Diurnal Variation of Subjective Visual Symptoms of Diabetic Patients

So Jin Hong; Kyung Min Lee; Joon Hong Sohn

doi:10.3341/jkos.2013.54.2.265

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Hong, Lee, and Sohn: Diurnal Variation of Subjective Visual Symptoms of Diabetic Patients

Original Article

J Korean Ophthalmol Soc 2007;54(2):265-271.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.265

Diurnal Variation of Subjective Visual Symptoms of Diabetic Patients

So Jin Hong, MD, Kyung Min Lee, MD, Joon Hong Sohn, MD, PhD

Han Gil Medical Foundation, Incheon, Korea

Address reprint requests to Joon Hong Sohn, MD, PhD Han Gil Medical Foundation #35 Bupyeong-daero, Bupyeong-gu, Incheon 403-722, Korea Tel: 82-32-503-3322, Fax: 82-32-504-3322, E-mail: Jhsohn19@hanafos.com

Received 10 August 201219 October 2012 Accepted 20 December 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the diurnal variation of subjective visual symptoms of diabetic patients and to evaluate its correlation with visual acuity, blood pressure, blood glucose and OCT-measured macular thickness.

Methods

Fifty-five diabetic patients (56 eyes) who were hospitalized for the operation of the fellow eye were enrolled in the study. They underwent optical coherence tomography (OCT) measurements of macular thickness with retinal mapping protocol of OTI/SLO OCT at 5PM, 8PM on operation day, and at 7AM, 10AM on following day. Visual acuity (log MAR), refraction, intraocular pressure, blood glucose and blood pressure were also measured at each time. We surveyed the patients' symptomatic visual variation and its pattern if there is any change over a day.

Results

Thirteen patients (25%) had reported changes in their subjective visual symptom over a day according to their blood glucose level. Among twenty-four cases with changes in their subjective visual acuity throughout the exam, only ten showed their real visual acuity change in accordance with their symptoms.

Conclusions

One fourth of our diabetic patients stated fluctuation in their vision according to their blood glucose level, but there were no correlations between visual acuity, blood glucose level and macular thickness.

Keywords: Diabetic retinopathy, Diurnal variation, Macular thickness, Optical coherence tomography, Visual symptom

References

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Figure 1.

Central subfield thickness, blood glucose, visual acuity, and blood pressure throughout the day from 7 AM to 8 PM.

Figure 2.

Correlation between blood pressure change and best corrected visual acuity, letter score change. There was no correlation between two factors (correlation coefficient = −0.081, p = 0.295, Pearson correlation test).

Figure 3.

Correlation between blood pressure change and retinal thickness change. There was no correlation between two factors (correlation coefficient = 0.098, p = 0.204, Pearson correlation test).

Figure 4.

Correlation between retinal thickness and best-corrected visual acuity, letter score. They showed significant relationship between two factors. (A = all group, B = macula edema group, C = macula edema-free group).

Table 1.

Characteristics of patients

Characteristics	Value
Female sex, No. (%)	22 (40)
Age, mean ± SD (year)	56.8 ± 13
Duration of diabetes, mean ± SD (year)	12 ± 8
Currently medically treated for hypertension, No. (%)	26 (46)
Currently treated with subcutaneous insulin, No. (%)	18 (32)
Blood BUN/creatine (mg/dl, mean ± SD)	16.6 ± 5.4
Vitrectomized eye, No. (%)	9 (16)
Pseudophakic eye, No. (%)	23 (41)
Diabetic retinopathy stage
Severe NPDR	42 (75)
PDR	14 (25)

Table 2.

Characteristics of eye in 7AM

Central subfield thickness at 7AM
≤ 250 (μm)	26
≥ 250 (μm)	30
Central subfield thickness at 7AM
Mean ± SD (μm)	272.9 ± 121.7
Visual acuity at 7AM, No. (%)
20/20 or better	9 (16)
20/25 to 20/40	33 (59)
20/50 to 20/100	10 (18)
Worse than 20/125 to 20/200	4 (7)
Visual acuity at 7AM, No. (%)
log MAR mean ± SD	0.3 ± 0.3
Intraocular pressure (mm Hg)	16 ± 5.4
Mean arterial pressure (mm Hg)	97 ± 10.9

Table 3.

Diurnal variations of central subfield thickness (CST). CST changes from supper fasting or pp2 state to morning fasting or pp2 state

			Fasting state		PP2
ME +*		No. of eye	CST change (μm)	No. of eye	CST change (μm)
	Decrease	14	-84.93 ± 92.46	14	19.86 ± 33.56
	Change -^†	1		2	0
	Increase	15	26.63 ± 12.71	14	-14.79 ± 21.3
	Total	30	-27.35 ± 69.33	30	4.58 ± 31.59
ME -^‡	Decrease	12	-7.0 ± 6.98	15	-6.87 ± 6.09
	Change -	1		1
	Increase	13	8.85 ± 7.66	10	6.6 ± 4.35
	Total	26	1.19 ± 10.6	26	-1.42 ± 8.44

Values are presented as mean ± SD.

^* With macular thickness over than 250 μm

^† No change in macular thickness

^‡ With macular thickness lesser than 250 μm

Table 4.

Differences between two groups divided by whether ordinary subjective visual symptom changes or not

	Ordinary symptom change (−)	Ordinary symptom change (+)	p-value
Number of case	43	13
Subjective visual symptom change, No. (%)	17 (40%)	7 (54%)	0.361
Currently medically treated for hypertension, No. (%)	31 (72%)	7 (54%)	0.541
Currently treated with subcutaneous insulin, No. (%)	10 (23%)	3 (23%)	0.424
Vitrectomized eye, No. (%)	4 (9%)	5 (40%)	0.012*
Abnormal BUN/Cr, No. (%)	16 (37%)	4 (31%)	0.671
Presence of ME, No. (%)	22 (51%)	8 (62%)	0.511
Pseudophakia, No. (%)	19 (44%)	4 (31%)	0.085
BUN/Cr (mg/dL)	16.3 ± 5.3	17.4 ± 5.8	0.554
BCVA, letter score	86.7 ± 15.1	82.2 ± 18.0	0.165
Maximum change in blood glucose (mg/dL)	144.3 ± 86.3	163.2 ± 74.8	0.388
CST (μm)	266.6 ± 105.6	285.5 ± 135.8	0.575
Maximal CST change, μm (%)	19.0 ± 16.6	54.6 ± 92.5	0.593
	(7.8 ± 6.4)	(16.6 ± 20.7)	(0.415)
Maximal mean arterial pressure change (mm Hg)	18.3 ± 8.9	14.2 ± 11.9	0.077

Values are presented as mean ± SD.

ME = macular edema; BCVA = best corrected visual acuity; CST = central subfield thickness.

^* p-value ≤ 0.05, chi-square test.

Table 5.

Differences between two groups divided by whether subjective visual acuity changes or not throughout the examination

	Subjective visual symptom change (-)	Subjective visual symptom change (+)	p-value
Number of case	32	24
Ordinary visual symptom change, No. (%)	6 (19)	7 (30)	0.361
Currently treated for hypertension, No. (%)	15 (47)	11 (46)	0.938
Currently treated with subcutaneous insulin, No. (%)	8 (25)	10 (42)	0.186
Vitrectomized eye, No. (%)	5 (16)	4 (17)	0.916
Abnormal BUN/Cr, No. (%)	10 (31%)	10 (42%)	0.421
Presence of ME, No. (%)	16 (50%)	14 (59%)	0.536
Pseudophakia, No. (%)	17 (53%)	6 (25%)	<0.001
BUN/Cr (mg/dL)	16.8 ± 5.5	16.4 ± 5.4	0.896
BCVA, letter score	86.7 ± 15.5	84.3 ± 16.3	0.113
Maximum change in blood glucose (mg/dL)	152.0 ± 84.0	144.4 ± 84.1	0.667
CST (μm)	266.9 ± 127.9	276.3 ± 90.6	0.325
Maximal CST change, μm (%)	34.5 ± 62.4	17.7 ± 19.7	0.182
	(11.4 ± 12.6)	(7.7 ± 10.5)	(0.042*)
Maximal mean arterial pressure change (mm Hg)	19.6 ± 10.1	14.5 ± 8.6	0.048*

Values are presented as mean ± SD.

ME = macular edema; BCVA = best corrected visual acuity; CST = central subfield thickness.

^* p-value ≤ 0.05, chi-square test.

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