Accommodative parameter assessment in peri-presbyopic early onset diabetics with age matched healthy individuals - A case control study

Abstract

To compare various accommodative parameters in peri-presbyopic diabetic patients with age-matched healthy individuals.To compare Four Accommodative parameters in peri-presbyopic early onset diabetic patients and age matched non-diabetic individuals.1. To compare and analyse Four accommodative parameters in peri-presbyopic early onset diabetics with that of peri-presbyopic age matched non-diabetic individuals (35-45; years); 2. To analyse the effect of treatment / metabolic control on the parameters. 3. To observe, if any, other systemic association that affects accomodation in both cases and controls.Study setting – peri-presbyopic symptomatic patients attending the Ophthalmology outpatient department, from August 2016- December 2016. This cross-sectional case-control study was performed on 50 young onset peri-presbyopic early onset symptomatic diabetics and 50 age-matched peri-presbyopic, Non-diabetic individuals. Using the best correction for distance visual acuity, multiple accommodative ability tests such as near point of accommodation, accommodative amplitude, negative or positive accommodative facility and near point of convergence were measured in both groups. Statistical analysis made using SPSS version 16 Normality of distribution was checked with Kolmogrov-Smirnov test. Differences in accommodative functions between groups tested using student T test, Man Whitney test and repeated measures of analysis of variances. Level of significance was set at p-values <0.001. Mean NPA, Mean AA and Mean AF were statistically significant (p<0.001).Mean positive RA, Mean negative RA and Mean NPC did not reach statistical significance. Majority of accommodative ability functions are decreased in Peri-presbyopic diabetic patients. Early detection and rehabilitation of such patients with full near vision correction is strongly recommended.

Vision‐related symptoms, accommodative and binocular vision performance in young diabetics vs. normal controls

“…As mentioned earlier, most previous studies focused on the AA, and the effects of DM on other accommodative parameters including AF and AR have been investigated less frequently. In line with the findings of the present study, Sridhar and Ramachandra reported a significantly lower mean AF in young diabetics compared to the control group (5.12 vs. 10.68 cpm) 15 . Additionally, in an investigation by Abokyi et al on young adults with DM, subjects with a higher fasting plasma sugar level (FBS > 7 mmol/L) had a significantly higher accommodative lag than those with a lower FBS (≤7 mmol/L).…”

“…In line with the findings of the present study, Sridhar and Ramachandra reported a significantly lower mean AF in young diabetics compared to the control group (5.12 vs. 10.68 cpm). 15 Additionally, in an investigation by Abokyi et al on young adults with DM, subjects with a higher fasting plasma sugar level (FBS > 7 mmol/L) had a significantly higher accommodative lag than those with a lower FBS (≤7 mmol/L). Moreover, the insulin control of DM for 3 months was associated with a significant reduction in the mean accommodative lag from 1.37 to 0.87 D (p < 0.001).…”

“…Due to the serious consequences of DR, numerous studies have been conducted on this complication and most ocular studies of DM in recent years were related to DR. 10 Ocular accommodation can be affected by diabetic hyperglycaemia, and previous studies have reported lower accommodative amplitude (AA) in young subjects with DM. [11][12][13][14][15][16][17] It seems that the loss of AA in diabetics is mainly due to changes in the crystalline lens. The crystalline lens has been shown to be thicker, more convex and less elastic in young pre-presbyopic diabetic subjects compared with age-matched controls.…”

Accommodative disorders in non‐presbyopic subjects with type 1 diabetes without retinopathy: A comparative, cross‐sectional study

“…On the other hand, Etezad et al 31 found significantly higher PRA in a T1D group compared with controls, whereas here, similar values were found in the two groups, consistent with Srihard and Ramachandra. 9 It should also be noted that there were significant differences in age between the two groups of participants in Etezad et al 31 However, as NRA and PRA are measured under binocular conditions, they are tests of both the accommodative and vergence system, and therefore should only be considered as supplementary tests in the diagnosis of accommodative disorders.…”

“…6 With regard to accommodation in individuals with diabetes, as a product of hyperglycaemia the proteins of the lens are lost, leading to a decline in elasticity and the ability to focus on near objects. Therefore, some authors have suggested that these subjects have decreased accommodative power for their age compared with patients without diabetes, [7][8][9][10] and in some cases, these changes are related to glycaemic control, with contradictory results in this regard. [11][12][13] Variations within the crystalline lens could lead to accommodative disorders, that is, visual disturbances that affect the subject's binocular vision and visual performance, particularly when performing near-vision tasks.…”