Abstract
Purpose :
Previously our group has established a relationship between retinal arteriole tortuosity (AT) and diabetic retinopathy (DR) in a population of well-controlled type II diabetes patients. Here we follow up to evaluate these retinal findings in patients with and without a diagnosis of peripheral neuropathy (PN). PN is a complication of diabetes known to be associated with DR, but the relationship of AT and PN has never been evaluated. If AT is associated with PN it could be an indicator of more advanced systemic disease detectable during an eye exam. However, if PN is not associated with AT, then the timeline of retinal tortuosity deserves further study as an early marker of disease.
Methods :
Two equal groups were selected for this study (n=244 total). One group did not have PN and the other group did have PN, diagnosed by their physician. All were participants in a VA telemedicine program and were selected based on diagnosis codes. All retinal photographs were independently evaluated by 3 graders for both DR and AT. A consensus was then assessed from the individual gradings for each eye for both DR (ETDRS scale) and AT (1-3 scale established before this study and taught to the graders before beginning). In the case that a consensus was not reached by the graders for either metric in any eye, the patient (both eyes) was not included in the final analysis (n= 22). The subjects were mostly male (96%) and aged 62.1 ± 9.0 years. Diabetic health indicators were also gathered for all subjects. Data was evaluated via logistic regression with a general estimating equation to account for two eyes in each patient.
Results :
The two groups were not significantly different in age, HbA1c levels, cholesterol levels, beta blocker usage, or AT grading (p=0.23). The PN group had a longer duration of disease (p<0.03), higher systolic blood pressures (p<0.03), more DR (p<0.001), and was more likely to be on insulin (p<0.002). A logistic model for PN included only DR, higher blood pressure and insulin use. As in our previous study, DR and AT were associated (p<0.03) if PN status was not considered.
Conclusions :
This study indicates that AT, while associated with DR, is not a good marker for evaluation of advanced systemic changes like PN in patients with diabetes. Further studies on the timeline of tortuosity changes in the eye are needed to answer its usefulness as an early biomarker in diabetes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.