Simultaneous Noninvasive Clinical Measurement of Lens Autofluorescence and Rayleigh Scattering Using a Fluorescence Biomicroscope

Burd, John F.; Lum, S.; Cahn, Frederick; Ignotz, Keith

doi:10.1177/193229681200600603

Cited by 15 publications

(27 citation statements)

References 49 publications

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“…Freedom Meditech, Inc has received US marketing clearance for a scanning confocal biomicroscope that rapidly measures lens autofluorescence without dilation of the pupils. 15 Our previous study of lens autofluorescence of 127 subjects with healthy eyes who had not been diagnosed with diabetes showed a linear relationship of lens autofluorescence with the age of the subject, 15 a result consistent with previous reports. 3,6,16 We wish to investigate 2 possible clinical uses of our instrument: (1) to identify subjects with undiagnosed type 2 diabetes and (2) to measure lens autofluorescence as a marker for the progression of diabetes.…”

Section: Original Articlesupporting

confidence: 90%

Measurement of Lens Autofluorescence Can Distinguish Subjects With Diabetes From Those Without

Cahn

Burd

Ignotz

et al. 2014

J Diabetes Sci Technol

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Lens autofluorescence is increased in patients with diabetes mellitus, but clinical application has been limited by the lack of an instrument suitable for routine clinical use. We investigate possible uses of a new scanning confocal biomicroscope (1) to identify subjects with undiagnosed type 2 diabetes and (2) as a marker for the progression of diabetes. One hundred seventyeight subjects self-reported as normal and 53 subjects physician-diagnosed with diabetes or prediabetes were recruited. Measurements were collected using a ClearPath DS-120 Lens Fluorescence Biomicroscope calibrated with standards traceable to National Institute of Standards and Technology (NIST). Fluorescence intensities were corrected for age by subtracting the value expected from a regression of intensity versus age for normal subjects. This "fluorescence deviation" showed progressively higher values for normal, prediabetes, type 2 diabetes, and type 1 diabetes and a high degree of predictability of diabetes diagnosis. A receiver operating characteristics curve was used to determine sensitivity and specificity for prediction of diabetes type 2. At a fluorescence deviation of 2500, a sensitivity of 67% at 94% specificity was observed detection of type 2 diabetes. The progressively higher fluorescence deviations are consistent with the physiological mechanisms of accumulation of fluorescent advanced glycation end products as the subject ages. The sensitivity and specificity performance of the lens autofluorescence test for type 2 diabetes is comparable to the performance of glucose threshold tests. The statistically significant difference between fluorescence deviations of normal and type 2 diabetes supports the feasibility of lens autofluorescence to screen subjects for undiagnosed type 2 diabetes. Ophthalmic practices are points of care at which there may be a public health benefit for screening patients for undiagnosed diabetes.

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Section: Original Articlesupporting

confidence: 90%

Measurement of Lens Autofluorescence Can Distinguish Subjects With Diabetes From Those Without

Cahn

Burd

Ignotz

et al. 2014

J Diabetes Sci Technol

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“…Lens fibers are free from organelles, and lens proteins within these fibers, such as crystallins (α, β and γ) are long‐lived, which facilitates the accumulation of AGEs throughout life . This accumulation is assumed to contribute to the gradual decrease in tissue and organ function observed with aging . All crystalline species show tryptophan fluorescence (excitation maximum at 290 nm and emission maximum ~340 nm) and their distribution is uniform throughout lens cross‐sections, as is the distribution of protein …”

Section: Ocular Endogenous Fluorophoresmentioning

confidence: 99%

“…In addition to age‐related changes in light transmission, several studies have revealed an increase in fluorescence and a decrease in transmission with certain conditions, such as diabetes . Several studies have reported that lens AF is higher in diabetic patients than in healthy subjects, and that lens transmission in subjects of about the same age was higher in diabetic patients than in healthy subjects …”

Section: Ocular Af In Diabetesmentioning

confidence: 99%

Ocular autofluorescence in diabetes mellitus. A review

Calvo-Maroto

Pérez-Cambrodí²,

García‐Lázaro

et al. 2016

Journal of Diabetes

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Diabetes mellitus is a metabolic disease with a considerable impact on healthcare owing to its increased prevalence and high mortality rate. Structural, morphological, and physiological changes in each of the ocular components have been described in detail. Autofluorescence has been described as a good indicator of metabolic activity. The aim of the present review is to provide an overview of ocular endogenous fluorophores in the cornea, the crystalline lens, and the retinal pigment epithelium, the effects of diabetes mellitus and therefore the potential of autofluorescence assessment for screening and monitoring changes in diabetic patients.

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“…26 One physiological aspect has to be particularly taken into account when measuring lens AF: The age-related opacification of the lens is part of the nonenzymatic glycation of the lens proteins and the degree of the glycation process (that can be assessed by measurements of the lens AF) reflect partly this physiologic process and can be exacerbated in the presence of hyperglycemia. [27][28][29][30] In this issue of the Journal of Diabetes Science and Technology, Cahn et al present data from a study aiming at investigating possible uses of a new scanning confocal biomicroscope to identify subjects with undiagnosed type 2 diabetes.…”

mentioning

confidence: 99%

“…Since lens AF physiologically increases with age, 30 all comparisons were performed with an age-adjusted lens AF value of healthy subjects. At a defined threshold (fluorescence deviation of 2500 counts above the value of age-matched healthy controls), the authors report for their method a sensitivity and a specificity (67% and 94%, respectively) for identifying subjects with type 2 diabetes that is comparable to that of glucose threshold tests.…”

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confidence: 99%

Measurement of Lens Autofluorescence for Diabetes Screening

Stirban

2014

J Diabetes Sci Technol

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Many efforts have been made lately to develop cost-effective, simple, and reproducible tests for diabetes screening besides the already established fasting plasma glucose, the oral glucose tolerance test, and the glycated hemoglobin A1 c. Several tests have been proposed lately, based on the measurement of the so-called advanced glycation endproducts (AGEs). AGEs production is exacerbated during hyperglycemia, and their accumulation in different tissues reflects the degree and duration of dysglycemia. The human lens represents a tissue where AGEs accumulation can be particularly well assessed. The present article comments on the article by Cahn et al. published in this issue of the Journal of Diabetes Science and Technology. Cahn and coauthors tested a new scanning confocal biomicroscope for its accuracy to detect noninvasively subjects with diabetes or at risk for developing diabetes.

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Simultaneous Noninvasive Clinical Measurement of Lens Autofluorescence and Rayleigh Scattering Using a Fluorescence Biomicroscope

Abstract: Abbreviations: (AGE) advanced glycation end product, (IR) infrared, (DFA) 1-deoxyfructosyl glycation adduct, (LED) light-emitting diode, (UV) ultraviolet Keywords: advanced glycation end products, biomicroscope, diabetes mellitus, fluorescence ratio, lens autofluorescence

Cited by 15 publications

References 49 publications

Measurement of Lens Autofluorescence Can Distinguish Subjects With Diabetes From Those Without

Measurement of Lens Autofluorescence Can Distinguish Subjects With Diabetes From Those Without

Ocular autofluorescence in diabetes mellitus. A review

Measurement of Lens Autofluorescence for Diabetes Screening

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