Abstract
PurposeVisual outcomes after cataract surgery in diabetic patients with retinal or visual pathway disease are difficult to predict as the fundus may be obscured, and assessment of visual potential is challenging. This study assessed the value of visual electrophysiology as a prognostic indicator of visual recovery in diabetic patients with cataract, prior to cataract surgery.MethodsForty-one diabetic patients (aged 52–80; 74 eyes) and 13 age-matched non-diabetic control patients (21 eyes) were examined prior to cataract surgery. Pre-surgical examinations included best-corrected visual acuity (BCVA), slit-lamp bio-microscopy, ISCEV-standard full-field electroretinography (ffERG), and flash visual evoked potential (flash VEP) testing. Electrophysiological assessments included quantification of the DA and LA ERG, oscillatory potentials (OPs; OP1, OP2, OP3, OP4) and flash VEP P1, P2, and P3 components. Post-operative BCVA was measured in all cases and the diabetic patients grouped according to the severity of visual acuity loss: mild (logMAR ≤ 0.1), moderate (0.1 < logMAR < 0.5), or severe (logMAR ≥ 0.5). A fourth group included those without diabetes. The pre-surgical electrophysiological data was compared between the four groups by analysis of variance.ResultsThe severity of post-surgical visual acuity loss in the diabetic patients was classified as mild (N=22 eyes), moderate (N=31 eyes), or severe (N=21 eyes). In the group without diabetes, post-surgical visual impairment was classified as mild (N=21 eyes). The pre-operative DA 10.0 ERG a-wave amplitudes, DA 3.0 ERG OP2 amplitudes, and the LA 3.0 a- and b-wave amplitudes showed best significant differences among the four groups. The flash VEP did not show significant difference between groups.ConclusionElectrophysiological assessment of diabetic patients with cataract can provide a useful measure of retinal function. Full-field ERG components, including the DA 10.0 ERG a-wave, DA 3.0 ERG OP2 component, and the LA 3.0 a- and b-wave amplitudes, are of prognostic value in predicting post-surgical visual acuity, and may inform the surgical management of cataract patients with diabetes.
Highlights
Type 2 diabetes is one of the most common diseases in older populations and is the major cause of blindness in young adults
Full-field electroretinography and flash visual evoked potential provide objective electrophysiological evaluations of retinal and optic nerve function, respectively [3, 4]. ffERG has been used in the assessment of retinal function associated with microvascular changes in type 2 diabetes [5] and has been used in patients with cataracts [6, 7]
The post-surgical classification of the diabetic patients based on the best-corrected visual acuity (BCVA) values 1 month after cataract surgery resulted in 15 patients (22 eyes) in the mild group; 20 patients (31 eyes) in the moderate group; and 14 patients (21 eyes) in the severe group
Summary
Type 2 diabetes is one of the most common diseases in older populations and is the major cause of blindness in young adults. Full-field electroretinography (ffERG) and flash visual evoked potential (flash VEP) provide objective electrophysiological evaluations of retinal and optic nerve function, respectively [3, 4]. FfERG has been used in the assessment of retinal function associated with microvascular changes in type 2 diabetes [5] and has been used in patients with cataracts [6, 7]. The value of the electrophysiological assessment of retinal and optic nerve function in diabetic patients with cataracts has yet to be established. The main aim of this study was to determine whether ffERG and flash VEP measures of retinal and optic nerve function are prognostic indicators of visual recovery in diabetic patients with significant lens opacities prior to cataract surgery
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