title: Retinal nerve fiber layer loss is associated with urinary albumin excretion in patients with type 2 diabetes.
abstract: OBJECTIVE
  To identify the factors associated with retinal nerve fiber layer (RNFL) loss in patients with type 2 diabetes.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Ninety-six nonglaucomatous patients with type 2 diabetes without renal impairment (estimated glomerular filtration rate, ≥60 ml/minute per 1.73 m(2)).
  
  
  METHODS
  Eyes were divided into 2 groups based on the presence or absence of RNFL defects detected by red-free retinal fundus photography. All participants underwent an eye fundus examination, and the urinary albumin-to-creatinine ratio (ACR) was determined. A cardiovascular autonomic function test was performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to the Valsalva maneuver, and standing. Multiple logistic regression analyses were performed to determine potential risk factors related to the presence of RNFL defects in these patients.
  
  
  METHODS
  The association between RNFL defects and diabetic complications.
  
  
  RESULTS
  Among the patients, 43 (44.8%) had localized RNFL defects (group 1), whereas the others (55.2%) did not (group 2). The RNFL defects occurred more frequently on the superior side (75.6% and 71.0% in right and left eyes, respectively) compared with the inferior side (13.8% and 0.0% in right and left eyes, respectively). Patients with RNFL defects (group 1) had significantly higher rates of diabetic retinopathy (60.5%) compared with those without RNFL defects (group 2; 32.1%; P = 0.007). The urinary ACR was significantly higher in patients with RNFL defects than in those without defects (45.3±72.1 μg/mg vs. 15.4±17.3 μg/mg creatinine, respectively; P = 0.015), whereas autonomic function test grading was similar between the groups. The urinary ACR was the only factor related to visual field defect location in both univariate (P = 0.021) and multivariate (P = 0.036) logistic regression analyses after adjusting for age; gender; presence of diabetic retinopathy; diabetes duration; smoking; statin use; and antiplatelet, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker treatment.
  
  
  CONCLUSIONS
  Urinary albumin excretion was associated with nerve fiber layer loss in patients with type 2 diabetes. Careful examination of the optic nerve head may be necessary, particularly in patients with type 2 diabetes exhibiting albuminuria.
authors: Department of Ophthalmology, St. Vincent's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Jin A
authors: JA
authors: Choi
authors: Division of Endocrinology and Metabolism, Cheonan Chungmu Hospital, Cheonan, Republic of Korea.
authors: Sun-Hee
authors: SH
authors: Ko
authors: Department of Ophthalmology, St. Vincent's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Yi Ryeung
authors: YR
authors: Park
authors: Department of Ophthalmology, St. Vincent's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Dong-Hyun
authors: DH
authors: Jee
authors: Division of Endocrinology and Metabolism, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Seung-Hyun
authors: SH
authors: Ko
authors: Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: ckpark@catholic.ac.kr.
authors: Chan Kee
authors: CK
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D001341:Autonomic Nervous System / Q000502:physiology; D002319:Cardiovascular System / Q000294:innervation; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000652:urine; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D012165:Retinal Ganglion Cells / Q000473:pathology*; D014792:Visual Acuity
chemical_list: D003404:Creatinine