Abstract 15681: Endothelial Dysfunction, Arterial Stiffness and Inflammation Are Associated With Visual Impairment in Diabetic Patients

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Introduction: Diabetic Retinopathy (DR) is a complication of diabetes mellitus (DM) leading to deterioration of vision. Hypothesis: We investigated the possible association of vascular function and inflammation with visual acuity in subjects with DM. Methods: We enrolled 100 consecutive subjects with DM. Patients were divided in those with DR (53 subjects, mean age 68±9) and those with no evidence of DR (NDR) (mean age 66±6). The diagnosis of DR was made by ophthalmoscopy and best-corrected visual acuity (BCVA) was measured in both eyes. A BCVA less than 0.8 was considered as severely impaired. Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery and arterial stiffness was evaluated by carotid femoral pulse wave velocity (PWV). C reactive protein (CRP) and interleukin 6 (IL6) levels were measured. Results: Patients with DR compared to NDR patients had impaired FMD (3.42±1.08% vs. 5.39±1.47%, p<0.001), impaired PWV (11.10±3.11m/sec vs. 9.02±2.13m/sec, p=0.001) and worse BCVA (p<0.001). Moreover in DM subjects, BCVA was positively correlated with FMD, creatinine clearance, and inversely correlated with PWV, glycosylated hemoglobin levels, C- reactive protein levels, IL6 levels, age and with duration of diabetes mellitus (p<0.01 for all). Interestingly, after adjustment for age, smoking habits and the aforementioned confounders, FMD, IL6 levels, DM duration and male gender were independently associated with BCVA (p<0.05 for all). Moreover, ROC curve analysis revealed that both impaired FMD (AUC=0.79, p<0.001) and PWV (AUC=0.8, p<0.001) have a significant diagnostic ability in detecting diabetic subjects with severely impaired BCVA. More precisely, FMD less than 4.5% has a sensitivity of 90% and a specificity of 60%, while PWV over 10.0 m/sec has a sensitivity of 83% and a specificity of 68%, for the diagnosis of severely impaired BCVA. Conclusion: Patients with DR have significantly impaired visual acuity witch is associated with impaired vascular function and inflammation. Moreover, both endothelial function and arterial stiffness were high sensitivity predictors of visual impairment highlighting their potential role on the prevention and management of the complications in diabetes mellitus.