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Original Investigation
July 25, 2019

Longitudinal Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness of Patients With Type 2 Diabetes

Author Affiliations
  • 1Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
  • 2Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Republic of Korea
  • 3Department of Ophthalmology, Konyang University Hospital, Daejeon, Republic of Korea
JAMA Ophthalmol. Published online July 25, 2019. doi:10.1001/jamaophthalmol.2019.2537
Key Points

Question  How does type 2 diabetes affect longitudinal changes in peripapillary retinal nerve fiber layer thickness?

Findings  In this study of 101 patients with type 2 diabetes, progressive reduction of peripapillary retinal nerve fiber layer thickness was observed in healthy controls and patients without and with diabetic retinopathy; however, type 2 diabetes was associated with a greater loss of peripapillary retinal nerve fiber layer, regardless of whether diabetic retinopathy was present.

Meaning  These findings suggest that peripapillary retinal nerve fiber layer loss may occur in people with type 2 diabetes even in the absence of diabetic retinopathy progression.

Abstract

Importance  Type 2 diabetes is expected to accelerate age-related peripapillary retinal nerve fiber layer (pRNFL) loss, but limited information on the rate of reduction in pRNFL thicknesses in patients with type 2 diabetes is available.

Objective  To investigate longitudinal changes in pRNFL thickness in patients with type 2 diabetes, with or without diabetic retinopathy (DR).

Design, Setting, and Participants  A total of 164 eyes of 63 healthy individuals and 101 patients with type 2 diabetes (49 patients without DR [non-DR group] and 52 patients with mild to moderate nonproliferative DR [NPDR group]) were enrolled in this prospective, longitudinal, observational study from January 2, 2013, through February 27, 2015. Participants were followed up for 3 years, and the peripapillary mean and sector RNFL thicknesses were measured at 1-year intervals. The mean rate of pRNFL loss was estimated using a linear mixed model and compared among the 3 groups. Follow-up was completed on March 16, 2018, and data were analyzed from April 2 through July 27, 2018.

Exposure  Type 2 diabetes.

Main Outcomes and Measures  The rate of reduction in pRNFL thickness in patients with type 2 diabetes.

Results  A total of 164 participants (88 women [53.7%]; mean [SD] age, 58.2 [8.7] years) were included in the study analysis. The mean (SD) age of the control group was 56.5 (9.3) years (39 women [61.9%]); the non-DR group, 59.1 (9.4) years (26 women [53.1%]); and the NPDR group, 59.4 (11.0) years (23 women [44.2%]). Mean (SD) duration of type 2 diabetes was 7.1 (4.4) years in the non-DR group and 13.2 (8.4) years in the NPDR group. The baseline mean (SD) pRNFL thickness was 96.2 (11.0) μm in the control group, 93.5 (6.4) μm in the non-DR group, and 90.4 (7.9) μm in the NPDR group. During 3 years of follow-up, these values decreased to 95.0 (9.2) μm in the control group, 90.3 (6.4) in the non-DR group, and 86.6 (7.9) μm in the NPDR group. In a linear mixed model, the estimated mean pRNFL loss was −0.92 μm/y in the non-DR group (P < .001) and −1.16 μm/y in the NPDR group (P < .001), which was 2.9-fold (95% CI, 1.1-14.8; P = .003) and 3.3-fold (95% CI, 1.4-18.0; P < .001) greater, respectively, than that of the control group (−0.35 μm/y; P = .01).

Conclusions and Relevance  Progressive reduction of pRNFL thickness was observed in healthy controls and patients with type 2 diabetes without and with DR; however, type 2 diabetes was associated with a greater loss of pRNFL regardless of whether DR was present. These findings suggest that pRNFL loss may occur in people with type 2 diabetes even in the absence of DR progression.

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