Grading of Retinal Nerve Fiber Layer With a Photographic Reference Set

BackgroundTo investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.MethodsWe studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.ResultsWe compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.ConclusionsCardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

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“…[20, 21] It is therefore important to determine the association of quantitative OCT parameters with the severity of diabetic complications.…”

Section: Introductionmentioning

confidence: 99%

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

et al. 2017

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“…Among the many conditions it has been recorded with are meibomian gland dysfunction and marginal blepharitis, 1 conjunctivitis, 2-4 contact lens wear, 5,6 cosmetics, 7 hypertension, diabetes, 8 acute angle-closure glaucoma, autoimmune disease, chemical injury, 9,10 episcleritis, uveitis, 9,11 sickle cell disease, 12 and pharmaceutical drug use. 13 Clinical grading scales that allow the assessment of severity have been developed for many ocular conditions, including the anterior chamber angle, 14 iris neovascularisation, 15 retinal nerve fibre layer atrophy, 16 focal narrowing of retinal arterioles in glaucoma, 17 diabetic retinopathy, 18 hypertensive arteriosclerosis, 19 tarsal abnormalities, 20 and lens opacities. 21 Similar scales have been developed to grade conjunctival hyperaemia.…”

Section: Introductionmentioning

confidence: 99%

How red is a white eye? Clinical grading of normal conjunctival hyperaemia

Murphy

Lau

Sim

et al. 2006

Eye

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Purpose To quantify the level of normal bulbar conjunctival hyperaemia using the Cornea and Contact Lens Research Unit (CCLRU) grading scale, and to investigate inter-observer agreement. Methods Bulbar conjunctival hyperaemia was assessed by two trained observers, using the CCLRU grading scale (zero to four units) interpolated into 0.1 increments, on the right eye of 121 healthy, non-contact lens-wearing subjects (male ¼ 58, female ¼ 63, median age ¼ 28 years, range 16-77). The eye was observed using a slit-lamp bio-microscope ( Â 10 magnification) under diffuse, white illumination. The subject's position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior, and temporal conjunctiva. Bulbar redness was defined as the average of those four grades of conjunctival hyperaemia. A further twenty subjects were recruited to assess interobserver agreement (male ¼ 8, female ¼ 12, median age ¼ 23 years). Results The average bulbar redness was 1.93 (70.32 SD) units. The nasal (2.370.4) and temporal (2.170.4) quadrants were significantly redder than the superior (1.670.4) and inferior (1.770.4) quadrants (Po0.0001). Males had redder eyes than females by 0.2 units. Inter-observer 95% limits of agreement for bulbar redness was 0.38 units. Conclusions The average bulbar redness of 1.9 units was higher than expected, reflecting the design of the grading scale. A bulbar redness of greater than 2.6 units may be considered abnormal, and a change in bulbar redness of Z0.4 units may be significant.

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“…Die Erkennbarkeit und Reproduzierbarkeit milder diffuser RNFS-Verluste ist dagegen geringer [3,117]. Referenzfotos [93] oder ein auf Sektoren basierender semiquantitativer Score [3] können die Auswertung erleichtern. Dennoch bleibt die Auswertung von RNF-Fotos ein subjektiver Prozess.…”

Section: Fundusfotounclassified

“…Die RNF-Fotografie wird an einigen spezialisierten Zentren zur Diagnose eingesetzt. Ein breiterer Einsatz in der augenärztlichen Praxis wird durch mehrere Faktoren behindert, wie die Notwendigkeit der Pupillenerweiterung, die Schwierigkeit, qualitativ ausreichende RNF-Photos bei älteren Patienten zu erhalten [94,103], sowie die subjektive und nicht einfache Auswertung [93,104,117]. Dennoch kann die qualitative subjektive Beurteilung von RNF-Fotos glaukomatöse Schäden zumindest ebenso gut aufdecken wie die quantitativen Verfahren HRT, GDx-FCC und OCT [47,149].…”

Section: Kombination Mehrerer Untersuchungenunclassified

Moderne diagnostische Verfahren bei Glaukomverdacht und Glaukom

Vass

2004

Klin Monatsbl Augenheilkd

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The new diagnostic techniques have not yet greatly influenced our diagnostic procedure. This is mainly due to the fact that, for the most difficult borderline cases of glaucoma, these methods are of limited value, or have not yet been sufficiently investigated. Nevertheless, the Heidelberg retina tomograph (HRT), the nerve fiber analyzer GDX, short wavelength perimetry (SWAP), and the frequency doubling test (FDT) may play a role in these cases. For follow-up, HRT and GDx have proven valuable, especially in early stages of the disease. The very short testing time of FDT together with good specificity qualifies this test for glaucoma screening.

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Grading of Retinal Nerve Fiber Layer With a Photographic Reference Set

Cited by 40 publications

References 22 publications

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

How red is a white eye? Clinical grading of normal conjunctival hyperaemia

Moderne diagnostische Verfahren bei Glaukomverdacht und Glaukom

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