Abstract
PurposeThe purpose of this study was to evaluate the role of photopic full-field electroretinography (ERG) and retinal thickness measurements by spectral-domain optical coherence tomography (SD-OCT) in the assessment of disease severity in type 1 diabetic retinopathy.MethodsA population-based cohort of 151 patients with type 1 diabetes underwent a complete ophthalmic examination, including photopic full-field ERG and SD-OCT for retinal thickness measurements. Stereoscopic fundus photographs were taken according to the Early Treatment Diabetic Retinopathy Study protocol, and the classification of diabetic retinopathy was based on the International Clinical Diabetic Retinopathy Disease Severity Scale. Associations between photographically determined retinopathy level, b-wave amplitude and peak time of the photopic single-flash and 30-Hz flicker ERG, and central retinal thickness parameters were evaluated.ResultsFor all ERG measurements, the amplitude decreased and peak time increased with progression of the disease, but these associations lost statistical significance after adjusting for age and excluding laser-treated patients. Mean retinal thickness was significantly associated with the b-wave amplitude of photopic single-flash and 30-Hz flicker responses (r2 = 0.08, p = 0.006; and r2 = 0.05, p = 0.025, respectively), but revealed no association with retinopathy level.ConclusionsPhotopic full-field ERG and SD-OCT-derived retinal thickness parameters have limited clinical value in the staging of diabetic retinopathy. However, thinning of the central retina leads to significant functional impairment and may reflect an ongoing neurodegenerative process in the retinal tissue.
Highlights
The global prevalence of diabetes mellitus has been rapidly increasing, and it has become a disease of epidemic proportions [1]
The majority of the patients included in the epidemiologic study of diabetic retinopathy in Western Norway agreed to participate in the present ERG and SD-OCT study
In light of current concepts of neurodegeneration in the pathogenesis of diabetic retinopathy, additional diagnostic tools like ERG and Spectral domain optical coherence tomography (SDOCT) may be of value in the management of the disease
Summary
The global prevalence of diabetes mellitus has been rapidly increasing, and it has become a disease of epidemic proportions [1]. Despite significant advances in medical and surgical management, diabetic retinopathy remains one of the most frequent and serious complications of diabetes These trends necessitate early diagnosis and improved monitoring of ocular disease in order to optimize patient care and to reduce the burden of illness on patients and society. One of the earliest signs of diabetic retinopathy, sometimes even preceding the vascular changes, is a reduction in the amplitude and an increase in the peak time (implicit time) of the oscillatory potentials [12, 13]. A reduction in amplitude and delayed peak time of the b-wave in single-flash and 30-Hz flicker ERG have been identified as significant markers of diabetic retinopathy, but are associated with more advanced disease [11, 16]. Using photopic single-flash ERG, Satoh et al found a delayed peak time and reduced b-wave amplitude, noting that peak time showed the highest association with progression of retinopathy [19]
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