Discriminating early-stage diabetic retinopathy with subjective and objective perimetry

Faran Sabeti; Joshua P van Kleef; Rakesh M Iyer; Corinne F Carle; Christopher J Nolan; Rong Hui Chia; Ted Maddess

doi:10.3389/fendo.2023.1333826

Discriminating early-stage diabetic retinopathy with subjective and objective perimetry

Front Endocrinol (Lausanne). 2024 Jan 8:14:1333826. doi: 10.3389/fendo.2023.1333826. eCollection 2023.

Authors

Faran Sabeti^{1

2}, Joshua P van Kleef¹, Rakesh M Iyer³, Corinne F Carle¹, Christopher J Nolan^{3

4}, Rong Hui Chia⁵, Ted Maddess¹

Affiliations

¹ Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.
² Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
³ Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia.
⁴ School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia.
⁵ School of Medicine, University of Western Australia, Crawley, WA, Australia.

Abstract

Introduction: To prevent progression of early-stage diabetic retinopathy, we need functional tests that can distinguish multiple levels of neural damage before classical vasculopathy. To that end, we compared multifocal pupillographic objective perimetry (mfPOP), and two types of subjective automated perimetry (SAP), in persons with type 2 diabetes (PwT2D) with either no retinopathy (noDR) or mild to-moderate non-proliferative retinopathy (mmDR).

Methods: Both eyes were assessed by two mfPOP test methods that present stimuli within either the central ±15° (OFA15) or ±30° (OFA30), each producing per-region sensitivities and response delays. The SAP tests were 24-2 Short Wavelength Automated Perimetry and 24-2 Matrix perimetry.

Results: Five of eight mfPOP global indices were significantly different between noDR and mmDR eyes, but none of the equivalent measures differed for SAP. Per-region mfPOP identified significant hypersensitivity and longer delays in the peripheral visual field, verifying earlier findings. Diagnostic power for discrimination of noDR vs. mmDR, and normal controls vs. PwT2D, was much higher for mfPOP than SAP. The mfPOP per-region delays provided the best discrimination. The presence of localized rather than global changes in delay ruled out iris neuropathy as a major factor.

Discussion: mfPOP response delays may provide new surrogate endpoints for studies of interventions for early-stage diabetic eye damage.

Keywords: diabetic retinopathy; multifocal; multifocal methods; objective perimetry; subjective perimetry; type 2 diabetes.

Publication types

Research Support, N.I.H., Intramural

MeSH terms

Diabetes Mellitus, Type 2*
Diabetic Retinopathy*
Eye
Humans
Retinal Diseases*
Visual Field Tests

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. NHMRC 1028560, ARC CE0561903, Our Health in Our Hands (OHIOH) ANU intramural grant.