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Retinal sensitivity changes associated with diabetic neuropathy in the absence of diabetic retinopathy
  1. Srividya Neriyanuri1,2,
  2. Shahina Pardhan2,
  3. Laxmi Gella3,
  4. Sakshyar Saumya Pal4,
  5. Suganeswari Ganesan4,
  6. Tarun Sharma4,
  7. Rajiv Raman2,4
  1. 1 Vision Research Foundation, Sankara Nethralaya Eye Hospital, Chennai, India
  2. 2 Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
  3. 3 Elite School of Optometry, Chennai, India
  4. 4 Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya Eye Hospital, Chennai, India
  1. Correspondence to Dr Rajiv Raman, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai 600 006, Tamil Nadu, India; rajivpgraman{at}


Purpose To explore any relationship between the markers of early retinal neuronal damage and peripheral diabetic neuropathy in subjects with no diabetic retinopathy (DR).

Methods A cross-sectional study in which type 2 diabetic subjects (n=743) without DR were studied. Visual functions including visual acuity, contrast sensitivity, colour vision, retinal sensitivity using microperimeter and retinal thicknesses by spectral domain optical coherence tomography were measured. Vibration perception thresholds of greater than or equal to 20 µV, measured by sensitometer using a biothesiometer probe, were defined as having peripheral diabetic neuropathy. Statistical analyses were performed using independent t-test, multivariate logistic regression and Pearson's correlation.

Results Of 743 subjects who had no DR, 24.9% had diabetic neuropathy. Independent comparisons among subjects who had diabetic neuropathy compared with those who did not showed statistically significant retinal nerve fibre layer thinning (p=0.01), reduced contrast sensitivity (p=0.0001), reduced retinal sensitivity (p=0.03), impaired colour vision (p=0.04) and reduced visual acuity (p=0.0001). Multivariate analysis showed significant association between the mean retinal sensitivity (measured using a microperimeter) and diabetic neuropathy (adjusted OR (95% CI): 0.76 (0.60 to 0.95), p=0.01).

Conclusions Significant association of neuroretinal dysfunction with the presence of diabetic neuropathy was noted among subjects with no DR.

  • Retina
  • Diagnostic tests/Investigation

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  • Contributors RR is the guarantor of the study. TS and RR: designed the study. LG, SSP, SG, TS and RR: data acquisition. SN, SP, LG and RR: statistical analysis plan. SN and SP: analysed the data and data interpretation. SN, SP and RR: drafting and revising the manuscript. SP, LG, SSP, SG, TS and RR: final approval.

  • Competing interests None declared.

  • Ethics approval Organization's Institutional Review Board, Vision Research Foundation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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