Abstract
Background Currently, diabetic retinopathy (DR) has a wide recognition as a neurovascular rather than a microvascular diabetic complication with an increasing need for enhanced detection approaches. Pattern-reversal visual evoked potentials (PRVEPs) test, as an objective electrophysiological measure of the optic nerve and retinal function, can be of great value in the detection of diabetic retinal changes. Objectives The use of two sizes of checkerboard PRVEPs testing to detect any neurological changes in persons with type 2 diabetes mellitus (T2DM) with and without a clinically detected DR. Also, to compare the results according to the candidate age, duration, and glycemic status of T2DM. Methods This study included 50 candidates as group A with T2DM and did not have a clinically detected DR and 50 candidates as group B with T2DM and had a clinically detected early DR and 50 candidates as controls who were neither diabetic nor had any other medical or ophthalmic condition that might affect PRVEPs test results. The PRVEPs were recorded in the consultant unit of ophthalmology in Almawani Teaching Hospital. Monocular PRVEPs testing of both eyes was done by using large (60 min) and small (15 min) checks to measure N75 latency and P100 latency and amplitude. Results There was a statistically significant P100 latency delay and P100 amplitude reduction in both groups A and B in comparison with the controls. The difference between groups A and B was also significant. In both test results of groups A and B, the proportions of abnormal P100 latency were higher than those of P100 amplitude with a higher abnormal proportions in 15 min test. Conclusions The PRVEP test detected neurological changes, mainly as conductive alterations affecting mostly the foveal region prior to any overt DR clinical changes, and these alterations were heightened by the presence of DR clinical changes.
Highlights
Diabetic retinopathy (DR) has a wide recognition as a neurovascular rather than a microvascular diabetic complication with an increasing need for enhanced detection approaches
E visual evoked potentials (VEPs) test is the primary tool and is superior to the magnetic resonance imaging (MRI) in assessing the functional integrity of the anterior visual pathways [5]. e pattern-reversal VEPs (PRVEPs) test is the standard and ideal modality for most clinical uses as it is less variable in timing and waveform than other VEP modalities. e use of large and small size checks is recommended by the International Society for Clinical Electrophysiology of Vision (ISCEV) standards [6]. e large size (60 min) mainly stimulates the retinal neural elements
Informed consents were taken from them. e study included 150 participants randomly who attended the ophthalmology consultant unit in Almawani Teaching Hospital. e age of the candidates was restricted to forty years and above at time of diabetes mellitus (DM) first diagnosed to limit the study to type 2 diabetes mellitus (T2DM) [10]. e candidates were divided into group A which included 50 persons with T2DM and did not have a clinically detected diabetic retinopathy (DR) and group B which included 50 persons with T2DM and had a clinically detected mildmoderate nonproliferative DR (NPDR) [11] (Supplementary Figure 1) and 50 candidates as the control group who were free from DM and did not have any of the exclusion criteria
Summary
Diabetic retinopathy (DR) has a wide recognition as a neurovascular rather than a microvascular diabetic complication with an increasing need for enhanced detection approaches. Pattern-reversal visual evoked potentials (PRVEPs) test, as an objective electrophysiological measure of the optic nerve and retinal function, can be of great value in the detection of diabetic retinal changes. E use of two sizes of checkerboard PRVEPs testing to detect any neurological changes in persons with type 2 diabetes mellitus (T2DM) with and without a clinically detected DR. Is study included 50 candidates as group A with T2DM and did not have a clinically detected DR and 50 candidates as group B with T2DM and had a clinically detected early DR and 50 candidates as controls who were neither diabetic nor had any other medical or ophthalmic condition that might affect PRVEPs test results. Neurology Research International responsible for peripheral vision (parafovea), while the small size (15 min) mainly stimulates the retinal neural elements responsible for central vision (fovea) [7, 8]. The P100 amplitude and waveform abnormalities may indicate axon loss in the visual pathway [9]
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