Decreased retinal ganglion cell layer thickness in patients with type 1 diabetes.
PURPOSE. To determine which retinal layers are most affected by diabetes and contribute to thinning of the inner retina and to investigate the relationship between retinal layer thickness (LT) and diabetes duration, diabetic retinopathy (DR) status, age, glycosylated hemoglobin (HbA1c), and the sex of the individual, in patients with type 1 diabetes who have no or minimal DR. METHODS. Mean LT was calculated for the individual retinal layers after automated segmentation of spectral domain-optical coherence tomography scans of patients with diabetes and compared with that in control subjects. Multiple linear regression analysis was used to determine the relationship between LT and HbA1c, age, sex, diabetes duration, and DR status. RESULTS. In patients with minimal DR, the mean ganglion cell layer (GCL) in the pericentral area was 5.1 mum thinner (95% confidence interval [CI], 1.1-9.1 mum), and in the peripheral macula, the mean retinal nerve fiber layer (RNFL) was 3.7 mum thinner (95% CI, 1.3-6.1 mum) than in the control subjects. There was a significant linear correlation (R = 0.53, P < 0.01) between GCL thickness and diabetes duration in the pooled group of patients. Multiple linear regression analysis (R = 0.62, P < 0.01) showed that DR status was the most important explanatory variable. CONCLUSIONS. This study demonstrates GCL thinning in the pericentral area and corresponding loss of RNFL thickness in the peripheral macula in patients with type 1 diabetes and no or minimal DR compared with control subjects. These results support the concept that diabetes has an early neurodegenerative effect on the retina, which occurs even though the vascular component of DR is minimal.
van Dijk
Hille W
HW
Departments of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands. h.w.vandijk@amc.nl
Verbraak
Frank D
FD
Kok
Pauline H B
PH
Garvin
Mona K
MK
Sonka
Milan
M
Lee
Kyungmoo
K
Devries
J Hans
JH
Michels
Robert P J
RP
van Velthoven
Mirjam E J
ME
Schlingemann
Reinier O
RO
Abràmoff
Michael D
MD
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D013997:Time Factors; D041623:Tomography, Optical Coherence
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human