Beyond Hyperglycemia, Evidence for Retinal Neurodegeneration in Metabolic Syndrome

Karaca, Cagatay; Karaca, Züleyha

doi:10.1167/iovs.17-23376

Cited by 30 publications

(25 citation statements)

References 46 publications

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“…Furthermore, postmortem human samples and in vivo OCT data show evidence that progressive cell death may eventually lead to the thinning of the retinal layers. Specifically, the inner retinal layers and ganglion cells are thought to be the most vulnerable 50 . According to some human OCT data, loss of ganglion cells may be the first morphological sign of diabetes, preceding clinically detectable vasculopathy 51,52 or even present in metabolic syndrome 53–55 .…”

Section: Discussionmentioning

confidence: 99%

Detailed Evaluation of Possible Ganglion Cell Loss in the Retina of Zucker Diabetic Fatty (ZDF) Rats

Hajdú

Laurik

Szabó

et al. 2019

Sci Rep

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A thinning of the inner retina is one of the earliest potential markers of neuroretinal damage in diabetic subjects. The histological background is uncertain; retinal ganglion cell (RGC) loss and changes in the structure or thickness of the inner plexiform layer (IPL) have been suspected. Studies conducted on animal models on RGC pathology gave contradictory results. Hereby we present RGC numbers, distribution patterns and IPL thickness from Zucker Diabetic Fatty (ZDF) rats. After labelling RGCs on retinal whole mounts, isodensity maps were constructed, RGC numbers and distribution patterns analysed using a custom-built algorithm, enabling point-by-point comparison. There was no change in staining characteristics of the antibodies and no significant difference in average RGC densities was found compared to controls. The distribution patterns were also comparable and no significant difference was found in IPL thickness and stratification or in the number of apoptotic cells in the ganglion cell layer (GCL). Our results provide a detailed evaluation of the inner retina and exclude major RGC loss in ZDF rats and suggest that other factors could serve as a potential explanation for inner retinal thinning in clinical studies. Our custom-built method could be adopted for the assessment of other animal or human retinas.

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Section: Discussionmentioning

confidence: 99%

Detailed Evaluation of Possible Ganglion Cell Loss in the Retina of Zucker Diabetic Fatty (ZDF) Rats

Hajdú

Laurik

Szabó

et al. 2019

Sci Rep

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“…Karaca et al reported that the patients with metabolic syndrome have inner and outer retinal thinning on OCT segmentation analysis. They investigated the retinal neurodegenerative factors in patients with metabolic syndrome other than hyperglycemia and speculated that IR, low grade sytemic inflammation and hypertension-related endothelial damage might have a neurodegenerative effect independent of the hyperglycemia [11].…”

Section: Recentmentioning

confidence: 99%

“…IR was found to cause neuroinflammation and have a role in the pathophysiological mechanisms of some neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, multiple sclerosis and schizophrenia [10]. In recent clinical studies, beyond hyperglycemia, IR itself was shown to cause retinal nerve fiber layer thinning and ganglion cell loss in patients with metabolic syndrome [11,12].…”

Section: Introductionmentioning

confidence: 99%

İnsülin rezistansı bulunan bireylerde retina sinir lifi tabakası kalınlığının değerlendirilmesi

Uzun¹,

Fındık²,

Polat³

2019

Pamukkale Medical Journal

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To measure the retinal nerve fiber layer thickness (RNFLT) in prediabetic subjects who were diagnosed with insulin resistance and to compare with healthy controls. Materials and methods: A standard ophthalmological examination including measurement of best corrected visual acuity and intraocular pressure, anterior segment biomicroscopy and funduscopy was performed. Average and four quadrant (superior, temporal, inferior, nasal) RNFLT measurements were performed using spectral domain optical coherence tomography (OCT). Plasma fasting insulin and glucose levels were noted and homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated. Results: A total of 37 patients with insulin resistance and 41 healthy controls were included in the study. Mean age of the insulin resistant group and healthy controls were 35.7±9.8 and 34.9±10.7 years, respectively. The average (95.03±11.38 µm vs 99.2±19.73 µm), inferior (119.11±18.27 µm vs 127.5±21.03 µm) and temporal (72.13±12.52 µm vs 79.2±15.97 µm) quadrant RNFL were significantly thinner in subjects with insulin resistance as compared with healthy controls (p<0.05). No significant difference was observed between the groups in the superior (121.01±9 µm vs 123.9±01 µm) and nasal (72.03±13.65 µm vs 74.52±10.52 µm) quadrants (p˃0.05). Conclusion: Despite there is lack of clinical findings in prediabetic stage, neurodegeneration of the retina may begin in the insulin resistance stage. OCT is a useful tool both in the early diagnosis and follow-up of retinal neurodegeneration.

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“…The retinal nerve fiber layer (RNFL) is the innermost retinal neural layer consisting of the unmyelinated axons of the retinal ganglion cells, making it ideal for assessment of central nervous system health and possible neurodegeneration [7]. The macula is the central 5 mm of the posterior pole, consisting of the fovea, a 1 mm-in-diameter area centered around a central depression called the foveola, specialized for high spatial acuity and color vision; the parafoveal area, a 2 mm wide ring surrounding the fovea, where the ganglion cell layer, inner nuclear layer, and outer plexiform layer are thickest; and the perifoveal zone, a ring approximately 2 mm wide next to the parafoveal area [8].…”

Section: Introductionmentioning

confidence: 99%

“…Reduced RNFL and macular thickness have been shown to occur in many metabolic diseases such as obesity, diabetes mellitus, and hypertension. Karaca et al found reduced thickness in the inner layers of various areas of the macula in 29 eyes of MetS patients compared to controls [7]. Laiginhas et al found reduced RNFL thickness in obese patients going for bariatric surgery [9].…”

Section: Introductionmentioning

confidence: 99%

Relationship between anthropometric and biochemical changes of metabolic syndrome with retinal nerve fiber layer and macular thickness

et al. 2021

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Objective To evaluate the retinal nerve fiber layer (RNFL) and macular thicknesses and identify systemic risk factors for thinning of these layers in patients with metabolic syndrome (MetS). Methodology A cross-sectional observational study was performed on patients diagnosed with MetS and compared to normal controls. All patients underwent ophthalmic and anthropometric examination, serological and biochemical blood investigations; and ocular imaging using spectral-domain optical coherence tomography. Patients with ocular pathology were excluded. Unpaired t-test was used to compare mean thickness between the two groups. One-way ANOVA with Bonferroni correction for multiple comparisons was used to compare mean thickness between different tertiles of MetS parameters, and a generalized estimating equation was used to correct for inter-eye correlation and to assess association between mean thickness and covariates. Results Two hundred and forty-eight eyes from 124 participants (1:1 ratio of MetS patients to controls) were included. Age ranged between 30 to 50 years old, and mean age was 40 ± 6.6 years. RNFL thickness was lower globally (93.6 ± 9.9 μm vs 99.0 ± 9.3, p<0.001) and in the inferior (124.5 ± 17.5 μm vs 131.0 ± 16.4 μm, p = 0.002), superior (117.2 ± 16.0 μm vs 126.3 ± 14.4 μm, p<0.001) and temporal (65.5 ± 10.2 μm vs 69.5 ± 9.8, p = 0.002) sectors in MetS patients compared to controls. Only the central (237.0 ± 14.0 μm vs 243.6 ± 18.0 μm, p = 0.002) and inferior parafoveal (307.8 ± 20.9 vs 314.6 ± 14.6, p = 0.004) area of the macula was significantly thinner. The inferior RNFL sector had the most difference (mean difference = 9.1 μm). The Generalized Estimating Equation found that, after adjusting for age, diastolic blood pressure, BMI, HDL and obesity; the number of MetS components and elevated triglyceride levels were independent risk factors for reduced thickness in global RNFL (β = -4.4, 95% CI = -7.29 to -1.5, p = 0.003) and inferior parafovea (β = -6.85, 95% CI = -11.58 to -2.13, p = 0.004) thickness respectively. Conclusion RNFL thinning was seen more than macula thinning in MetS patients, suggesting RNFL susceptibility to neurodegeneration than the macula. A higher number of metabolic components and elevated triglyceride levels were independent risk factors for retinal thinning in this group of patients.

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Beyond Hyperglycemia, Evidence for Retinal Neurodegeneration in Metabolic Syndrome

Cited by 30 publications

References 46 publications

Detailed Evaluation of Possible Ganglion Cell Loss in the Retina of Zucker Diabetic Fatty (ZDF) Rats

Detailed Evaluation of Possible Ganglion Cell Loss in the Retina of Zucker Diabetic Fatty (ZDF) Rats

İnsülin rezistansı bulunan bireylerde retina sinir lifi tabakası kalınlığının değerlendirilmesi

Relationship between anthropometric and biochemical changes of metabolic syndrome with retinal nerve fiber layer and macular thickness

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