Relationship between Systemic Vascular Characteristics and Retinal Nerve Fiber Layer Loss in Patients with Type 2 Diabetes

Abstract

Retinal nerve fiber layer (RNFL) loss in diabetic patients is especially common regardless of diabetic retinopathy (DR). The correlations between nonglaucomatous RNFL loss and systemic characteristics in diabetic patients have aroused interests in many aspects. 167 subjects with type 2 diabetes who underwent evaluation for arterial stiffness and cardiovascular autonomic function using heart rate variability (HRV) were included in this study. Arterial stiffness was measured using cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI). Multivariate regression analysis was performed to determine factors influencing the presence of RNFL loss according to age. Factors determining the superior location of diabetic RNFL loss were also investigated. CAVI were worse in patients with RNFL loss, especially in those with old age (≥50 yrs) (p = 0.037). Influential factor of RNFL defect in old group was ABI (p = 0.007). However, in young group (<50 yrs), HRV parameter (low-frequency/high-frequency ratio) determined the presence of RNFL loss (p = 0.040). Significant determinants of superior RNFL defect in old subjects were CAVI and ABI (p = 0.032 and p = 0.024). For young diabetic patients, autonomic dysfunction may have relationship with RNFL loss, but as patients get older, arterial stiffness could aggravate vascular autoregulation and diabetic RNFL loss. RNFL loss in diabetes may be correlated with systemic vascular conditions.

Optic Disc Measures in Obstructive Sleep Apnea: A Community-based Study of Middle-aged and Older Adults

“…In glaucoma, the RNFL is most commonly first affected at the inferotemporal sector, therefore it is curious that the superotemporal but not the inferotemporal RNFL was associated with OSA severity. Some studies have reported that in patients with cardiovascular diseases 22,23 or diabetes, [24][25][26] reduced RNFL thickness tends to occur more often at the superior quadrant rather than inferiorly. Hence, it is possible that the observed superotemporal or superior RNFL thinning may be a result of cardiovascular or metabolic diseases that commonly present with OSA, rather than a direct relationship between the RFNL and the sleep disorder.…”

Relationship Between Renal Function and Choroidal Thickness in Type 2 Diabetic Patients Detected by Swept-Source Optical Coherence Tomography

“…7 Studies have also found that CT reduction is associated with increased arterial stiffness. 28,30,31 Because the choroidal blood vessels nourish the outer retinal layer and RPE, it is possible that retinopathy is secondary to choroidal damage. Dysfunction of the autonomic nervous system can also cause CT changes, and overactivation of the sympathetic nervous system is a feature of DN.…”

Analysis of retinal nerve fiber layer birefringence in patients with glaucoma and diabetic retinopathy by polarization sensitive OCT

“…While diagnostics is mainly based on the identification of vascular changes, it is however still unclear if they appear first in the development of the disease, or rather simultaneously or consecutively to neurologic changes. In parallel to the work done on vascular changes, studies were carried out to analyze changes in retinal nerve fiber layer (RNFL) thickness in diabetic patients, diagnosed with and without DR [ 19 – 21 ]. However, the outcomes of these studies are somewhat controversial.…”