To determine if the RETeval system can be used for the screening of diabetic retinopathy (DR) to provide early diagnosis.
The subjects were 42 diabetic patients selectively recruited by examination of their medical records to have varying severities of DR. The severity of DR was classified into four groups according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Full-field electroretinograms (ERG) without mydriasis were obtained by the DR assessment protocol of the RETeval system. Macular retinal nerve fiber layer (RNFL) thickness was measured by optical coherence tomography. We compared the DR assessment protocol results and the macular RNFL thickness among four groups. Moreover, an analysis was conducted on whether there was any correlation among the DR assessment protocol results, duration of diabetes mellitus, and RNFL thickness individually for each group of patients.
The mean ages and mean duration of diabetes mellitus of the four groups were similar. The DR assessment protocol results in the moderate–severe nonproliferative DR, and proliferative DR groups were significantly higher than those in the other groups (p < 0.001). The mean macular RNFL thickness was similar in all groups. No significant correlation was found between the DR assessment protocol results and duration of DM and the RNFL thickness.
Our results suggest that the RETeval full-field ERG system can be used as an adjunctive tool for the mass screening of DR, while macular RNFL thickness would not be useful.
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Keenan TD, Johnston RL, Donachie PH et al (2013) United Kingdom National Ophthalmology Database Study: diabetic retinopathy; report 1: prevalence of centre-involving diabetic macular oedema and other grades of maculopathy and retinopathy in hospital eye services. Eye (Lond) 27:1397–1404
Early Treatment Diabetic Retinopathy Study Research Group (1991) Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology 98:786–806
Ku JJ, Landers J, Henderson T et al (2013) The reliability of single-field fundus photography in screening for diabetic retinopathy: the Central Australian Ocular Health Study. Med J Aust 198:93–96
Lawrance MG (2004) The accuracy of digital-video retinal imaging to screen for diabetic retinopathy: an analysis of two digital-video retinal imaging systems using standard stereoscopic seven-field photography and dilated clinical examination as reference standards. Trans Am Ophthalmol Soc 102:321–340
Williams GA, Scott IU, Haller JA et al (2004) Single field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. Ophthalmology 111:1055–1062
McCulloch DL, Marmor MF, Brigell MG et al (2015) ISCEV standard for full-field clinical electroretinography (2015 update). Doc Ophthalmol 130:1–12
Bush RA, Sieving PA (1996) Inner retinal contributions to the primate photopic fast flicker electroretinogram. J Opt Am A Opt Image Sci Vis 13:557–565
Bresnick GH, Palta M (1987) Temporal aspects of the electroretinogram in diabetic retinopathy. Arch Ophthalmol 105:660–664
Tahara K, Matsuura T, Otori T (1993) Diagnostic evaluation of diabetic retinopathy by 30-Hz flicker electroretinography. Jpn J Ophthalmol 37:204–210
Holopigian K, Seiple W, Lorenzo M et al (1992) A comparison of photopic and scotopic electroretinographic changes in early diabetic retinopathy. Invest Ophthalmol Vis Sci 33:2773–2780
Satoh S, Iijima H, Imai M et al (1994) Photopic electroretinogram implicit time in diabetic retinopathy. Jpn J Ophthalmol 38:178–184
Kim SH, Lee SH, Bae JY et al (1997) Electroretinographic evaluation in adult diabetics. Doc Ophthalmol 94:201–213
Han YK, Ohn YH (2000) Changes of ERG parameters in diabetic retinopathy. J Korean Ophthalmol Soc 41:149–155
Park SE, Sun HJ, Lee HJ et al (2010) The role of electroretinography in assessing the progression of diabetic retinopathy. J Korean Ophthalmol Soc 51:693–699
Tyrberg M, Lindblad U, Melander A et al (2011) Electrophysiological studies in newly onset type 2 diabetes without visible vascular retinopathy. Doc Ophthalmol 123:193–198
Maa AY, Feuer WJ, Davis CQ et al (2016) A novel device for accurate and efficient testing for vision-threatening diabetic retinopathy. J Diabetes Complic 30:524–532
Formaz F, Riva CE, Geiser M (1997) Diffuse luminance flicker increases retinal vessel diameter in humans. Curr Eye Res 16:1252–1257
Lecleire-Collet A, Audo I, Aout M et al (2011) Evaluation of retinal function and flicker light-induced retinal vascular response in normotensive patients with diabetes without retinopathy. Invest Ophthalmol Vis Sci 52:2861–2867
Garhöfer G, Zawinka C, Resch H et al (2004) Reduced response of retinal vessel diameters to flicker stimulation in patients with diabetes. Br J Ophthalmol 88:887–891
Kato K, Kondo M, Sugimoto M et al (2015) Effect of pupil size on flicker ERGs recorded with RETeval system: new mydriasis-free full-field ERG system. Invest Ophthalmol Vis Sci 56:3684–3690
Smith SA, Smith SE (1983) Reduced pupillary light reflexes in diabetic autonomic neuropathy. Diabetologica 24:330–332
Straub RH, Jeron A, Kerp L (1992) The pupillary light reflex. 2. Prevalence of pupillary autonomic neuropathy in diabetics using age-dependent and age-independent pupillary parameters. Ophthalmologica 204:143–148
Straub RH, Thies U, Jeron A et al (1994) Valid parameters for investigation of the pupillary light reflex in normal and diabetic subjects shown by factor analysis and partial correlation. Diabetologica 37:414–419
Nakayama M, Nakamura J, Hamada Y et al (2001) Aldose reductase inhibition ameliorates pupillary light reflex and F-wave latency in patients with mild diabetic neuropathy. Diabetes Care 24:1093–1098
Ortube MC, Kiderman A, Eydelman Y et al (2013) Comparative regional pupillography as a noninvasive biosensor screening method for diabetic retinopathy. Invest Ophthalmol Vis Sci 54:9–18
Miura G, Nakamura Y, Sato E et al (2016) Effects of cataracts on flicker electroretinograms recorded with RETeval system: new mydriasis-free ERG device. BMC Ophthalmol 16:22
Wilkinson CP, Ferris FL 3rd, Klein RE et al (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682
Bagust A, Hopkinson PK, Maslove L et al (2002) The projected health care burden of type 2 diabetes in the UK from 2000 to 2060. Diabet Med 4:1–5
Engelgau MM, Geiss LS, Saaddine JB et al (2004) The evolving diabetes burden in the United States. Ann Intern Med 140:945–950
Woodcock A, Bradley C, Plowright R et al (2004) The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL. Patient Educ Couns 53:365–383
Tapp RJ, Shaw JE, Harper CA et al (2003) The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 26:1731–1737
Kashim RM, Newton P, Ojo O (2018) Diabetic retinopathy screening: a systematic review on patients’ non-attendance. Int J Environ Res Public Health 15:157
Hipwell AE, Sturt J, Lindenmeyer A et al (2014) Attitudes, access and anguish: a qualitative interview study of staff and patients’ experiences of diabetic retinopathy screening. BMJ Open 4:e005498
Al-Otaibi H, Al-Otaibi MD, Khandekar R et al (2017) Validity, usefulness and cost of RETeval system for diabetic retinopathy screening. Transl Vis Sci Technol 6:3
Fukuo M, Kondo M, Hirose A et al (2016) Screening for diabetic retinopathy using new mydriasis-free, full-field flicker ERG recording device. Sci Rep 6:36591. https://doi.org/10.1038/srep36591
Gungor A, Ates O, Bilen H et al (2015) Retinal nerve fiber layer thickness in early-stage diabetic retinopathy with vitamin D deficiency. Invest Ophthalmol Vis Sci 56:6433–6437
Biallosterski C, van Velthoven ME, Michels RP et al (2007) Decreased optical coherence tomography-measured pericentral retinal thickness in patients with diabetes mellitus type 1 with minimal diabetic retinopathy. Br J Ophthalmol 91:1135–1138
Nilsson M, von Wendt G, Wanger P et al (2007) Early detection of macular changes in patients with diabetes using rarebit fovea test and optical coherence tomography. Br J Ophthalmol 91:1596–1598
Picconi F, Parravano M, Ylli D et al (2017) Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability. Acta Diabetol 54:489–497
Yasuda S, Kachi S, Ueno S et al (2015) Flicker electroretinograms before and after intravitreal ranibizumab injection in eyes with central retinal vein occlusion. Acta Ophthalmol 93:e465–e468
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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Değirmenci, M.F.K., Demirel, S., Batıoğlu, F. et al. Role of a mydriasis-free, full-field flicker ERG device in the detection of diabetic retinopathy. Doc Ophthalmol 137, 131–141 (2018) doi:10.1007/s10633-018-9656-8
- Diabetic retinopathy
- Electroretinogram (ERG)
- Flicker ERG