanning laser polarimetry
Eye, 2002
Objective To evaluate the effects of diabetes mellitus, diabetic retinopathy and degree of blood glucose (BG) regulation on retinal nerve fiber layer (RNFL) thickness by using a scanning laser polarimeter (NFA-GDx). Methods We prospectively assessed RNFL thickness in four groups of patients, who were all age matched. Diabetic patients without diabetic retinopathy were grouped according to their BG regulation level into two, as: BG-regulated group (BG Ͻ140 mg/dl, HbA1c Ͻ8%, fructosamine Ͻ285 mol/l, TG Ͻ200 mg/dl, n = 50), and BG-non-regulated group (BG = 140-250 mg/dl, HbA1c Ͼ8%, fructosamine Ͼ285 mol/l, TG Ͼ200 mg/dl, n = 44). A group of patients with nonproliferative diabetic retinopathy (NPDR) formed the 3rd group (n = 41). The 4th group consisted of healthy subjects and acted as a control group (n = 50). Symmetry, superior maximum, ellipse modulation and the average thickness variables of NFA-GDx were used for the assessment. ANOVA test was used for the statistical analysis of variables between groups. Results The mean superior maximum and ellipse modulation values were statistically significantly lower than the control group in BG-non-regulated and NPDR groups (P Ͻ 0.05). The average thickness value was also statistically significantly lower than the control group in NPDR group. These values in the BG-regulated group were not statistically significantly different from the control group (P Ͼ 0.05). Conclusions This is the first clinical study demonstrating the effects of diabetic glucose regulation level on RNFL by using NFA-GDx. RNFL thickness was seen to decrease with development of diabetic retinopathy and with impairment of metabolic regulation. This issue should be taken into account while assessing RNFL in diabetic glaucomatous patients.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Diabetes mellitus is one of the major component of metabolic syndrome and a leading cause of ocular morbidity in modern era and India will be considered to be the diabetes capital of the world. Before the onset of diabetic retinopathy, other structural and functional changes may predict the visual diminution of the individual. MATERIALS AND METHODS In this cross-sectional study in a tertiary care hospital, after inclusion and exclusion, the age-gender matched groups (diagnosed type 2 diabetes patients without diabetic retinopathy and controls without diabetes) were thoroughly examined clinically and by noninvasive and invasive examination (after proper counselling of the patient and informed consent). Then, they are tested for functional loss of retina by Humphrey FDT, GDx VCC. Comparison done between cases and controls as well as poorly-controlled and well-controlled diabetic groups. RESULTS It was found that the average RNFL thickness was significantly reduced in diabetics (mean 53.48, SD 2.69) compared to controls (mean 60.21, SD 1.87) (p<0.05). Also, in patients with uncontrolled diabetes (HbA1c >7%), the RNFL thickness was significantly reduced (mean 52.23, SD 1.31) compared to diabetics with good metabolic control (mean 56.38, SD 2.92) (p<0.05). In retinal functional testing, it was found that the Humphrey FDT mean deviation (FDT MD) and pattern standard deviation (FDT PSD) were significantly worse in diabetics (FDT MD-1.478, SD 0.386), (FDT PSD-3.485, SD 0.403) compared to normal controls (FDT MD-0.442, SD 0.536), (FDT PSD-1.438, SD 0.404). The parameters were also found to be significantly worse in uncontrolled diabetics (p<0.05). CONCLUSION To conclude, without diabetic retinopathy, functional and structural loss in retina in diabetes patients compared to age-sex matched individual and especially in poorly-controlled diabetes should be of concern as there are no detectable vasculopathy. So, early diagnosis and control of diabetes is advocated to control this functional loss.
RETINAL NERVE FIBER LAYER THICKNESS IN DIABETIC PATIENTS WITH AND WITHOUT DIABETIC RETINOPATHY
Transstellar Journal , 2019
Study aims to evaluate the retinal nerve fiber layer thickness in diabetic patients with and without retinopathy and to assess the correlation of retinal nerve fiber layer thickness among the cases diabetic retinopathy. A cross-sectional observational study was conducted at Department of Ophthalmology, PESIMSR, Kuppam during 2016–2019. Total 200 consecutive cataract known patients were selected based on SOP. Inclusion and exclusion criteria were employed to conduct the research work inclusion; all the patients with diabetes mellitus willing to give consent to clinical examination and evaluation. Exclusion; secondary glaucoma, patients who are mentally challenged, corneal and lenticular opacity, diabetic retinopathy with vitreous haemorrhage or retinal detachment and post retinal surgery. A total of 200 (400 eyes) cases were considered for the study group (G1:G2 = 100). Of which male comprises (61%) and females (39.0%), sex ratio 2:1. Diabetic status was recorded and it revealed that a total of 150 (75%) cases were subjected to diabetes and 50(25%) cases were subjected to non diabetes and it was found that the DM status is found to be statistically significant (p < 0.01). As per the findings, the average RNFL in the case of RE was 95.58 ± 6.96 in DM with DR and 98.08 ± 1.44 in DM without DR. It was found to be statistically significant (p < 0.01). In case of RNFL of LE was 95.80 ± 6.93 in DM with DR and 98.18 ± 1.48 in DM without DR, it was also found that there is a statistically significant (p < 0.001) with and without DR. The superior retinal nerve fibre layer thickness (p < 0.001), nasal retinal fiber layer thickness (p < 0.001), inferior retinal nerve layer thickness (p < 0.001), temporal nerve fibre layer thickness, macular thickness (p < 0.001), HBa1C (p < 0.001), serum creatine and serum cholestrol (p < 0.001) were found to be statistically significant. The present study concludes that the optical coherence tomography is an important non invasive tool for the assessment and quantification of the RNFL thickness in diabetes patients, while on evaluating for DR.
RNFL in glaucomatous Nepalese eyes and their relation with visual field sensitivity
Background: To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous Nepalese eyes using spectral domain optical coherence tomography (SD-OCT) and study its relationship with visual field sensitivity. Methods: A total of 120 eyes comprising primary open angle glaucoma (POAG), glaucoma suspects (GS), normal tension glaucoma (NTG) and healthy subjects (n = 30 cases in each group) underwent a complete ophthalmic examination, including optic nerve head (ONH) evaluation and standard automated perimetry (SAP). RNFL thickness measurements around the optic disk were taken with circular spectral domain optical coherence tomography (SD-OCT) scans. Analysis of variance (ANOVA) was used for comparison of RNFL parameters among various study groups. The relationship of RNFL parameters with visual field (VF) global indices was evaluated with regression analysis. Results: The mean pRNFL thickness was significantly less in the POAG (64.30 ± 14.45 m, p < 0.01), NTG (85.43 ± 9.79 m, p < 0.001) and GS (102.0 ± 9.37 m, p < 0.001) groups than in the healthy group (109.8 ± 8.32 m). The RNFL was significantly thinner across all quadrants in all study group pairs (p < 0.05) except for normal vs. GS (only superior and inferior quadrant, significant). Linear regression plots with RNFL thickness as a predictor of MD and LV demonstrated a strong and statistically significant degree of determination in the POAG group (R 2 = 0.203 and 0.175, p = 0.013 and 0.021).
European Journal of Ophthalmology, 2002
PURPOSE. To assess the thickness of the retinal nerve fiber layer (RNFL) in patients with different stages of glaucoma, in comparison with ocular hypertensive (OHT) and healthy subjects in a Turkish population. METHODS. Scanning laser polarimetry was done with a GDx Nerve Fiber Analyzer (NFA, GDx version, 1.0.08) on 270 eyes with glaucoma, 52 OHT eyes, and 81 normal eyes. The eyes were classified as having early (146 eyes), moderate (66 eyes) and severe (58 eyes) glaucoma based on the Humphrey Visual Field indices. We compared 14 NFA parameters by analysis of variance (ANOVA) and Scheffe multiple comparison analysis. Receiver operator characteristic curves (ROC) and Fisher linear discriminant analysis (LDF) were used to measure the sensitivity and specificity of the NFA parameters. RESULTS. Except for symmetry, all NFA parameters showed significant differences between the groups (p<0.05). The eyes with glaucoma had significantly thinner RNFL than healthy eyes (p<0.01). The RNFL retardation measurements of OHT eyes were lower than controls, but higher than the early glaucoma group. The sensitivity and specificity of the GDx System were 87% and 72.8%, respectively. Applying LDF, the group with the highest sensitivity and specificity (85.9% and 74.1%) was determined as inferior ratio, superior/nasal ratio, superior maximum and the Number. CONCLUSIONS. Assessment of RNFL thickness with scanning laser polarimetry can distinguish glaucoma, OHT and normal subjects with relatively high sensitivity and specificity.
Associations With Retinal Nerve Fiber Layer Measures in the EPIC-Norfolk Eye Study
Investigative Opthalmology & Visual Science, 2013
PURPOSE. To describe GDxVCC retinal nerve fiber layer (RNFL) measures and associations in a predominantly white British population. METHODS. The EPIC-Norfolk Eye Study is nested within a large multicenter cohort study, the European Prospective Investigation of Cancer. RNFL measurements were taken using the GDxVCC. Generalized estimating equation models were used to assess associations of RNFL measures with age, sex, body mass index (BMI), height, blood pressure, social class, education level, alcohol intake, smoking status, axial length, intraocular pressure, and lens status. Models were linearly adjusted for typical scan score to handle scans with atypical retardation. RESULTS. There were complete data from 11,030 eyes of 6309 participants with mean age 68 years (48-90 years). Older age (À1.53 lm/decade [95% confidence interval {CI} À1.73, À1.33], P < 0.001), male sex (À0.44 lm [95% CI À0.04, À0.84], P ¼ 0.031), shorter axial length (À0.15 lm/mm [95% CI À0.02, À0.28], P ¼ 0.024), and pseudophakia (À0.49 lm [95% CI À0.94, À0.04], P ¼ 0.033) were associated with thinner RNFL after adjustment for possible confounders. Higher BMI was associated with a thinner RNFL in men only (À0.30 lm/5 kg/m 2 [95% CI À0.58, À0.02], P ¼ 0.039). CONCLUSIONS. This analysis of associations with RNFL thickness in a largely healthy population may provide insight into the determinants of glaucoma, suggesting higher risk in those who are older, in men, and in men with a higher BMI.
PloS one, 2017
We investigated the relationship between the peripapillary retinal nerve fiber layer and peripapillary retinal thickness in patients with diabetic macular edema. Fifty eyes (group I) with non-proliferative diabetic retinopathy and diabetic macular edema receiving intravitreal anti-VEGF injection, and 90 eyes (group II) without diabetic macular edema were included in this case-control study. The peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, and a new retinal nerve fiber layer index using a modeled relationship between the two parameters were evaluated with spectral-domain optical coherence tomography, at baseline and at the 6-month follow-up. In group I, the peripapillary retinal nerve fiber layer thickness decreased from 126.4 μm at baseline to 117.6 μm at 6 months (p < 0.001), while the peripapillary retinal thickness decreased from 376.0 μm at baseline to 359.6 μm at 6 months (p < 0.001) after intravitreal anti-VEGF injection. In group I...
Acta Ophthalmologica, 2022
Purpose: Detection of early glaucoma remains limited with the conventional analysis of the retinal nerve fiber layer (RNFL). This study assessed whether compensating the RNFL thickness for multiple demographic and anatomic factors improves the detection of glaucoma. Design: Cross-sectional study. Participants: Three hundred eighty-seven patients with glaucoma and 2699 healthy participants. Methods: Two thousand six hundred ninety-nine healthy participants were enrolled to construct and test a multivariate compensation model, which then was applied in 387 healthy participants and 387 patients with glaucoma (early glaucoma, n ¼ 219; moderate glaucoma, n ¼ 97; and advanced glaucoma, n ¼ 71). Participants underwent Cirrus spectral-domain OCT (Carl Zeiss Meditec) imaging of the optic disc and macular cubes. Compensated RNFL thickness was generated based on ethnicity, age, refractive error, optic disc (ratio, orientation, and area), fovea (distance and angle), and retinal vessel density. The RNFL thickness measurements and their corresponding areas under the receiver operating characteristic curve (AUCs) were obtained. Main Outcome and Measures: Measured and compensated RNFL thickness measurements. Results: After applying the Asian-specific compensation model, the standard deviation of RNFL thickness reduced, where the effect was greatest for Chinese participants (16.9%), followed by Malay participants (13.9%), and Indian participants (12.1%). Multivariate normative comparison outperformed measured RNFL for discrimination of early glaucoma (AUC, 0.90 vs. 0.85; P < 0.001), moderate glaucoma (AUC, 0.94 vs. 0.91; P < 0.001), and advanced glaucoma (AUC, 0.98 vs. 0.96; P < 0.001). Conclusions: The multivariate normative database of RNFL showed better glaucoma discrimination capability than conventional age-matched comparisons, suggesting that accounting for demographic and anatomic variance in RNFL thickness may have usefulness in improving glaucoma detection.
Journal of Glaucoma, 2014
Purpose: To evaluate the (i) effects of biological (age and axial length) and instrument-related [typical scan score (TSS) and corneal birefringence] parameters on the retinal nerve fiber layer (RNFL) measurements and (ii) repeatability of RNFL measurements with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in healthy subjects. Methods: In a cross-sectional study, 140 eyes of 73 healthy subjects underwent RNFL imaging with the ECC protocol of SLP. Linear mixed modeling methods were used to evaluate the effects of age, axial length, TSS, and corneal birefringence on RNFL measurements. One randomly selected eye of 48 subjects from the cohort underwent 3 serial scans during the same session to determine the repeatability. Results: Age significantly influenced all RNFL measurements. RNFL measurements decreased by 1 mm for every decade increase in age. TSS affected the overall average RNFL measurement (b = À 0.62, P = 0.003), whereas residual anterior segment retardance affected the superior quadrant measurement (b = 1.14, P = 0.01). Axial length and corneal birefringence measurements did not influence RNFL measurements. Repeatability, as assessed by the coefficient of variation, ranged between 1.7% for the overall average RNFL measurement and 11.4% for th nerve fiber indicator. Conclusions: Age significantly affected all RNFL measurements with the ECC protocol of SLP, whereas TSS and residual anterior segment retardance affected the overall average and the superior average RNFL measurements, respectively. Axial length and corneal birefringence measurements did not influence any RNFL measurements. RNFL measurements had good intrasession repeatability. These results are important while evaluating the change in structural measurements over time in glaucoma patients.
Journal of Optometry, 2014
Background: To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous Nepalese eyes using spectral domain optical coherence tomography (SD-OCT) and study its relationship with visual field sensitivity. Methods: A total of 120 eyes comprising primary open angle glaucoma (POAG), glaucoma suspects (GS), normal tension glaucoma (NTG) and healthy subjects (n = 30 cases in each group) underwent a complete ophthalmic examination, including optic nerve head (ONH) evaluation and standard automated perimetry (SAP). RNFL thickness measurements around the optic disk were taken with circular spectral domain optical coherence tomography (SD-OCT) scans. Analysis of variance (ANOVA) was used for comparison of RNFL parameters among various study groups. The relationship of RNFL parameters with visual field (VF) global indices was evaluated with regression analysis. Results: The mean pRNFL thickness was significantly less in the POAG (64.30 ± 14.45 m, p < 0.01), NTG (85.43 ± 9.79 m, p < 0.001) and GS (102.0 ± 9.37 m, p < 0.001) groups than in the healthy group (109.8 ± 8.32 m). The RNFL was significantly thinner across all quadrants in all study group pairs (p < 0.05) except for normal vs. GS (only superior and inferior quadrant, significant). Linear regression plots with RNFL thickness as a predictor of MD and LV demonstrated a strong and statistically significant degree of determination in the POAG group (R 2 = 0.203 and 0.175, p = 0.013 and 0.021).