Van Dijk HW, Verbraak FD, Kok PH, Garvin MK, Sonka M, Lee K, Devries JH, Michels RP, van Velthoven ME, Schlingemann RO, Abramoff MD.
Ophthalmology, Academic Medical Center, Amsterdam, Netherlands.
Purpose: To determine which retinal layers are most affected by diabetes and contribute to thinning of the inner retina, and to investigate the relationship between retinal layer thicknesses (LT) and diabetes duration, diabetic retinopathy (DR) status, age, glycosylated hemoglobin (HbA1c) and gender, in type 1 diabetic patients with no or minimal DR. Methods: Mean LT was calculated for individual retinal layers following automated segmentation of Spectral Domain-Optical Coherence Tomography scans of patients with diabetes and compared with controls. Multiple linear regression analysis was used to determine the relationship between LT and HbA1c, age, gender, diabetes duration and DR status. Results: In patients with minimal DR, the mean ganglion cell layer (GCL) in the pericentral area was 5.1 mum thinner (95% CI, 1.1 - 9.1 mum) and in the peripheral macula the mean retinal nerve fiber layer (RNFL) was 3.7 mum thinner (95% CI, 1. 3 - 6.1 mum) than controls. There was a significant linear correlation (R= 0.53, p-value < 0.01) between GCL thickness and diabetes duration in the pooled group of patients. Multiple linear regression analysis (R=0.62, p-value < 0.01) showed that DR status was the most important explanatory variable. Conclusion: This study demonstrates GCL thinning in the pericentral area and corresponding loss of RNFL thickness in the peripheral macula in type 1 diabetic patients with no or minimal DR compared to controls. These results support the concept that diabetes has an early neurodegenerative effect on the retina, which occurs even though the vascular component of diabetic retinopathy is minimal.
PMID: 20130282
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