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Wang R, Xu YX, Xu F, Wang CH, Zhao LH, Wang LH, Chen WG, Wang XQ, Duan CW, Su JB. Increased blood urea nitrogen levels and compromised peripheral nerve function in patients with type 2 diabetes. World J Diabetes 2025; 16:101966. [DOI: 10.4239/wjd.v16.i4.101966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 12/14/2024] [Accepted: 01/09/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Increased blood urea nitrogen (BUN) levels have been demonstrated to be associated with broader metabolic disturbances and the incidence of type 2 diabetes (T2D), potentially playing a role in the development of diabetic complications, including diabetic peripheral neuropathy.
AIM To examine the relationship between BUN levels and peripheral nerve function in patients with T2D.
METHODS This observational study involved the systematic recruitment of 585 patients with T2D for whom BUN levels and estimated glomerular filtration rate were measured. Electromyography was used to assess peripheral motor and sensory nerve function in all patients, and overall composite Z-scores were subsequently calculated for nerve latency, amplitude, and conduction velocity (NCV) across the median, ulnar, common peroneal, posterior tibial, superficial peroneal, and sural nerves.
RESULTS Across the quartiles of BUN levels, the overall composite Z-score for latency (F = 38.996, P for trend < 0.001) showed a significant increasing trend, whereas the overall composite Z-scores for amplitude (F = 50.972, P for trend < 0.001) and NCV (F = 30.636, P for trend < 0.001) exhibited a significant decreasing trend. Moreover, the BUN levels were closely correlated with the latency, amplitude, and NCV of each peripheral nerve. Furthermore, multivariate linear regression analysis revealed that elevated BUN levels were linked to a higher overall composite Z-score for latency (β = 0.166, t = 3.864, P < 0.001) and lower overall composite Z-scores for amplitude (β = -0.184, t = -4.577, P < 0.001) and NCV (β = -0.117, t = -2.787, P = 0.006) independent of the estimated glomerular filtration rate and other clinical covariates. Additionally, when the analysis was restricted to sensory or motor nerves, elevated BUN levels remained associated with sensory or motor peripheral nerve dysfunction.
CONCLUSION Increased BUN levels were independently associated with compromised peripheral nerve function in patients with T2D.
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Affiliation(s)
- Rui Wang
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Yu-Xian Xu
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Feng Xu
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Chun-Hua Wang
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Li-Hua Zhao
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Li-Hua Wang
- Department of Nursing, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Wei-Guan Chen
- Department of Rehabilitation, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Xue-Qin Wang
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Cheng-Wei Duan
- Medical Research Center, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
| | - Jian-Bin Su
- Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
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Vrabec R, Bulum T, Ljubić S, Tomić M. Association Between Macular Ganglion Cell-Inner Plexiform Layer and Non-Proliferative Retinopathy Without Macular Edema in Type 2 Diabetes via Diabetes Duration and HbA 1c Link. Biomedicines 2025; 13:398. [PMID: 40002811 PMCID: PMC11853396 DOI: 10.3390/biomedicines13020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/26/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: This study aimed to evaluate the association between the thickness of the macular ganglion cell-inner plexiform layer (GC-IPL), a marker of retinal neurodegeneration, and diabetic retinopathy (DR), a microvasculopathy, in type 2 diabetic patients (T2DM), and to determine the related risk factors. Methods: This cross-sectional study included 50 eyes of 25 T2DM with a median age of 64 and a median diabetes duration of 13 years. Complete diabetological, nephrological, and ophthalmological examination was performed, including color fundus photography according to the EURODIAB methodology and optical coherence tomography (OCT) of the macula. Patients with proliferative DR and diabetic macular edema were not included in the study. Data were analyzed using the software package Statistica™ 14.0.1.25 (TIBCO Inc., USA). Results: Fifty eyes were divided into two groups: no DR (n = 34) and non-proliferative DR (NPDR) (n = 16). The NPDR group had longer diabetes duration (p = 0.042), higher HbA1c (p = 0.002), lower HDL cholesterol (p = 0.036), and also lower macular GC-IPL thickness (p = 0.027) than those without DR. The correlation between DR and GC-IPL was significantly negative (R = -0.319, p = 0.024). DR was positively related to diabetes duration (p = 0.047) and HbA1c (p = 0.003), while the relation between GC-IPL and diabetes duration (p = 0.042) and HbA1c (p = 0.043) was negative. Binary logistic regression analysis showed that HbA1c (OR = 2.77, p = 0.007) and HDL cholesterol (OR = 0.08, p = 0.031) were the main predictors for DR, whereas the best model for predicting the GC-IPL thickness (R2 = 0.223) obtained from stepwise regression analysis included HDL cholesterol, triglycerides, estimated glomerular filtration rate, and albumin/creatinine ratio. Conclusions: The negative correlation between macular GC-IPL and DR in T2DM indicates the coexistence of two parts, neurodegenerative and microvascular, in one diabetic eye complication, linked by the same well-known risk factors: diabetes duration and HbA1c.
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Affiliation(s)
- Romano Vrabec
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Tomislav Bulum
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Spomenka Ljubić
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
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Zhang Z, Lv D, You Y, Zhao Z, Hu W, Xie F, Lin Y, Xie W, Wu X. Assessing the importance of risk factors for diabetic retinopathy in patients with type 2 diabetes mellitus: Results from the classification and regression tree models. J Family Community Med 2024; 31:197-205. [PMID: 39176009 PMCID: PMC11338385 DOI: 10.4103/jfcm.jfcm_354_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the serious complications of diabetes mellitus (DM). Many studies have identified the risk factors associated with DR, but there is not much evidence on the importance of these factors for DR. This study aimed to investigate the associated factors for patients with type 2 DM (T2DM) and calculate the importance of the identified factors. MATERIALS AND METHODS Using probability proportionate to size sampling method in this community-based cross-sectional study, 22 community health service centers were selected from 10 administrative districts in Shenzhen, China. Approximately 60 T2DM patients were recruited from each center. The participants completed a structural questionnaire, had their venous blood collected, and underwent medical examinations and fundus photography. Logistic regression models were used to identify the risk factors of DR. The classification and regression tree (CART) model was used to calculate the importance of the identified risk factors. RESULTS This study recruited 1097 T2DM patients, 266 of whom were identified as having DR, yielding a prevalence rate of 24.3% (95% confidence interval [CI]: 21.7%-26.9%). Results showed that a longer duration of DM, indoor-type lifestyle, and higher levels of hemoglobin A1c (HbA1c) or urea increased the risk of DR. Patients with HbA1c values ≥7% were about 2.45 times (odds ratio: 2.45; 95% CI: 1.83-3.29) more likely to have DR than their counterparts. The CART model found that the values of variable importance for HbA1c, DM duration, lifestyle (i.e., indoor type), and urea were 48%, 37%, 10%, and 4%, respectively. CONCLUSION The prevalence of DR is high for T2DM patients who receive DM health management services from the primary healthcare system. HbA1c is the most important risk factor for DR. Integration of DR screening and HbA1c testing into the healthcare services for T2DM to reduce vision impairment and blindness is urgently warranted.
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Affiliation(s)
- Ziyang Zhang
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Deliang Lv
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yueyue You
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Zhiguang Zhao
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Wei Hu
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Fengzhu Xie
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yali Lin
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Wei Xie
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xiaobing Wu
- Department of Cardio-Cerebrovascular and Diabetes Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
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Boned-Murillo A, Fernández-Espinosa G, Orduna-Hospital E, Díaz-Barreda MD, Sánchez-Cano A, Sopeña-Pinilla M, Bielsa-Alonso S, Pinilla I. Changes in Inner Retina Thickness and Macular Sensitivity in Patients with Type 2 Diabetes with Moderate Diabetic Retinopathy. Biomedicines 2023; 11:2972. [PMID: 38001971 PMCID: PMC10669203 DOI: 10.3390/biomedicines11112972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
The increase in diabetic retinopathy (DR) prevalence demonstrates the need for the determination of biomarkers for assessing disease development to obtain an early diagnosis and stop its progression. We aimed to analyse total retinal (RT) and inner retinal layer (IRL) thicknesses in type 2 diabetes mellitus (DM2) patients and correlate these results with retinal sensitivity using swept-source OCT (SS-OCT) and microperimetry. For this purpose, a total of 54 DM2 subjects with moderate diabetic retinopathy (DR) with no signs of diabetic macular oedema (DME) and 73 age-matched healthy individuals were assessed using SS-OCT to quantify retinal thickness in the nine macular areas of the ETDRS grid. Retinal sensitivity was measured via microperimetry with a Macular Integrity Assessment Device (MAIA). The mean ages were 64.06 ± 11.98 years for the DM2 group and 60.79 ± 8.62 years for the control group. DM2 patients presented lower visual acuity (p < 0.001) and a thicker RT (260.70 ± 19.22 μm in the control group vs. 271.90 ± 37.61 μm in the DM2 group, p = 0.01). The retinal nerve fibre layer (RNFL) was significantly lower in the outer nasal area (50.38 ± 8.20 μm vs. 45.17 ± 11.25 μm, p = 0.005) in ganglion cells and inner plexiform layers (GCL+) in DM2. A positive correlation between the LDL-C and RNFL and a negative correlation between HDL-C levels and the inner temporal and central RNFL thickness were detected. The central (p = 0.021) and inner nasal (p = 0.01) areas were negatively correlated between the RNFL and MAIA, while GCL++ was positively correlated with the outer inferior (p = 0.015) and outer nasal areas (p = 0.024). Retinal sensitivity and macular RNFL thickness decrease in DM2 patients with moderate DR with no DME, and this study enables an accurate approach to this disease with personalised assessment based on the DR course or stage. Thus, GCL+ and GCL++ thinning may support ganglion cell loss before the RNFL is affected.
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Affiliation(s)
- Ana Boned-Murillo
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Ophthalmology, Infanta Sofía University Hospital, 28703 Madrid, Spain
| | - Guisela Fernández-Espinosa
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
| | - Elvira Orduna-Hospital
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Maria Dolores Díaz-Barreda
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Ophthalmology, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - Ana Sánchez-Cano
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Sopeña-Pinilla
- Department of Ophthalmology, Miguel-Servet University Hospital, 50009 Zaragoza, Spain;
| | | | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain; (A.B.-M.); (G.F.-E.); (E.O.-H.); (M.D.D.-B.); (A.S.-C.)
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain;
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Lin W, Luo Y, Liu F, Li H, Wang Q, Dong Z, Chen X. Status and Trends of the Association Between Diabetic Nephropathy and Diabetic Retinopathy From 2000 to 2021: Bibliometric and Visual Analysis. Front Pharmacol 2022; 13:937759. [PMID: 35795563 PMCID: PMC9251414 DOI: 10.3389/fphar.2022.937759] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Diabetic nephropathy (DN) and diabetic retinopathy (DR) are microvascular complications of diabetes that share a similar pathogenesis and clinical relevance. The study aimed to visually analyze the research status and development trend of the relationship between DN and DR by means of bibliometrics and knowledge mapping. Methods: Publications were collected from the Science Citation Index-Expanded of the Web of Science Core Collection between 2000 and 2021. CiteSpace, Alluvial Generator, and Microsoft Excel were used to analyze and present the data. Results: A total of 3,348 publications were retrieved and 3,285 were included in the analysis after deduplication. The publications demonstrated an annually increasing trend. The results of the collaborative network analysis showed that the United States, Steno Diabetes Center, and Tien Y. Wong were the most influential country, institution and author, in this field of research, respectively. The analysis of references and keywords showed that the pathogenesis of DN and DR and their relationship with cardiovascular disease are research hotspots. The clinical relevance and drug therapy for DN and DR will become frontiers of future research in this field. Conclusion: This study is the first to visualize the correlation between DN and DR using a bibliometric approach. This study provides a reference of research trends for scholars.
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Affiliation(s)
- Wenwen Lin
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Yayong Luo
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Fang Liu
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Hangtian Li
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Qian Wang
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Zheyi Dong
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
- *Correspondence: Zheyi Dong, ; Xiangmei Chen,
| | - Xiangmei Chen
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
- *Correspondence: Zheyi Dong, ; Xiangmei Chen,
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Chow JY, She PF, Pee XK, Wan Muda WN, Catherine Bastion ML. Comparison of peripapillary retinal nerve fiber layer and macular thickness in non-diabetic chronic kidney disease and controls. PLoS One 2022; 17:e0266607. [PMID: 35385541 PMCID: PMC8985942 DOI: 10.1371/journal.pone.0266607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective This study aimed to compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular thickness (MT) between patients with non-diabetic chronic kidney disease (NDCKD) and controls, as well as between different stages of NDCKD. We also evaluated the correlation between pRNFL thickness and MT with duration of NDCKD. Methods This was a comparative cross-sectional study. Subjects were divided into NDCKD and control groups. Both pRNFL thickness and MT, including center subfield thickness (CST), average MT as well as average ganglion cell-inner plexiform layer (GC-IPL) were measured using spectral-domain optical coherence tomography. One-way ANCOVA test was used to compare the differences in pRNFL and MT between NDCKD and controls, as well as between the different stages of NDCKD. Spearman rank-order correlation coefficients were employed to determine the effects of NDCKD duration on pRNFL thickness and MT. Results A total of 132 subjects were recruited, 66 with NDCKD and 66 controls. There was a statistically significant difference in superior (110.74 ± 23.35 vs 117.36 ± 16.17 μm, p = 0.022), nasal (65.97 ± 12.90 vs 69.35 ± 10.17 μm, p = 0.006), inferior quadrant (117.44 ± 23.98 vs 126.15 ± 14.75 μm, p = 0.006), average pRNFL (90.36 ± 14.93 vs 95.42 ± 9.87 μm, p = 0.005), CST (231.89 ± 26.72 vs 243.30 ± 21.05 μm, p = 0.006), average MT (268.88 ± 20.21 vs 274.92 ± 12.79 μm, p = 0.020) and average GC-IPL (75.48 ± 12.44 vs 81.56 ± 6.48, p = 0.001) values between the NDCKD group and controls. The superior quadrant (p = 0.007), nasal quadrant (p = 0.030), inferior quadrant (p = 0.047), average pRNFL (p = 0.006), average MT (p = 0.001) and average GC-IPL (p = 0.001) differed significantly between different stages of NDCKD. There was no correlation between pRNFL thickness and MT with duration of NDCKD. Conclusion CST, average MT, average GC-IPL thickness, average pRNFL and all quadrants of pRNFL except the temporal quadrant were significantly thinner in NDCKD patients compared to controls. These changes were associated with the severity of CKD, but not its duration.
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Affiliation(s)
- Jun Yong Chow
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
- * E-mail: (MLCB); (JYC)
| | - Poh Fong She
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
| | - Xu Kent Pee
- Department of Ophthalmology, Hospital Umum Sarawak, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Wan Norliza Wan Muda
- Department of Ophthalmology, Hospital Tengku Ampuan Afzan, Ministry of Health, Kuantan, Pahang, Malaysia
| | - Mae-Lynn Catherine Bastion
- Faculty of Medicine, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
- * E-mail: (MLCB); (JYC)
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Rauscher FG, Wang M, Francke M, Wirkner K, Tönjes A, Engel C, Thiery J, Stenvinkel P, Stumvoll M, Loeffler M, Elze T, Ebert T. Renal function and lipid metabolism are major predictors of circumpapillary retinal nerve fiber layer thickness-the LIFE-Adult Study. BMC Med 2021; 19:202. [PMID: 34488766 PMCID: PMC8422631 DOI: 10.1186/s12916-021-02064-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Circumpapillary retinal nerve fiber layer thickness (cpRNFLT) as assessed by spectral domain optical coherence tomography (SD-OCT) is a new technique used for the detection and evaluation of glaucoma and other optic neuropathies. Before translating cpRNFLT into clinics, it is crucially important to investigate anthropometric, biochemical, and clinical parameters potentially affecting cpRNFLT in a large population-based dataset. METHODS The population-based LIFE-Adult Study randomly selected 10,000 participants from the population registry of Leipzig, Germany. All participants underwent standardized systemic assessment of various cardiometabolic risk markers and ocular imaging, including cpRNFLT measurement using SD-OCT (Spectralis, Heidelberg Engineering). After employing strict SD-OCT quality criteria, 8952 individuals were analyzed. Multivariable linear regression analyses were used to evaluate the independent associations of various cardiometabolic risk markers with sector-specific cpRNFLT. For significant markers, the relative strength of the observed associations was compared to each other to identify the most relevant factors influencing cpRNFLT. In all analyses, the false discovery rate method for multiple comparisons was applied. RESULTS In the entire cohort, female subjects had significantly thicker global and also sectoral cpRNFLT compared to male subjects (p < 0.05). Multivariable linear regression analyses revealed a significant and independent association between global and sectoral cpRNFLT with biomarkers of renal function and lipid profile. Thus, thinner cpRNFLT was associated with worse renal function as assessed by cystatin C and estimated glomerular filtration rate. Furthermore, an adverse lipid profile (i.e., low high-density lipoprotein (HDL) cholesterol, as well as high total, high non-HDL, high low-density lipoprotein cholesterol, and high apolipoprotein B) was independently and statistically significantly related to thicker cpRNFLT. In contrast, we do not observe a significant association between cpRNFLT and markers of inflammation, glucose homeostasis, liver function, blood pressure, or obesity in our sector-specific analysis and globally. CONCLUSIONS Markers of renal function and lipid metabolism are predictors of sectoral cpRNFLT in a large and deeply phenotyped population-based study independently of previously established covariates. Future studies on cpRNFLT should include these biomarkers and need to investigate whether incorporation will improve the diagnosis of early eye diseases based on cpRNFLT.
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Affiliation(s)
- Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Mengyu Wang
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Mike Francke
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Anke Tönjes
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Joachim Thiery
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Markus Loeffler
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Ebert
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.
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Wysocka-Mincewicz M, Gołębiewska J, Baszyńska-Wilk M, Olechowski A. Gender-Specific Risk Factors for the Development of Retinal Changes in Children with Type 1 Diabetes. J Pers Med 2021; 11:588. [PMID: 34205725 PMCID: PMC8235352 DOI: 10.3390/jpm11060588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/29/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to determine gender-specific risk factor sets which could influence optical coherence tomography (OCT) results in children with type 1 diabetes (T1D). MATERIAL AND METHODS 175 children with T1D without symptoms of diabetic retinopathy were enrolled, but 330 eyes were used for the final analysis (168 children, mean age 12.81 ± 3.63 years, diabetes duration 4.59 ± 3.71 years). The multivariate regression models for retinal thickness (foveal FT, and parafoveal PFT) and vascular densities (superficial and deep) were carried out separately for both genders using all metabolic and demographic parameters. RESULTS In the statistically significant multiple regression models for all analyzed OCT parameters for both genders, pH at the onset of diabetes were in existence, as well as for retinal thickness current HbA1c. Duration of continuous insulin infusion (CSII) was an important factor in all parameters, except PFT. For the girls, the most significant factors were daily insulin dose, uric acid, and triglycerides, but for the boys, it was serum creatinine, systolic pressure, and free thyroxine level. CONCLUSIONS We detected significant risk factors set for development of OCT parameters changes, and they were not identical for both genders. Current metabolic control, diabetic ketoacidosis at the disease onset, serum creatinine and longer use of CSII are the most important factors for retinal thickness and vessel densities in both genders in children with type 1 diabetes. For the girls, elements of metabolic syndrome (uric acid and triglycerides) and parameters of insulin amount were more pronounced.
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Affiliation(s)
- Marta Wysocka-Mincewicz
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | | | - Marta Baszyńska-Wilk
- Clinic of Endocrinology and Diabetology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | - Andrzej Olechowski
- Ophthalmology Department, South TEES Hospitals NHS Foundation Trust the James Cook University Hospital, Marton Road, Middlesbrough S4 3BW, UK;
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9
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Gong X, Wang W, Li W, Jin L, Wang L, Meng J, Xiong K, Li Y, Han X, Liang X, Huang W. Association between renal function and retinal neurodegeneration in Chinese patients with type 2 diabetes mellitus. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:560. [PMID: 33987258 DOI: 10.21037/atm-20-6957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic kidney disease (CKD) and diabetic retinopathy (DR) are two serious complications of diabetes. However, the association between retinal neurodegeneration in DR and renal function decline is still unclear. Our objective was to evaluate the association by measure estimated glomerular filtration rate (eGFR), macular ganglion cell-inner plexiform layer (GC-IPL), and ganglion cell complex (GCC) thickness in patients with type 2 diabetes mellitus (T2DM). Methods We analyzed the baseline data of the Guangzhou Diabetic Eye Study. T2DM patients from communities in Guangzhou were enrolled and all participants went through ophthalmic and general examinations. The thickness of the macular GC-IPL and GCC in their right eyes were measured by swept-source optical coherence tomography. CKD was defined as eGFR <60 mL/min/1.73 m2. Results One thousand three hundred and nine patients were included (mean age 64.4±7.6 years, 59.1% female), and fifty-eight (4.4%) of them had CKD. Average macular GC-IPL thickness was significantly thinner in CKD patients (96.5±9.1 µm) than non-CKD patients (101.3±9.2 µm) (P<0.01). Average macular GCC thickness was also significantly thinner in CKD patients (123.5±13.2 µm) than non-CKD patients (129.9±12.8 µm) (P<0.01). The significant thinning of macular GC-IPL and GCC thickness presented in every gird in the macula (all, P<0.05) except for central grid (P≥0.05). In the patients without DR, the eGFR was linearly correlated with the average macular GC-IPL thickness [β=0.07 (95% CI, 0.02-0.12), P<0.01] and GCC thickness [β=0.09 (95% CI, 0.03-0.16), P<0.01] after adjustment for age, sex, axial length, intraocular pressure (IOP) and combination of hypertension. However, no linear correlation was found between eGFR and macular GC-IPL or GCC thickness in DR patients. Conclusions Renal function decrease is associated with the thinning of the macular GC-IPL and GCC in T2DM patients, suggesting the potential value of ganglion cell lose to detect early function decline in the kidney in diabetic patients, especially in patients without DR.
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Affiliation(s)
- Xia Gong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Wangting Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Lanhua Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Jie Meng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Kun Xiong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Yuting Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Xiao Han
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiaoling Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
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Wu YB, Wang CG, Xu LX, Chen C, Zhou XB, Su GF. Analysis of risk factors for progressive fibrovascular proliferation in proliferative diabetic retinopathy. Int Ophthalmol 2020; 40:2495-2502. [PMID: 32468429 DOI: 10.1007/s10792-020-01428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the risk factors associated with progressive fibrovascular proliferation (FVP) in proliferative diabetic retinopathy (PDR). METHODS We retrospectively reviewed the clinical data of patients who underwent pars plana vitrectomy for PDR between August 2017 and October 2019 at our department of ophthalmology. The FVP was divided into five grades based on the coverage area of proliferative membrane. Then we compared the patients with different severities of FVP to analyze the risk factors for higher grade of FVP in PDR. RESULTS Univariate analysis showed that positive urinary protein (p = 0.007), higher levels of serum blood urea nitrogen (BUN) (p < 0.001) and serum creatinine (p < 0.001), more severe stage of estimated glomerular filtration rate (p < 0.001), age < 45 years (p = 0.005), longer duration of diabetic retinopathy (p = 0.007), history of hypertension (p = 0.034) and smoking (p = 0.008) were related to FVP grade ≥ 3. Multivariate analysis showed that the level of BUN, age < 45 years and smoking were independent risk factors for FVP grade ≥ 3 in PDR patients. CONCLUSION This study demonstrated that BUN (odds ratio [OR] = 1.318, 95% confidence interval [CI] = 1.150-1.511, p < 0.001), age ≤ 45 years (OR = 3.774, 95% CI = 1.762-8.082, p = 0.001) and smoking (OR = 2.111, 95% CI = 1.040-4.288, p = 0.039) were independent risk factors for progressive FVP in PDR among northeastern Chinese patients.
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Affiliation(s)
- Yu-Bo Wu
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China
| | - Chen-Guang Wang
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China
| | - Ling-Xian Xu
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China
| | - Chen Chen
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China
| | - Xue-Bin Zhou
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China
| | - Guan-Fang Su
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, No. 218, ChangChun, Ziqiang Street, Changchun, 130041, People's Republic of China.
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Cho BJ, Bae SH, Park SM, Shin MC, Park IW, Kim HK, Kwon S. Comparison of systemic conditions at diagnosis between central retinal vein occlusion and branch retinal vein occlusion. PLoS One 2019; 14:e0220880. [PMID: 31393915 PMCID: PMC6687171 DOI: 10.1371/journal.pone.0220880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/25/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To compare systemic conditions at the time of diagnosis between patients with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Design This study included patients diagnosed with CRVO or BRVO between February 2009 and August 2017 at three branch hospitals of Hallym University Medical Center. Demographic and anthropometric variables, systemic comorbidity profiles, and laboratory findings at diagnosis were collected from a clinical data warehouse system, and were compared between the CRVO and BRVO groups. Result Four hundred and seventeen patients with CRVO and 1,511 patients with BRVO were included. The mean age was 61.8 ± 13.9 years, which was comparable between two groups (P = .332). Female proportion was higher in the BRVO group (55.0%) than in the CRVO group (48.0%; P = .013). Diabetes mellitus (P = .017) and chronic kidney disease (P = .004) were more prevalent in the CRVO group. Serum homocysteine level was abnormally high in 23.5% of CRVO patients and in 8.4% of BRVO patients (P < .001). Blood urea nitrogen and serum creatinine levels were abnormally elevated in more subjects with CRVO (P = .002). Conclusion CRVO is associated with higher prevalence of diabetes mellitus and chronic kidney disease, as well as with elevated serum homocysteine level. These results might suggest a difference between the pathophysiologies of CRVO and BRVO.
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Affiliation(s)
- Bum-Joo Cho
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - So Hyun Bae
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Sang Min Park
- Cardiovascular Center, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Min Chul Shin
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - In Won Park
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ha Kyoung Kim
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- * E-mail:
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12
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Jung SH, Jeon S, Park CK, Park HYL. Associations between Retinal Nerve Fiber Layer Defect and Systemic Indices According to the KNHNES 2010–2012. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.11.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Suk Hoon Jung
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sooji Jeon
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Madanagopalan VG, Kumari B. Predictive Value of Baseline Biochemical Parameters for Clinical Response of Macular Edema to Bevacizumab in Eyes With Central Retinal Vein Occlusion: A Retrospective Analysis. Asia Pac J Ophthalmol (Phila) 2018; 7:321-330. [PMID: 29082677 DOI: 10.22608/apo.2017205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the influence of baseline biochemical parameters on the improvement in best corrected visual acuity (BCVA) and reduction in central foveal thickness (CFT) in patients treated with intravitreal bevacizumab (IVB; Avastin, Genentech, Inc) for macular edema (ME) secondary to central retinal vein occlusion (CRVO). DESIGN A retrospective study. METHODS Seventy eyes of 70 participants with CRVO who underwent IVB for ME and had at least 1 month of follow-up after the last injection were studied. Demographic variables, systolic and diastolic blood pressure (SBP and DBP), BCVA, CFT measured by optical coherence tomography (OCT), and biochemical investigations [hemoglobin, fasting and postprandial blood sugar (FBS and PPBS), lipid profile, blood urea (BU), serum creatinine (SC), glycosylated hemoglobin (HbA1c)] at baseline were noted. IVB need at every visit was based on clinical and OCT parameters. Changes in BCVA (ΔBCVA) and CFT (ΔCFT) from baseline to last injection were estimated. RESULTS After IVB, there was a statistically significant reduction in mean CFT (P < 0.01). The group of patients with normal BU and SC had more than 2 lines of improvement compared with those with elevated values (P = 0.043 and 0.009, respectively). Other parameters like FBS, PPBS, hemoglobin, HbA1c, and serum lipids were not associated with improvement of BCVA and reduction of CFT. CONCLUSIONS Normal baseline renal parameters (BU and SC) predict better visual outcome after treatment for ME in CRVO and offer additional benefit over and above that obtained with ME reduction.
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Affiliation(s)
- V G Madanagopalan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Bibha Kumari
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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14
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Azeze TK, Sisay MM, Zeleke EG. Incidence of diabetes retinopathy and determinants of time to diabetes retinopathy among diabetes patients at Tikur Anbessa Hospital, Ethiopia: a retrospective follow up study. BMC Res Notes 2018; 11:542. [PMID: 30068385 PMCID: PMC6071390 DOI: 10.1186/s13104-018-3660-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Data regarding diabetes retinopathy and associated factors are currently lacking in Ethiopia. The study aims to determine the incidence and determinants of time to diabetes retinopathy among diabetes mellitus patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. RESULTS The incidence of diabetes retinopathy is a rapidly growing burden of disease in Ethiopia. The incidence rate of diabetes retinopathy was 2.65 (95% CI 2. 54, 4.05) per 1000 person-years observation. Moreover, 70 (18.57%, 95% CI 14.63, 22.5) DM patients developed diabetes retinopathy. The median time was 74.07 months (with IQR 53.60, 89.88). Male sex (AHR = 1.94, 95% CI = 1.10, 3.39), type 2 DM (AHR = 4.01, 95% CI = 1.34, 12.00), creatinine (AHR = 2.59, 95% CI = 1.91, 3.52), borderline triglyceride (AHR = 2.87, 95% CI 1.33, 6.21) and high triglyceride levels (AHR = 2.59, 95% CI = 1.31, 4.97) were positively correlated factors to diabetes retinopathy occurrence. Multisectoral, population-based approaches are needed to reduce type 2 DM complications.
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Affiliation(s)
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Lamparter J, Schmidtmann I, Schuster AK, Siouli A, Wasielica-Poslednik J, Mirshahi A, Höhn R, Unterrainer J, Wild PS, Binder H, Lackner K, Beutel ME, Münzel T, Pfeiffer N, Hoffmann EM. Association of ocular, cardiovascular, morphometric and lifestyle parameters with retinal nerve fibre layer thickness. PLoS One 2018; 13:e0197682. [PMID: 29787603 PMCID: PMC5963756 DOI: 10.1371/journal.pone.0197682] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 05/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Glaucoma is a neurodegenerative disease, leading to thinning of the retinal nerve fibre layer (RNFL). The exact influence of ocular, cardiovascular, morphometric, lifestyle and cognitive factors on RNFL thickness (RNFLT) is unknown and was analysed in a subgroup of the Gutenberg Health Study (GHS). Methods Global peripapillary RNFLT was measured in 3224 eyes of 1973 subjects (49% female) using spectral-domain optical coherence tomography (SD-OCT). The association of age, sex, ocular, cardiovascular, morphometric, lifestyle and cognitive factors on RNFLT was analysed using Pearson correlation coefficient and fitting a linear mixed model. Results In the univariable analysis highest correlations were found for axial length (r = -0.27), spherical equivalent (r = 0.24), and glaucoma (r = -0.15) (p<0.0001, respectively). Other significant correlations with RNFLT were found for age, sex, intraocular pressure, systemic hypertension and systolic blood pressure, previous eye surgery, cholesterol, homocysteine, history of coronary artery disease, history of myocardial infarction, apnoea, diabetes and alcohol intake, p<0.05, respectively. Body length, body weight, BMI, diastolic blood pressure, blood glucose, HbA1c, history of apoplexy, cognitive function, peripheral artery disease, tinnitus, migraine, nicotine intake, central corneal thickness, and pseudophakia were not significantly correlated with RNFLT. The regression model revealed a significant relationship between RNFLT and age in decades (p<0.02), spherical equivalent (p<0.0001), axial length (p<0.0001), glaucoma (p<0.0001), tinnitus (p = 0.04), apnoea (p = 0.047), homocysteine (p = 0.05) and alcohol intake >10g/d for women and >20g/d for men (p = 0.02). Glaucoma, apnoea, higher homocysteine, higher alcohol intake and higher axial length as well as age were related to decreased RNFLT while higher spherical equivalent or history for tinnitus were related to thicker RNFL. Conclusion RNFLT is related to age, ocular parameters and lifestyle factors. Considering these parameters in normative databases could improve the evaluation of peripapillary RNFLT. It is necessary to evaluate if a reduction of alcohol intake as well as the therapy of apnea or high homocysteine levels could positively influence RNFLT.
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Affiliation(s)
- Julia Lamparter
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Augenzentrum Leinfelden-Echterdingen, Leinfelden-Echterdingen, Germany
- * E-mail:
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology, and Informatics (IMBEI) of the University Medical Center Mainz, Mainz, Germany
| | | | - Angeliki Siouli
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Clinic for Ophthalmology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | | | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Dardenne Eye Hospital, Bonn, Germany
| | - René Höhn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Josef Unterrainer
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine / Center for Cardiology, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Harald Binder
- Institute for Medical Biometry, Epidemiology, and Informatics (IMBEI) of the University Medical Center Mainz, Mainz, Germany
| | - Karl Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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16
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Phadikar P, Saxena S, Ruia S, Lai TYY, Meyer CH, Eliott D. The potential of spectral domain optical coherence tomography imaging based retinal biomarkers. Int J Retina Vitreous 2017; 3:1. [PMID: 28078103 PMCID: PMC5220620 DOI: 10.1186/s40942-016-0054-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023] Open
Abstract
Background Biomarker”, a merged word of “biological marker”, refers to a broad subcategory of medical signs that objectively indicate the state of health, and well-being of an individual. Biomarkers hold great promise for personalized medicine as information gained from diagnostic or progression markers can be used to tailor treatment to the individual for highly effective intervention in the disease process. Optical coherence tomography (OCT) has proved useful in identifying various biomarkers in ocular and systemic diseases. Main body Spectral domain optical coherence tomography imaging-based biomarkers provide a valuable tool for detecting the earlier stages of the disease, tracking progression, and monitoring treatment response. The aim of this review article is to analyze various OCT based imaging biomarkers and their potential to be considered as surrogate endpoints for diabetic retinopathy, age related macular degeneration, retinitis pigmentosa and vitreomacular interface disorder. These OCT based surrogate markers have been classified as retinal structural alterations (macular central subfield thickness and cube average thickness); retinal ultrastructural alterations (disruption of external limiting membrane and ellipsoid zone, thinning of retinal nerve fiber layer and ganglion cell layer); intraretinal microangiopathic changes; choroidal surrogate endpoints; and vitreoretinal interface endpoints. Conclusion OCT technology is changing very quickly and throughout this review there are some of the multiple possibilities that OCT based imaging biomarkers will be more useful in the near future for diagnosis, prognosticating disease progression and as endpoint in clinical trials.
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Affiliation(s)
- Prateep Phadikar
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Surabhi Ruia
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carsten H Meyer
- Department of Ophthalmology, Pallas Klinik, Aarau, Switzerland
| | - Dean Eliott
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA USA
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Dhasmana R, Sah S, Gupta N. Study of Retinal Nerve Fibre Layer Thickness in Patients with Diabetes Mellitus Using Fourier Domain Optical Coherence Tomography. J Clin Diagn Res 2016; 10:NC05-9. [PMID: 27630874 DOI: 10.7860/jcdr/2016/19097.8107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Diabetic retina undergoes degenerative changes in retinal nerve fiber layer (RNFL) in addition to vascular changes. Loss of RNFL with changes in inner retina and their association with metabolic control have been studied with varied results in diabetic patients. AIM To compare the RNFL thickness between diabetic patients and age matched healthy controls and to correlate the thickness to metabolic control. MATERIALS AND METHODS One hundred and sixty five patients were enrolled in the study out of which 50 served as controls, 58 patients were diabetic without retinopathy and 57 patients had diabetic retinopathy. Both eyes of all patients underwent optical coherence tomography scans for RNFL and ganglion cell complex. Foveal and parafoveal thickness were also measured. All the parameters were compared to patient's metabolic control. RESULTS RNFL thinning was observed in superotemporal (p-value = 0.001) and upper nasal sectors (p-value = 0.031) around the optic disc in eyes with diabetic retinopathy. Ganglion cell complex also showed statistically significant thinning in diabetic patients. Creatinine levels showed a weak negative correlation to the RNFL. CONCLUSION This study positively concluded that neurodegeneration in an early component of diabetic retinopathy.
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Affiliation(s)
- Renu Dhasmana
- Professor, Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun, Uttarakhand, India
| | - Sonal Sah
- Retina Fellow, Department of Ophthalmology, Eye Q, Prakash Netra Kendra , NH2, Vipul Khand IV, Gomti Nagar, Lucknow, Uttar Pradesh, India
| | - Neeti Gupta
- Assistant Professor, Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun, Uttarakhand, India
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