Vision function in individuals with diabetes and moderate to severe diabetic retinopathy with and without diabetic macular edema

摘要

Purpose : To determine which psychophysical measures of foveal function can distinguish among three groups of eyes with moderate-severe diabetic retinopathy: eyes with No Edema, eyes with clinically significant macular edema (CSME), and eyes with diabetic macular edema elsewhere in the macula (DME-E). Methods : Eyes were classified into 1 of the 3 groups according to the grading of dilated color fundus photographs by a retinal specialist. Fifty-five eyes (34 No Edema; 5 DME-E; 16 CSME) are included in the analyses. Foveal function was assessed using several simple, rapid, clinically practicable tests: standard (high contrast) visual acuity (VA); low contrast VA (LCVA); low contrast acuity at reduced luminance measured using the dark chart of the SKILL card (SKD); contrast sensitivity (CS; Pelli-Robson chart); and color vision (color confusion score [CCS] of the Adams desaturated D-15). Testing was monocular. A non-parametric test (Kruskal-Wallis) was used to evaluate potential differences among groups. For significant differences, post-hoc pairwise comparisons were carried out using the Mann-Whitney U test. Results : Neither VA nor LCVA differs among the 3 groups (p0.05). CS and SKD show marginally significant differences among the groups (p= 0.04 and 0.02, respectively). However, given the multiple comparisons, only the D15 CCS differs significantly among groups (p0.002). The median CCS of the CSME group is highest (76.00) and is significantly different (P=0.004) from the No Edema group (CCS= 17.18) , but neither of these groups differ significantly from the DME-E group, which has a median CCS between the other 2 groups (CCS=42.81). A CCS of a?￥ 30 was considered to be abnormal. Using this criterion, the frequency of abnormalities for the CSME group and the DME-E group are very similar (62.5% vs 60% respectively) and 3 times the rate of abnormalities seen in the No Edema group (20.6%). Among those that fail, approximately 60% of each group show a blue-yellow defect pattern in each group. These findings suggest that edema outside the fovea may also affect color vision. Conclusions : Color vision, assessed with the Adams desaturated D-15 test is sensitive to the presence of CSME, and is also affected by more peripheral edema (DME-E). This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.