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.
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.
![jkos-54-265f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-265f1.gif)
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).
![jkos-54-265f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-265f2.gif)
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).
![jkos-54-265f3.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-265f3.gif)
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).
![jkos-54-265f4.tif](/upload/SynapseXML/0035jkos/thumb/jkos-54-265f4.gif)
Table 1.
Characteristics of patients
Table 2.
Characteristics of eye in 7AM
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 |
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 |
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* |