June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
The relationship between Multifocal Electroretinogram Implicit Times, Blood Glucose and Blood insulin in Patients with Diabetes and Prediabetes
Author Affiliations & Notes
  • Jennyffer Smith
    University of Houston College of Optometry, Houston, Texas, United States
  • Cecilia Chao
    University of Houston College of Optometry, Houston, Texas, United States
  • Ted Zderic
    Health and Human Performance, University of Houston, Houston, Texas, United States
  • Marc Hamilton
    Health and Human Performance, University of Houston, Houston, Texas, United States
  • Kathryn Richdale
    University of Houston College of Optometry, Houston, Texas, United States
  • Wendy Watkins Harrison
    University of Houston College of Optometry, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   Jennyffer Smith, None; Cecilia Chao, None; Ted Zderic, None; Marc Hamilton, None; Kathryn Richdale, None; Wendy Harrison, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1344. doi:
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      Jennyffer Smith, Cecilia Chao, Ted Zderic, Marc Hamilton, Kathryn Richdale, Wendy Watkins Harrison; The relationship between Multifocal Electroretinogram Implicit Times, Blood Glucose and Blood insulin in Patients with Diabetes and Prediabetes. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1344.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Blood glucose (Bgl) concentration is known to have effects on retinal function testing, such as the multifocal electroretinogram (mfERG). Insulin is also known to impact pathophysiological processes in diabetes. However, there are no studies showing the relationship between insulin and retinal function at the time of testing. The purpose of this study is to assess the relationship between endogenous insulin and Bgl levels on mfERGs implicit times (IT) and amplitudes (Amp) in controls and subjects with pre-diabetes and diabetes (DM).

Methods : Forty-nine subjects participated in this cross-sectional study; 15 controls (HbA1c under 5.7%), 21 with pre-diabetes (HbA1c 5.7-6.4% with no DM medications), and 13 with type 2DM (HbA1c over 6.4% or on DM medications; average HbA1c 7.3%). Testing included endogenous insulin, Bgl, and HbA1c, all gathered within 15 minutes of mfERG testing. The last meal and time were surveyed. MfERG (VERIS) was completed on the right eye with 103 hexagons at near 100% contrast with a 4-minute m-sequence and a Burian-Allen electrode. MfERGs were evaluated for IT and Amp over the entire eye and at the fovea. Regression analyses, controlled for age, were used to determine associations between mfERG and blood analyses.

Results : There were significant associations between longer whole eye and foveal mfERG IT and higher Bgl (r2 = 0.17 p=0.012; r2 =0.11 p=0.05). There was no relationship between insulin level and mfERG IT or Amp, but insulin was a confounder of the relationship between Blg and IT. Including insulin in the model strengthens the relationship (r2=0.18 p=0.010; r2 = 0.14 p=0.03) for the whole eye and fovea, respectively. If Bgl and insulin are considered as a ratio (bgl/insulin) rather than independent factors, its relationship to IT is significant for the fovea (r2 =0.18 p=0.045), but not the whole eye (p=0.42). There was no relationship with mfERG Amp in any of these comparisons.

Conclusions : This study indicates that while Bgl is the most powerful influencer of retinal function in diabetes and prediabetes, insulin dysfunction may play a role. Insufficient insulin may be an important consideration for foveal health. Further studies with fasted participants and a wider range of HbA1c values are needed to determine insulin’s implications in diabetic retinal neuropathy and retinopathy prevention.

This is a 2021 ARVO Annual Meeting abstract.

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