Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

Josef Huemer,Konstantinos Balaskas,Edward Korot,Neringa Jurkute,Catherine A Egan,Livia Faes,Daniel Ferraz,Hagar Khalid,Axel Petzold,Pearse A Keane

doi:10.1038/s41433-021-01664-1

Abstract

Background/ObjectivesTo re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness.Subjects/MethodsIn this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling.ResultsThe mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm3, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm3. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001).ConclusionAfter resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.

Highlights

Diabetic papillopathy is defined as uni- or bilateral optic nerve head swelling which is aetiologically thought to be directly caused by diabetes mellitus, and was first described in 1971 [1]
Diabetic papillopathy was defined as disc swelling with no or mild optic nerve dysfunction in the presence of diabetes, the Between June 2008 and July 2019, 451 patients with diabetes presented to the Moorfields Eye Hospital NHS Foundation Trust with optic disc swelling
In 169 eyes of 158 patients, diabetic papillopathy or non-arteritic ischaemic optic neuropathy (NAION) was diagnosed by a comprehensive neuroophthalmological assessment including visual fields and optical coherence tomography (OCT), or, if indicated, magnetic resonance imaging after exclusion of other causes of optic disc swelling

Summary

INTRODUCTION

Diabetic papillopathy is defined as uni- or bilateral optic nerve head swelling which is aetiologically thought to be directly caused by diabetes mellitus, and was first described in 1971 [1]. While diabetic papillopathy and NAION have a similar structural phenotype at presentation in terms of optic disc swelling, anatomical and functional prognosis is significantly worse in NAION, eventually resulting in optic nerve head atrophy and permanently impaired visual fields or visual acuity [11]. Functional assessments such as visual field testing and visual acuity assessment at presentation are used in daily ophthalmological practice to differentiate between diabetic papillopathy and NAION. The aim of this exploratory study was to evaluate OCT and a global volume measurement of all quadrants combined.

RESULTS

DISCUSSION

Summary What was known before