Evaluation of Retinal Nerve Fibre Layer Thickness as a Possible Measure of Diabetic Retinal Neurodegeneration in the EPIC-Norfolk Eye Study

Authors

Sidra Zafar
Kristen A Staggers
Jie Gao
Yao Liu
Praveen J Patel
Paul J Foster
Benjamin J Frankfort
Michael Abramoff
Charles G Minard
Alasdair Warwick
Anthony P Khawaja
Roomasa Channa

Publication Date

5-1-2023

Journal

British Journal of Ophthalmology

DOI

10.1136/bjophthalmol-2021-319853

PMID

34952836

PMCID

PMC9460960

PubMedCentral® Posted Date

5-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Retinal Ganglion Cells, Diabetic Retinopathy, Glycated Hemoglobin, Tomography, Optical Coherence, Nerve Fibers, Diabetes Mellitus

Abstract

BACKGROUND/AIMS: Markers to clinically evaluate structural changes from diabetic retinal neurodegeneration (DRN) have not yet been established. To study the potential role of peripapillary retinal nerve fibre layer (pRNFL) thickness as a marker for DRN, we evaluated the relationship between diabetes, as well as glycaemic control irrespective of diabetes status and pRNFL thickness.

METHODS: Leveraging data from a population-based cohort, we used general linear mixed models (GLMMs) with a random intercept for patient and eye to assess the association between pRNFL thickness (measured using GDx) and demographic, systemic and ocular parameters after adjusting for typical scan score. GLMMs were also used to determine: (1) the relationship between: (A) glycated haemoglobin (HbA1c) irrespective of diabetes diagnosis and pRNFL thickness, (B) diabetes and pRNFL thickness and (2) which quadrants of pRNFL may be affected in participants with diabetes and in relation to HbA1c.

RESULTS: 7076 participants were included. After controlling for covariates, inferior pRNFL thickness was 0.94 µm lower (95% CI -1.28 µm to -0.60 µm), superior pRNFL thickness was 0.83 µm lower (95% CI -1.17 µm to -0.49 µm) and temporal pRNFL thickness was 1.33 µm higher (95% CI 0.99 µm to 1.67 µm) per unit increase in HbA1c. Nasal pRNFL thickness was not significantly associated with HbA1c (p=0.23). Similar trends were noted when diabetes was used as the predictor.

CONCLUSION: Superior and inferior pRNFL was significantly thinner among those with higher HbA1c levels and/or diabetes, representing areas of the pRNFL that may be most affected by diabetes.

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