Joltikov Katherine A, de Castro Vinicius M, Davila Jose R, Anand Rohit, Khan Sami M, Farbman Neil, Jackson Gregory R, Johnson Chris A, Gardner Thomas W
Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States.
MacuLogix, Inc., Hummelstown, Pennsylvania, United States.
Invest Ophthalmol Vis Sci. 2017 May 1;58(6):BIO277-BIO290. doi: 10.1167/iovs.17-21863.
To test whether quantitative functional tests and optical coherence tomography (OCT)-defined structure can serve as effective tools to diagnose and monitor early diabetic neuroretinal disease.
Fifty-seven subjects with diabetes (23 without diabetic retinopathy [no DR], 19 with mild nonproliferative diabetic retinopathy [mild NPDR], 15 with moderate to severe [moderate NPDR]), and 18 controls underwent full ophthalmic examination, fundus photography, spectral-domain optical coherence tomography (SD-OCT), e-ETDRS (Early Treatment Diabetic Retinopathy Study) acuity, and the quick contrast sensitivity function (qCSF) method. Perimetry testing included short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), frequency doubling perimetry (FDP), and rarebit perimetry (RBP).
ETDRS acuity and RBP were not sensitive for functional differences among subjects with diabetes. AULCSF, a metric of qCSF, was reduced in diabetics with moderate compared to mild NPDR (P = 0.03), and in subjects with no DR compared to controls (P = 0.04). SWAP and SAP mean deviation (MD) and foveal threshold (FT) were reduced in moderate compared to mild NPDR (SWAP, MD P = 0.002, FT P = 0.0006; SAP, MD P = 0.02, FT P = 0.007). FDP 10-2 showed reduced MD in moderate compared to mild NPDR (P = 0.02), and FDP 24-2 revealed reduced pattern standard deviation (PSD) in mild NPDR compared to no DR (P = 0.02). Structural analysis revealed thinning of the ganglion cell layer and inner plexiform layer (GCL+IPL) of moderate NPDR subjects compared to controls. The thinner GCL+IPL correlated with impaired retinal function.
This multimodal testing analysis reveals insights into disruption of the neuroretina in diabetes and may accelerate the testing of novel therapies.
测试定量功能测试和光学相干断层扫描（OCT）定义的结构是否可作为诊断和监测早期糖尿病性神经视网膜病变的有效工具。
57例糖尿病患者（23例无糖尿病视网膜病变[无DR]，19例轻度非增殖性糖尿病视网膜病变[轻度NPDR]，15例中度至重度[中度NPDR]）和18例对照者接受了全面眼科检查、眼底照相、光谱域光学相干断层扫描（SD-OCT）、早期糖尿病性视网膜病变研究（ETDRS）视力检查以及快速对比敏感度函数（qCSF）方法检查。视野检查包括短波自动视野检查（SWAP）、标准自动视野检查（SAP）、频率加倍视野检查（FDP）和兔形视野检查（RBP）。
ETDRS视力和RBP对糖尿病患者之间的功能差异不敏感。与轻度NPDR相比，中度糖尿病患者的qCSF指标AULCSF降低（P = 0.03），与对照组相比，无DR患者的AULCSF也降低（P = 0.04）。与轻度NPDR相比，中度NPDR患者的SWAP和SAP平均偏差（MD）及黄斑阈值（FT）降低（SWAP，MD P = 0.002，FT P = 0.0006；SAP，MD P = 0.02，FT P = 0.007）。与轻度NPDR相比，中度NPDR患者的FDP 10-2显示MD降低（P = 0.02），与无DR相比，轻度NPDR患者的FDP 24-2显示模式标准差（PSD）降低（P = 0.02）。结构分析显示，与对照组相比，中度NPDR患者的神经节细胞层和内网状层（GCL+IPL）变薄。较薄的GCL+IPL与视网膜功能受损相关。
这种多模式测试分析揭示了糖尿病中神经视网膜破坏的相关情况，并可能加速新型疗法的测试。
