Visual Field Loss in Patients With Diabetes in the Absence of Clinically-Detectable Vascular Retinopathy in a Nationally Representative Survey.

Yicheng K Bao,Mae Gordon,Michael Kass,Yan Yan,Janet B Mcgill,Rithwick Rajagopal

doi:10.1167/iovs.19-28063

Abstract

PurposeNeuroretinopathy is increasingly being recognized as an independent cause of vision loss in diabetes. Visual field loss, as detected by frequency doubling technology (FDT)-based visual perimetry, is a sign of neuroretinopathy and occurs in early stages of diabetic retinopathy (DR). Here, we hypothesized that FDT visual field testing could identify patients with diabetic neuroretinopathy in the absence of clinically detectable microvascular DR.MethodsAll National Health and Nutrition Examination Survey (NHANES) 2005–2008 participants receiving fundus photography and visual field screening by FDT were included in this study. Participants with self-reported glaucoma, use of glaucoma medications, or determination of glaucoma based on disk features were excluded. Visual fields were screened using FDT protocol in which participants underwent a 19-subfield suprathreshold test.ResultsPatients with diabetes but no DR were more likely to have ≥1 subfield defects at 5%, 2%, and 1% probability levels than patients without diabetes (41.3% vs. 28.6%; 27.4% vs. 17.5%; 15.9% vs. 9.4%; all P < 0.0008). Multivariable regression showed that each additional glycated hemoglobin % (HbA1c) was associated with 19% greater odds of having ≥1 visual subfield defects in those with diabetes without DR (odds ratio: 1.19, 95% confidence interval: 1.07–1.33; P = 0.0020).ConclusionsPatients with diabetes have visual field defects in the absence of clinically detectable DR, suggesting neuroretinopathy precedes classical microvascular disease. These defects become more frequent with the onset of visible retinopathy and worsen as the retinopathy becomes more severe. Longitudinal studies are required to understand the pathogenesis of diabetic neuroretinopathy in relation to classic DR.

Highlights

Patients with diabetes have visual field defects in the absence of clinically detectable diabetic retinopathy (DR), suggesting neuroretinopathy precedes classical microvascular disease. These defects become more frequent with the onset of visible retinopathy and worsen as the retinopathy becomes more severe
Current diagnostic criteria for diabetes established by the American Diabetes Association are based on plasma glucose levels associated with the incidence of moderate DR in large, population-based studies.[1]
We report findings from a secondary analysis of a large cohort representative of the US noninstitutionalized civilian population showing that patients with diabetes, but no clinically detectable DR, have significant frequency doubling technology (FDT)-detected field loss and that these patterns of field loss worsen during the course of classical DR

Summary

Introduction

McGill Michael Kass See page for additional authors. Neuroretinopathy is increasingly being recognized as an independent cause of vision loss in diabetes. As detected by frequency doubling technology (FDT)-based visual perimetry, is a sign of neuroretinopathy and occurs in early stages of diabetic retinopathy (DR).

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Conclusion