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. 2017 Mar 23;12(3):e0174377.
doi: 10.1371/journal.pone.0174377. eCollection 2017.

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

Jin A Choi  1 , Hyo Won Kim  1 , Jin-Woo Kwon  1 , Yun-Sub Shim  1 , Dong Hyun Jee  1 , Jae-Seung Yun  2 , Yu-Bae Ahn  2 , Chan Kee Park  3 , Seung-Hyun Ko  2
Affiliations

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

Jin A Choi et al. PLoS One. .

Abstract

Background: To 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.

Methods: We 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.

Results: We 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.

Conclusions: Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparisons of sectorial GCIPL thickness according to the presence of RNFL defect in diabetes.
GCIPL ganglion cell-inner plexiform layer, RNFLD retinal nerve fiber layer defect, SN superonasal, S superior, ST superotemporal, IN inferonasal, I inferior, IT inferoteporal. *independent t-test.
Fig 2
Fig 2. Representative case showing the association between photographic RNFL defect and macular GCIPL thickness.
A 57-year old female with a 17-year history of type 2 diabetes exhibited a definite involvement of cardiac autonomic neuropathy. In the red-free photograph, retinal nerve fiber layer (RNFL) defects are observed (A, white arrow). In the quadrant and clock-hour based map, the circumpapillary RNFL thickness is within normal limit (B). However, in the GCA deviation map and sector map exhibit abnormal finding (C)
See this image and copyright information in PMC

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