Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters

Abstract

To investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = - 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.

Figure 1

CRAE, CRVE, BAa, BCa, BCv, DFa, DFv, duration of diabetes, and VPT in different DPN stages. CRAE Central retinal artery equivalent, CRVE Central retinal vein equivalent, Baa Branching angle arterioles, BCa Branching coefficient arterioles, BAv Branching angle veins, BCv Branching coefficient veins, DFa Fractal dimension arterioles, DFv Fractal dimension veins, VPT Vibration perception threshold, DPN diabetic peripheral neuropathy.

Figure 2

Correlation of CRVE, DFa, and VPT with duration of diabetes. CRVE Central retinal vein equivalent, DFa Fractal dimension arterioles, VPT Vibration perception threshold.

Figure 3

ROC curves for VPT, CRVE, BCa, BCv, DFa, DFv and BAv. ROC Receiver operating characteristics, VPT Vibration perception threshold, CRVE Central retinal vein equivalent, BCa Branching coefficient arterioles, BAv Branching angle veins, BCv Branching coefficient veins, DFa Fractal dimension arterioles, DFv Fractal dimension veins.