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W. W. Harrison, M. A. Bearse, M. E. Schneck, J. S. Ng, K. W. Bronson-Castain, S. Barez, A. J. Adams; Diastolic Blood Pressure and Retinal Thickness in Patients With Diabetes and Hypertension. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1368.
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OCT measurements of retinal thickness (RT) are often used to diagnose diabetic macular edema (DME) in patients with diabetes (DM). However, other factors affecting RT could impact OCT interpretation. In this study we investigate the associations between RT and a number of factors in DM patients with and without non-proliferative diabetic retinopathy (NPDR) but no DME.
We evaluated 22 diabetic subjects (9 with mild-moderate central NPDR, 13 without retinopathy) and 15 control subjects. All 9 subjects with NPDR, and 11 without retinopathy, had hypertension (HTN) controlled by medications. Blood pressure (BP), fundus photography, mfERGs (VERIS 103 elements, 10-100Hz), and RT was measured on all subjects; HbA1c was measured in all diabetics. MfERG N1-P1 amplitudes and P1 implicit times were derived for all 103 elements and implicit time and amplitude Z-scores were calculated, and then averaged together. RT was measured with the macular scan of Stratus OCT3, and overall mean thickness and average thickness for each of 9 sectors was evaluated.
Increases in mean RT were linearly associated with increases in diastolic BP (p<0.01) in the NPDR group only. This relationship was present throughout the macula but was weakest in the macular center where there are no large vessels. Systolic BP, HbA1c, average mfERG N1-P1 amplitude and P1 implicit time were not associated with RT in any subject group. MfERG amplitude and implicit time were not related to BP in this study.
The results suggest that higher diastolic BP is associated with increased RT in hypertensive DM patients with NPDR but no DME. While it is unclear if retinal thickening prior to the development of clinically detectable DME is a concern, it could be a precursor to further retinal swelling in these at-risk DM patients. Further studies of these relationships and their implications are warranted.
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