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Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy

Srinivasan, Sangeetha, Pritchard, Nicola, Sampson, Geoff P., Edwards, Katie, Vagenas, Dimitrios, Russell, Anthony W., Malik, Rayaz A. and Efron, Nathan 2016, Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy, Journal of optometry, pp. 1-11, doi: 10.1016/j.optom.2016.05.003.

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Title Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy
Author(s) Srinivasan, Sangeetha
Pritchard, Nicola
Sampson, Geoff P.
Edwards, Katie
Vagenas, Dimitrios
Russell, Anthony W.
Malik, Rayaz A.
Efron, Nathan
Journal name Journal of optometry
Start page 1
End page 11
Total pages 11
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-07-14
ISSN 1888-4296
Keyword(s) capa de fibras nerviosas de la retina
capacidad diagnóstica
complejo de células ganglionares
diagnostic capability
ganglion cell complex
grosor de la retina
optical coherence tomography
retinal nerve fiber layer
retinal thickness
tomografía de coherencia óptica
Área bajo la curva
Summary PURPOSE: To examine the diagnostic capability of the full retinal and inner retinal thickness measures in differentiating individuals with diabetic peripheral neuropathy (DPN) from those without neuropathy and non-diabetic controls. METHODS: Individuals with (n=44) and without (n=107) diabetic neuropathy and non-diabetic control (n=42) participants underwent spectral domain optical coherence tomography (SDOCT). Retinal thickness in the central 1mm zone (including the fovea), parafovea and perifovea was assessed in addition to ganglion cell complex (GCC) global loss volume (GCC GLV) and focal loss volume (GCC FLV), and retinal nerve fiber layer (RNFL) thickness. Diabetic neuropathy was defined using a modified neuropathy disability score (NDS) recorded on a 0-10 scale, wherein, NDS ≥3 indicated neuropathy and NDS indicated <3 no neuropathy. Diagnostic performance was assessed by areas under the receiver operating characteristic curves (AUCs), 95 per cent confidence intervals (CI), sensitivities at fixed specificities, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and the cut-off points for the best AUCs obtained. RESULTS: The AUC for GCC FLV was 0.732 (95% CI: 0.624-0.840, p<0.001) with a sensitivity of 53% and specificity of 80% for differentiating DPN from controls. Evaluation of the LRs showed that GCC FLV was associated with only small effects on the post-test probability of the disease. The cut-off point calculated using the Youden index was 0.48% (67% sensitivity and 73% specificity) for GCC FLV. For distinguishing those with neuropathy from those without neuropathy, the AUCs of retinal parameters ranged from 0.508 for the central zone to 0.690 for the inferior RNFL thickness. For distinguishing those with moderate or advanced neuropathy from those with mild or no neuropathy, the inferior RNFL thickness demonstrated the highest AUC of 0.820, (95% CI: 0.731-0.909, p<0.001) with a sensitivity of 69% and 80% specificity. The cut-off-point for the inferior RNFL thickness was 97μm, with 81% sensitivity and 72% specificity. CONCLUSIONS: The GCC FLV can differentiate individuals with diabetic neuropathy from healthy controls, while the inferior RNFL thickness is able to differentiate those with greater degrees of neuropathy from those with mild or no neuropathy, both with an acceptable level of accuracy. Optical coherence tomography represents a non-invasive technology that aids in detection of retinal structural changes in patients with established diabetic neuropathy. Further refinement of the technique and the analytical approaches may be required to identify patients with minimal neuropathy.
Language eng
DOI 10.1016/j.optom.2016.05.003
Field of Research 1113 Ophthalmology And Optometry
Socio Economic Objective 920104 Diabetes
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Spanish General Council of Optometry
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Document type: Journal Article
Collection: School of Medicine
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