Abstract
Purpose :
Diabetic retinopathy (DR) is classified according to the presence and severity of vascular abnormalities. Electroretinography (ERG) has demonstrated early retinal neuronal dysfunction in DR, but longitudinal data assessing the clinical utility of ERG in DR are lacking. The purpose of this study is to evaluate the role of light-adapted full-field ERG (LA ffERG) in the risk assessment of DR progression.
Methods :
A prospective cohort study analyzing the 10-year progression of DR in a population-based Norwegian cohort of 151 patients with type 1 diabetes. Baseline examination (2010–2013) included a complete ophthalmic examination, LA ffERG, fundus photographs according to the ETDRS protocol and spectral-domain optical coherence tomography (OCT) for retinal thickness measurements. Follow-up examination included wide-field fundus photographs, OCT and OCT-angiography. The level of DR at baseline and follow-up was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale, and structural neurodegenerative changes at follow-up were assessed by measurements of the retinal layers on OCT. An ordinal regression model will be used to predict the DR level at follow-up based on the baseline LA ffERG responses (amplitude and peak time of the single-flash and 30-Hz flicker), with DR level, previous retinal laser treatment and HbA1c at baseline, and current age, sex and length of follow-up as additional predictors. A similar logistic regression model will be used to predict risk of DR progression.
Results :
The cohort consisted of 151 patients (53% men) with a median age of 36 years (17–74 years) at baseline. Ten patients died before the 10-year follow-up, of whom five had end-stage DR at baseline. The distribution of DR severity level at baseline was (number of patients in parentheses): No DR (55), mild (45), moderate (24) and severe (7) non-proliferative DR, and proliferative DR (20). A total of 126 patients had completed follow-up examinations by December 2023. Preliminary data suggest that 30Hz flicker ERG peak time delay is associated with increased risk of DR progression and the final results will be presented.
Conclusions :
This study provides novel information on neurodegenerative changes in DR measured by LA ffERG and their association with long-term progression of DR, thereby elucidating the utility of ERG as a clinical tool for DR screening.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.