Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy
Pritchard, Nicola, Sampson, Geoff, Edwards, Katie, Vagenas, Dimitrios, Russell, Anthony W., Malik, Rayaz A., & Efron, Nathan (2016) Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy. Journal of Optometry. (In Press)
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Purpose: To examine the diagnostic capability of the full retinal and inner retinal thickness measures in differentiating individuals with diabetic peripheral neuropathy (DPN) from those without neuropathy and non-diabetic controls.
Methods: Forty-four individuals with (n = 44) and without (n = 107) diabetic neuropathy and nondiabetic control (n = 42) participants underwent spectral domain optical coherence tomography (SDOCT). Retinal thickness in the central 1mm zone (including the fovea), parafovea and perifovea was assessed in addition to ganglion cell complex (GCC), global loss volume (GCC GLV) and focal loss volume (GCC FLV) volume, and retinal nerve fiber layer (RNFL) thickness. Diabetic neuropathy was defined using a modified neuropathy disability score (NDS) recorded on a 0---10 scale, wherein, NDS ≥3 indicated neuropathy and NDS <3 no neuropathy. Diagnostic performance was assessed by areas under the receiver operating characteristic curves (AUCs), 95 per cent confidence intervals (CI), sensitivities at fixed specificities, positive likelihood ratio (+LR), and negative likelihood ratio (−LR) and the cut-off points for the best AUCs obtained.
Results: The AUC for GCC FLV was 0.732, 95% CI: 0.624---0.840, p < 0.001 with a sensitivity of 53% and specificity of 80% for differentiating DPN from controls. Evaluation of the LRs showed that GCC FLV was associated with only small effects on the post-test probability of the disease. The cut-off point calculated using the Youden index was 0.48% (67% sensitivity and 73% specificity) for GCC FLV. For distinguishing those with neuropathy from those without neuropathy, the AUCs of retinal parameters ranged from 0.508 for the central zone to 0.690 for the inferior RNFL thickness. For distinguishing those with moderate or advanced neuropathy from those with mild or no neuropathy, the inferior RNFL thickness demonstrated the highest AUC of 0.820, 95% CI: 0.731---0.909, p < 0.001 with a sensitivity of 69% and 80% specificity. The cut-off-point for the inferior RNFL thickness was 97 �m, with 81% sensitivity and 72% specificity.
Conclusions: The GCC FLV can differentiate individuals with diabetic neuropathy from healthy controls, while the inferior RNFL thickness is able to differentiate those with greater degrees of neuropathy from those with mild or no neuropathy, both with an acceptable level of accuracy. Optical coherence tomography represents a non-invasive technology that aids in detection of retinal structural changes in patients with established diabetic neuropathy. Further refinement of the technique and the analytical approaches may be required to identify patients with minimal neuropathy.
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|Item Type:||Journal Article|
|Keywords:||Retinal thickness, Diagnostic capability, Retinal nerve fiber layer, Ganglion cell complex, Optical coherence tomography|
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
|Copyright Owner:||Copyright 2016 Spanish General Council of Optometry|
|Deposited On:||06 Jul 2016 23:18|
|Last Modified:||04 Sep 2016 22:20|
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