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Systematic assessment of clinical methods to diagnose and monitor diabetic retinal neuropathy
Author(s) -
Jenkins K.S.,
Rowan A.,
Layton C.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0565
Subject(s) - medicine , scotopic vision , diabetic retinopathy , retinal , diabetes mellitus , microperimetry , diabetic neuropathy , retinopathy , clinical trial , ophthalmology , intensive care medicine , endocrinology
Purpose Background and Purpose: Diabetic retinal neuropathy refers to retinal neural tissue damage occurring before diabetic retinopathy and fulfils many of the criteria for causality for the subsequent vasculopathy. Developing reliable means of measuring neuronal damage in diabetes may be important in efforts to prevent retinopathy. This study aimed to systematically assess current clinical measurements of diabetic retinal neuropathy. Methods A systematic search of the medical literature since 1984 was performed on PUBMED and EMBASE and the evidence supporting each identified method as an indicator for clinically important diabetic retinal neuropathy was graded relatively as strong, medium or weak according to criteria assessing its relationship to subsequent diabetic retinopathy, quality of supporting studies and published reproducibility. Results The systematic search yielded 6,421 results. Subsequent assessment by two independent investigators identified 601 multiple subject studies in humans assessing clinical aspects of retinal structure, function or psychophysics in the pre‐diabetic retina. Clinical methods assessed as being supported by relatively ‘strong’ evidence included FM‐100 hue colour vision changes, flash ERG b‐wave latency, flash multifocal b‐wave latency, scotopic flash ERG oscillatory potential amplitude and contrast sensitivity. Conclusions Conclusions/Discussions: The results showed moderately poor quality of extant evidence and indicate the best clinical methods for assessing diabetic retinal neuropathy remain to be confirmed. This is the first systematic assessment of the medical literature aiming to assess the breadth and validity of these methods and represents an early step in identifying and developing endpoints for use in trials designed to identify at risk patients or prevent diabetic retinopathy.