title: Evidence for photoreceptor changes in patients with diabetic retinopathy.
abstract: OBJECTIVE
  To determine whether the rod and cone photoreceptors are affected in patients with diabetic retinopathy.
  
  
  METHODS
  Twelve patients with diabetes and varying levels of retinopathy and nine age-similar control observers participated in this study. Two-color (500 versus 650 nm) dark-adapted thresholds were measured as a function of retinal eccentricity. Full-field flash electroretinograms were obtained using brief, high-intensity flashes. Dark-adapted rod-isolated (Wratten 47B filter) and light-adapted cone-isolated (Wratten 26 filter) electroretinographic responses were measured as a function of flash intensity. The a-wave data were fitted with a model based on photopigment transduction to obtain values for the parameters of Rmax (the maximal response) and log S (sensitivity). Standard clinical 30-Hz flicker electroretinographic responses were also measured.
  
  
  RESULTS
  Psychophysically measured dark-adapted thresholds were elevated primarily at eccentricities of 5 degrees and 10 degrees from the fovea. Analysis of rod and cone a-wave data showed that Rmax was normal in most of the patients, but log S was reduced. Analysis of b-wave and oscillatory potential parameters showed rod and cone postreceptoral abnormalities, including changes in the rod-isolated semisaturation constant (log k), cone-mediated 30-Hz flicker, and cone-isolated oscillatory potentials. The electrophysiological results were not significantly correlated with blood glucose or glycosylated hemoglobin level.
  
  
  CONCLUSIONS
  The results provide evidence for rod and cone receptoral and postreceptoral deficits in patients with diabetic retinopathy. The photoreceptor changes are primarily in the log S (sensitivity) parameter and are attributed to transduction abnormalities.
authors.affiliation: Department of Ophthalmology, New York University Medical Center, New York 10016, USA.
authors.forename: K
authors.initials: K
authors.lastname: Holopigian
authors.forename: V C
authors.initials: VC
authors.lastname: Greenstein
authors.forename: W
authors.initials: W
authors.lastname: Seiple
authors.forename: D C
authors.initials: DC
authors.lastname: Hood
authors.forename: R E
authors.initials: RE
authors.lastname: Carr
mesh_terms: D000328:Adult; D003623:Dark Adaptation; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D004596:Electroretinography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D017949:Retinal Cone Photoreceptor Cells / Q000503:physiopathology*; D017948:Retinal Rod Photoreceptor Cells / Q000503:physiopathology*; D012684:Sensory Thresholds