Correlation of ocular surface parameters, retinopathy and autonomic and peripheral neuropathy in type 2 diabetic patients

Abstract

Purpose : To evaluate the correlations of ocular surface parameters, pupillogram and retinopathy in type 2 with cardiovascular autonomic neuropathy (CAN) and peripheral neuropathy (PN) in diabetic type 2 patients compared to age and sex matched control subjects.

Methods : 38 diabetic patients and 28 non diabetic subjects were recruited to participate in a cross-sectional, observational and descriptive study. Ocular surface evaluation and Dry Eye (DE) were investigated through OSDI questionnaire; Schirmer 1 test, fluorescein and lissamine green staining evaluated by clinical exam; non-invasive break-up time, lacrimal meniscus height, conjunctiva hyperemia, meibography and pupillogram evaluated by Oculus Keratograph 4. Indeed, we evaluate cardiovascular autonomic and peripheral neuropathy and diabetic retinopathy.

Results : 47.3% diabetic patients and 30.7% of matched control presented DE. Regarding ocular evaluation, most of the evaluated parameters differed between diabetic and controls. 65.7% had diabetic retinopathy, 84.2% CAN and 81.5% PN. Pupillogram evaluation revealed that pupil amplitude was significantly lower in diabetes. Besides, a positive correlation was observed between the of ocular parameters with those associated with CAN and PN. Pupillogram measures were statistically lower in diabetic patients than in control group (min size 2.2 mm OD and 2.1 mm OE vs 2.2 mm OD and 2.3 mm OE, p = 0.71 OD and 0.03 OE; mean size 3.4 mm OD and 3.4 mm OE vs 3.7 mm OD and 4.0 mm OE, p = 0.08 OD and 0.004 OE.; max size 4.1 mm OD and 4.4 mm OE vs 4.7 mm OD and 5.0 OE, p = 0.03 OD and 0.04 OE).

Conclusions : We observed significant correlations between surface parameters, pupillogram and systemic diabetic neuropathy. Such findings may allow mapping of pathophysiological mechanisms of diabetes complications in the eye as well as the neurological responses. One of the main findings is related to pupillary reflex abnormalities that may contribute to early diagnosis of autonomic dysfunction in diabetic patients.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.