Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Objective Perimetry in Diagnosing Early Retinopathy in Type II Diabetes (#258)

Rong Hui Chia 1 , Rakesh Mallikarjunan 2 , Corrine Carle 2 , Christopher Nolan 2 , Ted Maddess 1 , Andrew James 1 , Faran Sabeti 1
  1. ARC Centre of Excellence in Vision Science, John Curtin School of Medical Research, ACT, Australia
  2. The Department of Ophthalmology, Canberra Hospital, ACT, Australia

The asymmetry of retinal performance between eyes to various stimuli can be assessed to diagnose diabetic retinopathy [1]. This is a preliminary report looking at the ability of multifocal pupillographic objective perimetry (mfPOP) to differentiate non-proliferative DR (NPDR) from absence of diabetic retinopathy (NoDR), in patients with Type 2 Diabetes (T2D). 24 patients with T2D were recruited. Retinopathy severity was measured for each patient qualitatively based on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, using five 45˚ fundus photos. A grade of ETDRS 1 indicated NoDR while grades of 2 to 5 indicated NPDR; 19 and 29 eyes were rated NoDR and NPDR respectively. The mean age of the NoDR eyes was 58.5 ± 10.1 years, and the NPDR eyes 57.5 ± 11.2  (mean ± SD). All patients were tested with 3 mfPOP stimuli (2 with 44 stimuli within the central 60˚ presenting either yellow or red/green contrast, and 1 with 44 yellow stimuli within the central 30˚).  The 44 amplitudes and delays per eye of the peak contractions of these patients’ pupils to the 3 stimuli were analysed.  Areas under the curve (AUC) of Receiver Operator Characteristic plots were computed for discriminating NoDR from NPDR eyes. The visual field regions with the single largest asymmetries between eyes were most diagnostic. For contraction amplitudes, the macular yellow stimulus was most diagnostic, with %AUC 100.0 ± 0.0 (mean ± SE). For delays, the AUCs were similar across stimuli ranging from 91.2 ± 3.5 to 93.1 ± 3.3%. In conclusion, the macular yellow stimuli had the most consistent results showing response suppression peripherally, and increased response delays that scaled with disease severity. The mfPOP markers can quantify severity of retinopathy in relatively early stage disease for patients with Type 2 Diabetes.

  1. Bell A, James AC, Kolic M, Essex RW, Maddess T, Dichoptic multifocal pupillography reveals afferent visual field defects in early Type 2 Diabetes. IOVS: 2010.