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Radha Das, Jennifer Perais, Katie Graham, Klainti Timos Naska, Sophia Halliday, Nicola B Quinn, Usha Chakravarthy, Ruth Hogg; Can visual function tests act as early functional biomarkers of Diabetic Retinopathy prior to clinical features?. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5317.
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© ARVO (1962-2015); The Authors (2016-present)
To explore whether measures of vision can differentiate between: (i) persons with Diabetes Mellitus (DM) without Diabetic Retinopathy (DR) and age-matched normals, and (ii) those with manifest DR without diabetic macular edema (DME).
We recruited 553 participants consisting of 344 population-based controls, 175 with DM with no evidence of DR and 34 with mild to moderate DR without DME based on ultrawidefield imaging and central macular optical coherence tomography. Best corrected visual acuity (BCVA) low luminance acuity (LLA), low luminance deficit (LLD), near VA (NVA), LLD for near (SKILL score) and contrast sensitivity (CS) was assessed in both the eyes. MAIA microperimetry and frequency doubling threshold (FDT) perimetry were performed on the selected study eye.GEE logistic models corrected for age and sex for all measures of vision [BCVA, LLA, LLD, NVA, CS, SKILL score, FDT mean deviation (MD), MAIA mean sensitivity (MS) and MAIA central mean sensitivity (CMS)] compared (a) controls vs DM without DR and (b) DM without DR vs DR. ROC curves were generated and corresponding AUC used to compare the ability of the functional measures to differentiate between conditions.
Mean age of the controls was 58.8 ± 13.33 and participants with DM were 64.53 ± 12.4. A higher proportion of control participants were females (55.1%), compared to 28.8% in DM. Most participants had T2 DM (n= 180, 82.2%). All measures of vision distinguished between controls and those with DM but no DR except LLD at distance (mean difference -0.23, 95%CI -1.359 - 0.895, p=0.7, AUC 391.28)with CS performing best (mean difference 0.06, 95% CI 0.040 - 0.094, p<0.001, AUC 607.64). The differences between those with DM and presence vs absence of DR were much smaller and LLD at near (SKILL score) was the only measure to show a clear difference (mean difference -8.06, 95% CI -11.589 to -4.532 p<0.001, AUC 159.41).
Visual function impairment exists in patients with DM before detectable vasculopathy and suggest the presence of neural dysfunction.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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