Correlation between corneal and retinal neurodegenerative changes and their association with microvascular perfusion in type <scp>II</scp> diabetes

Häfner, Julia; Karst, Sonja; Sacu, Stefan; Scholda, Christoph; Pablik, Eleonore; Schmidt–Erfurth, U.

doi:10.1111/aos.13938

Cited by 14 publications

(5 citation statements)

References 21 publications

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“…Although we found reductions in both the RNFL and corneal nerve parameters independently, we and others (51) found no correlation between neural changes in the retina (central nervous system) and cornea (peripheral nervous system). At present, the reason for this finding is unclear.…”

Section: Discussioncontrasting

confidence: 92%

Neurodegeneration of the cornea and retina in patients with type 1 diabetes without clinical evidence of diabetic retinopathy

Carmichael

Fadavi²,

Tavakoli³

2022

Front. Endocrinol.

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AimDiabetic retinopathy (DR) is widely considered the earliest and most common microvascular complication of diabetes. However, recent studies have shown that retinal nerve fiber layer and corneal nerve abnormalities may be present in diabetic patients without retinopathy. This preliminary study aimed to establish if structural and functional changes in the nerve fiber layer of the retina and cornea occur in patients with type 1 diabetes (T1DM) without retinopathy.MethodsTwenty patients with T1DM, without clinical evidence of retinopathy (Age: 47.0 ± 2.5 years; Duration diabetes: 27.0 ± 3 years) and 15 age-matched healthy control subjects underwent detailed medical neurological examinations. Ophthalmic examinations using Spectral Domain Optical coherence tomography (SD-OCT), Standard Automated Perimetry (SAP), Flicker Defined Form High Edge Perimetry (FDF), Corneal Confocal Microscopy (CCM) and Non-contact corneal Aesthesiometry (NCCA) were performed to quantify the structure and function of the nerves in the retina and cornea, respectively.ResultsAt the structural level, retinal nerve fiber layer thickness (RNFL) was significantly reduced in the superior nasal (p=0.001) and inferior temporal (p=0.004) sectors, in diabetic patients. Retinal ganglion layer function was reduced in the patient group when assessed using Flicker Defined Form Perimetry (FDF), but this was not significant. The function of the cornea assessed by corneal sensitivity, using a non-contact corneal aesthesiometer (NCCA), was significantly reduced (p=0.001). Structural assessment of corneal nerves using corneal confocal microscopy (CCM) showed reduction at corneal nerve fiber density (CNFD) (p=0.01), branch density (CNBD) (p=0.006) and length (CNFL) (p=0.01) in patients with diabetes. Compared to control subjects, the percentage of abnormality in patients with T1DM for RNFL was 32% while the FDF was abnormal in 61% of patients. Corneal abnormality was observed in 47% for NCCA, 28% for CNFD, and 17% for CNFL. There was no correlation between neuronal damage in the retina and cornea.ConclusionsNeuronal abnormalities were observed in both the retina and cornea of diabetic patients without evidence of retinopathy. The prevalence of structural and functional changes was higher in the retina compared to the cornea. This preliminary study suggests that structural neuronal changes may occur in parallel and correlate with functional changes. The assessment of corneal and retinal nerve structure may be clinically useful for detecting and monitoring the earliest stages of diabetic microvascular abnormalities.

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Section: Discussioncontrasting

confidence: 92%

Neurodegeneration of the cornea and retina in patients with type 1 diabetes without clinical evidence of diabetic retinopathy

Carmichael

Fadavi²,

Tavakoli³

2022

Front. Endocrinol.

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“…Changes detected in this layer can be indicative of neurodegeneration and can potentially occur in patients with DM even before the development of DR. This may be due to damage from chronically elevated blood sugar levels [53][54][55]. A 3-year longitudinal study confirmed significantly faster rates of GC-IPL thinning in eyes that developed incident DR compared to those that remained non-DR, although both groups showed decreased thickness [56].…”

Section: Retinal Neurodegenerationmentioning

confidence: 87%

“…Apart from the GC-IPL, the peripapillary retinal nerve fiber layer (pRNFL) and macular retinal nerve fiber layer (mRNFL) are other important retinal structural parameters that need to be considered for early detection of DR [57][58][59][60]. More recently, Hafner et al reported a significant association between pRNFL but not mRNFL with parafoveal vessel density detected by OCTA [55]. This finding corroborated the result reported by the EU-ROCONDOR study, which demonstrated a strong correlation between narrower retinal arteriolar caliber and thinning of the pRNFL, reflecting the close relationship between microvascular abnormalities and neurodegeneration in the pathophysiology of diabetic retinopathy [61].…”

Section: Retinal Neurodegenerationmentioning

confidence: 99%

Advances in Structural and Functional Retinal Imaging and Biomarkers for Early Detection of Diabetic Retinopathy

Zhang,

Deng,

Paulus

2024

Biomedicines

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Diabetic retinopathy (DR), a vision-threatening microvascular complication of diabetes mellitus (DM), is a leading cause of blindness worldwide that requires early detection and intervention. However, diagnosing DR early remains challenging due to the subtle nature of initial pathological changes. This review explores developments in multimodal imaging and functional tests for early DR detection. Where conventional color fundus photography is limited in the field of view and resolution, advanced quantitative analysis of retinal vessel traits such as retinal microvascular caliber, tortuosity, and fractal dimension (FD) can provide additional prognostic value. Optical coherence tomography (OCT) has also emerged as a reliable structural imaging tool for assessing retinal and choroidal neurodegenerative changes, which show potential as early DR biomarkers. Optical coherence tomography angiography (OCTA) enables the evaluation of vascular perfusion and the contours of the foveal avascular zone (FAZ), providing valuable insights into early retinal and choroidal vascular changes. Functional tests, including multifocal electroretinography (mfERG), visual evoked potential (VEP), multifocal pupillographic objective perimetry (mfPOP), microperimetry, and contrast sensitivity (CS), offer complementary data on early functional deficits in DR. More importantly, combining structural and functional imaging data may facilitate earlier detection of DR and targeted management strategies based on disease progression. Artificial intelligence (AI) techniques show promise for automated lesion detection, risk stratification, and biomarker discovery from various imaging data. Additionally, hematological parameters, such as neutrophil–lymphocyte ratio (NLR) and neutrophil extracellular traps (NETs), may be useful in predicting DR risk and progression. Although current methods can detect early DR, there is still a need for further research and development of reliable, cost-effective methods for large-scale screening and monitoring of individuals with DM.

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“…In this study, it was found that although there was no significant difference of CRT between preoperative and postoperative, the thickness of the paracentral fovea retina in all quadrants was significantly increased 3 months after surgery, and the thickness of the nasal paracentral retina was significantly increased 3 months after surgery compared with that before surgery. In addition, the blood flow density postoperative in superficial and deep nasal paracentral fovea retina was significantly lower than that before surgery, suggesting that the decrease of GCL-IPL complex may be an important reason for the blood flow density change in superficial and deep layers after surgery ( Hafner et al, 2019 ). At present, OCTA can only evaluate the retina of optic disk area within 4.5 mm × 4.5 mm.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Microcirculation Changes in the Macular Area and Para-Optic Disk Region After Implantable Collamer Lens Implantation in Patients With High Myopia

Yang

Tan³

et al. 2022

Front. Neurosci.

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Myopia has become an important public health problem to be solved urgently. Posterior chamber phakic implantable Collamer lens (ICL) implantation is one of the latest and safest products for myopia correction worldwide. This prospective cross-sectional case series aimed to observe changes in the macular retinal thickness, retinal nerve fiber layer (RNFL) thickness of para-optic disk region, and blood flow density after posterior ICL implantation in patients with high myopia using optical coherence tomography angiography (OCTA). A total of 67 eyes of 67 patients with high myopia, who underwent ICL implantation at The Affiliated Eye Hospital of Nanjing Medical University from January 2020 and December 2020, were included. The spherical equivalent (SE) of the operative eyes was >−6.00 D. The changes in vision, intraocular pressure (IOP), SE, and vault were observed pre-operatively, and follow-up were performed 1 week, 1 month, and 3 months. OCTA was used to observe the changes in the CRT, retinal thickness of paracentral fovea, FAZ, superficial and deep retinal blood flow density in the macular area, RNFL thickness of para-optic disk region, and blood flow density before and after ICL implantation. The uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) of the patients post-operation were significantly improved (P < 0.001). The IOP increased in comparison with other time points at 1 week post-operation (P < 0.05). There were no significant changes in CRT post-operation. The retinal thickness in the upper, lower, nasal, and temporal quadrants of the paracentral fovea increased significantly at 1 month and 3 months post-operation (P < 0.05). The FAZ area at all postoperative time points were decreased (P < 0.001). At 3 months post-operation, the blood flow density of the superficial and deep retinal layers in the upper, lower, and nasal macular area were significantly reduced (P < 0.05). At 1 month post-operation, the RNFL thickness in the temporal para-optic disk region and blood flow density were significantly reduced (P = 0.001 and P < 0.05, respectively). ICL implantation for highly myopic eyes led to an increase of the retinal thickness in the upper, lower, nasal, and temporal regions of the paracentral fovea; reduction of RNFL thickness in the temporal area of para-optic disk; decrease in FAZ area; and decrease in the blood flow density of some deep and superficial retinal layers as well as that of the temporal para-optic disk region.

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Correlation between corneal and retinal neurodegenerative changes and their association with microvascular perfusion in type II diabetes

Cited by 14 publications

References 21 publications

Neurodegeneration of the cornea and retina in patients with type 1 diabetes without clinical evidence of diabetic retinopathy

Neurodegeneration of the cornea and retina in patients with type 1 diabetes without clinical evidence of diabetic retinopathy

Advances in Structural and Functional Retinal Imaging and Biomarkers for Early Detection of Diabetic Retinopathy

Analysis of Microcirculation Changes in the Macular Area and Para-Optic Disk Region After Implantable Collamer Lens Implantation in Patients With High Myopia

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