The Investigation of the Effect of Hyperglycemic Changes on Psychophysical Measurements of Visual Function in Pseudophakic People Living with Diabetes Mellitus

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Abstract

Purpose

The purpose of this study was to show the effect of increasing blood glucose level (BGL) on psychophysical visual function represents by visual acuity and contrast sensitivity in pseudophakic people living with diabetes (PDM).

Study Design

This was quasi-experimental, quantitative study using a pretest–posttest approach.

Methods

The study was conducted at Gamalakhe community health centre located in Gamalakhe township and included a sample of 50 pseudophakic people living without diabetes mellitus (PWDM) and 50 pseudophakic PDM. BGL as well as psychophysical measurements of visual function were measured preprandial and postprandial. Visual acuity (VA) was measured at distance (4 m) and near (40 cm) using logMAR VA charts, and contrast sensitivity (CS) was measured at 50 cm using a Mars chart. The data collected were captured and subsequently analyzed using SPSS version 25.

Results

Glycemic changes measured preprandial and postprandial observed a mean increase of 2.06±1.35 mmol/L ( p=0.350) and 1.08±0.47 mmol/L ( p=0.291) in pseudophakia PDM and pseudophakic PWDM, respectively. CS showed a mean increase of 0.01±0.10 ( p=0.23) and 0.002±0.02 ( p=0.19) log units in PDM and PWDM, respectively; however, the independent t-test showed this was insignificant between PDM and PWDM ( p=0.27). A insignificant mean increase of 0.01±0.04 log units ( p=0.25) and 0.001±0.01 ( p=0.32) in distance VA of pseudophakic PDM and PWDM was found, respectively. A mean increase of 0.001±0.01 log units ( p=0.32) and 0.01±0.03 ( p=0.06) near logMAR VA of pseudophakic PDM and PWDM was found, respectively.

Conclusion

Acute hyperglycemic changes do not result in overall significant changes in visual acuity and contrast sensitivity in pseudophakic PDM and PWDM for an increase in glycemia of 2 mmol/L. We recommend studies investigate if changes occur for glycemic increases exceeding 2 mmol/L.

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Most cited references 24

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Letter contrast sensitivity changes in early diabetic retinopathy.

Efty Stavrou, J. Wood (2003)

To investigate the discriminative ability of letter contrast sensitivity (CS) and visual acuity (VA) in detecting functional losses in participants with type 2 diabetes. LogMAR VA and letter CS were measured on 20 type 2 diabetic and 24 age-matched control participants. The diabetic participants were sub-grouped according to the level of retinopathy present. Letter CS was able to distinguish those participants with and without macular oedema and those with no or minimal diabetic retinopathy from the control group, whereas VA was not. Letter CS may be used as an effective screening tool to assess damage to the visual pathway of diabetic participants both with and without clinically detectable signs.

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Nonselective loss of contrast sensitivity in visual system testing in early type I diabetes.

M A S Di Leo, S Caputo, B Falsini … (1992)

Psychophysical methods in patients with diabetes mellitus reveal deficits of central or foveal vision. Our aim was to evaluate the contrast-sensitivity thresholds in 24 insulin-dependent (type I) diabetic patients with a short disease duration and without retinopathy, taking into account metabolic control. The control group consisted of age-matched nondiabetic subjects. None had visual or systemic symptoms. Contrast sensitivity measured at eight different spatial frequencies to sinusoidal bar patterns of 0.6-12.2 cycles/deg can detect functional defects in the spatially sensitive retinal ganglion cells or in higher visual pathways. We performed two different temporal types of contrast-sensitivity testing, dynamic (8 Hz) and static (0 Hz). Significant losses with dynamic contrast-sensitivity test at all but the highest spatial frequencies (i.e., 12.2 cycles/deg) were shown, whereas there was significant attenuation of contrast sensitivity at five spatial frequencies (1.0, 1.4, 2.2, 7.1, and 9.6 cycles/deg) in the static mode. Grating losses (less than 2SD of control means) of contrast sensitivity were found in 33.3% (dynamic) and in 72.9% (static) of eyes of diabetic patients. HbA1c values were positively correlated at variable spatial frequencies (1.0, 1.4, and 2.2 cycles/deg for dynamic test and 0.6, 1.0, 1.4, 2.2, 4.8, and 7.1 cycles/deg for static test). Our results suggest an early, generally nonselective neuronal damage of visual pathways that occurs before the onset of clinically detectable retinopathy. The visual deficit may be related directly to the effects of diabetes; repetitive minor hypoglycemic insults may contribute more than a marked hyperglycemic condition to the mechanisms underlying physiological changes along the optic nerve.

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Influence of retinopathy on the achromatic and chromatic vision of patients with type 2 diabetes

Luciana Cristina O Andrade, Givago Souza, Eliza Lacerda … (2014)

Background Luminance contrast sensitivity and colour vision are considered to have great predictive value in the evaluation of type 2 diabetic retinopathy. However, these two visual characteristics have seldom been investigated in the same group of patients. In the present study we measured contrast sensitivity and colour vision in a group of patients with type 2 diabetes and correlated the results with estimates of common metabolic markers for the disease. A subgroup of the patients had no clinical signs of retinopathy. Methods The vision of 27 patients (n = 50 eyes) with type 2 diabetes, with retinopathy (n = 20 eyes), or without retinopathy (n = 30 eyes) were evaluated using two psychophysical tests, the Farnsworth–Munsell 100 hue test (FM 100), and measurements of the luminance contrast sensitivity at 11 spatial frequencies. The results were compared with measurements obtained from an age-matched control group (n = 32), and were correlated with the level of glycated haemoglobin, glycaemic level, and time of disease onset. Signs of retinopathy were identified during the ophthalmological examinations. Results Contrast sensitivity and colour vision impairments were present at different levels in diabetes patients. Eyes with retinopathy showed more severe vision loss than eyes without retinopathy. The FM 100 test was more sensitive for separation of patients from controls. Colour vision loss had no colour axes preference. The contrast sensitivity test appeared to have some advantage in differentiating patients with retinopathy from patients without retinopathy. Conclusions Both methods can be useful to follow the visual function of diabetic patients and should be used together to discriminate patients from controls, as well as to identify early signs of retinal damage.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Optom (Auckl)

Journal ID (iso-abbrev): Clin Optom (Auckl)

Journal ID (publisher-id): opto

Title: Clinical Optometry

Publisher: Dove

ISSN (Electronic): 1179-2752

Publication date (Electronic): 20 July 2021

Publication date Collection: 2021

Volume: 13

Pages: 191-199

Affiliations

[1 ]Department of Health , Port Shepstone, South Africa

[2 ]Discipline of Optometry, School of Health Science, University of KwaZulu-Natal , Durban, South Africa

Author notes

Correspondence: Lindokuhle Majola Department of Health, Ugu District , PO Box 951, Hibberdene, Port Shepstone, 4220, South AfricaTel +27 79 347 8540 Email lindokuhle.majola2@gmail.com

Alvin J Munsamy Discipline of Optometry, School of Health Science, University of KwaZulu-Natal , Private Bag X54001, Durban, 4000, South AfricaTel +27 31 260 7352Fax +27 31 260 7666 Email Munsamya1@ukzn.ac.za

Author information

Lindokuhle Majola http://orcid.org/0000-0002-5748-1584

Article

Publisher ID: 284490

DOI: 10.2147/OPTO.S284490

PMC ID: 8309657

PubMed ID: 34321947

SO-VID: 56fc25ee-cfaf-428d-940b-2ac5e7d01913

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 07 April 2021

Date accepted : 02 June 2021

Page count

Figures: 2, Tables: 5, References: 24, Pages: 9

The Investigation of the Effect of Hyperglycemic Changes on Psychophysical Measurements of Visual Function in Pseudophakic People Living with Diabetes Mellitus

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Purpose

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Conclusion

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Most cited references 24

Letter contrast sensitivity changes in early diabetic retinopathy.

Nonselective loss of contrast sensitivity in visual system testing in early type I diabetes.

Influence of retinopathy on the achromatic and chromatic vision of patients with type 2 diabetes

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