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Michelle McFarlane, Tom Wright, Derek Stephens, Josefin Nilsson, Carol A. Westall; Blue Flash ERG PhNR Changes Associated with Poor Long-Term Glycemic Control in Adolescents with Type 1 Diabetes. Invest. Ophthalmol. Vis. Sci. 2012;53(2):741-748. doi: https://doi.org/10.1167/iovs.11-8263.
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To investigate the relationship between long-term glycemic control and photopic negative response (PhNR) changes in the blue flash ERG in adolescents with type 1 diabetes (T1D) without diabetic retinopathy (DR).
After light adaptation, ERG responses to 1.60 cd·s/m2 blue (420 nm) flashes (blue flash ERG) and 3.0 cd·s/m2 white flashes (LA 3.0 ERG) were recorded in 22 patients (age range, 12 to 19 years) and 28 age-similar control subjects. The primary outcome measure was the amplitude of the PhNR. Secondary outcome measures were the amplitude and implicit time of the a-wave and b-wave. Multiple regression analyses were conducted with glycated hemoglobin (HbA1c) values and the time since diagnosis of T1D as covariates.
Blue flash ERG PhNR amplitudes were reduced (P = 0.005) in patients compared with control subjects. Multiple regression analysis demonstrated that a 1-unit increase in HbA1c was associated with a 15% decrease in the blue flash ERG PhNR amplitude (r = 0.61, P = 0.003). Compared with controls blue flash ERG a-waves (P = 0.03) and b-waves (P = 0.02) were delayed in patients but were not significantly associated with HbA1c or time since diagnosis of T1D. None of the ERG measures in the LA 3.0 ERG were significantly different in patients compared with controls.
Poorer long-term glycemic control is associated with worsening inner retinal dysfunction involving short-wavelength cone pathways of adolescents with T1D and no clinically visible DR. Future studies are warranted to determine whether changes in the blue flash ERG PhNR are a predictive marker of subclinical DR.
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