Publication: Función visual fotópica y mesópica y el perfil del espesor retiniano en diabéticos tipo 2 sin retinopatía
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2018-09-24
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Universidad Complutense de Madrid
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Abstract
La evidencia en la literatura ha demostrado que los cambios degenerativos tempranos de la retina preceden a la aparición de la retinopatía diabética como se ha mostrado por los estudios electrofisiológicos. Se ha detectado que la retina neural se ve afectada directamente por las alteraciones metabólicas como consecuencia de la diabetes, por un aumento de la apoptosis (muerte celular) debido a la pérdida neuronal progresiva e irreversible. Además, se produce un proceso inflamatorio antes de que puedan detectarse clínicamente los cambios vasculares en la retina y se relaciona con el deterioro neurosensorial en la retinopatía diabética. Las células neuronales y gliales de la retina también sufren reacciones anormales como consecuencia de la hiperglucemia. Esto se reflejó en los cambios en la función visual y en el espesor retiniano debido a alteraciones en la retina interna y externa en los diabéticos tipo 2 sin retinopatía. La evaluación temprana de la función visual central y periférica es esencial antes de la aparición de la retinopatía diabética. Los estudios previos sobre el espesor retiniano en los diabéticos tipo 2 sin retinopatía mostraron resultados inconsistentes: algunos mostraron un aumento en el espesor, otros una disminución y en otros no se encontró ninguna diferencia en comparación con los sujetos sanos. A pesar de los esfuerzos que se han hecho para identificar los cambios en el espesor retiniano y la visión en los diabéticos sin retinopatía, todavía hay falta de información sobre la función visual y capacidad de diagnóstico en los diabéticos tipo 2 sin retinopatía con el nivel de glucosa bien controlado y con una buena AV estándar en condiciones de iluminación bajas (mesópica). Además, existe falta de información sobre la correlación entre el espesor retiniano y la AV, y entre el espesor retiniano y la SC para predecir los cambios futuros que pueden ocurrir en la retina antes de la aparición de la retinopatía...
Evidence in the literature has shown that early retinal degenerative changes precede the onset of diabetic retinopathy shown by electrophysiological studies. The neural retina is reported to be directly affected by disrupted metabolism as a result of diabetes which will lead to increased apoptosis (cell death) due to irreversible gradual neural loss. Also, inflammation occurs before retinal vascular changes can be clinically identified and is related to the neurosensory deterioration in diabetic retinopathy. As a response to hyperglycemia, the retinal neural and glial cells undergo abnormal reactions. Alterations in the inner and outer retina have been reported in type 2 diabetics without retinopathy as reflected by changes in visual function and retinal thickness. Central and peripheral visual function evaluation are both essential at early onset before clinically significant retinopathy is diagnosed. Reports on retinal thickness in type 2 diabetics without retinopathy show inconsistent results; some showing an increase, others showing a decrease, while others did not find any difference compared to healthy subjects. Although efforts have been focused to identify retinal thickness and visual changes in diabetics without retinopathy, there is however lack of information about visual function in early type 2 diabetics without retinopathy with well-controlled glucose and good standard visual acuity (VA) under low luminance conditions (mesopic) and its diagnostic capacity. Also, the information lacks about the correlation between retinal thickness and VA, and retinal thickness and contrast sensitivity (CS) to predict future retinal changes before the onset of retinopathy...
Evidence in the literature has shown that early retinal degenerative changes precede the onset of diabetic retinopathy shown by electrophysiological studies. The neural retina is reported to be directly affected by disrupted metabolism as a result of diabetes which will lead to increased apoptosis (cell death) due to irreversible gradual neural loss. Also, inflammation occurs before retinal vascular changes can be clinically identified and is related to the neurosensory deterioration in diabetic retinopathy. As a response to hyperglycemia, the retinal neural and glial cells undergo abnormal reactions. Alterations in the inner and outer retina have been reported in type 2 diabetics without retinopathy as reflected by changes in visual function and retinal thickness. Central and peripheral visual function evaluation are both essential at early onset before clinically significant retinopathy is diagnosed. Reports on retinal thickness in type 2 diabetics without retinopathy show inconsistent results; some showing an increase, others showing a decrease, while others did not find any difference compared to healthy subjects. Although efforts have been focused to identify retinal thickness and visual changes in diabetics without retinopathy, there is however lack of information about visual function in early type 2 diabetics without retinopathy with well-controlled glucose and good standard visual acuity (VA) under low luminance conditions (mesopic) and its diagnostic capacity. Also, the information lacks about the correlation between retinal thickness and VA, and retinal thickness and contrast sensitivity (CS) to predict future retinal changes before the onset of retinopathy...
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Tesis de la Universidad Complutense de Madrid, Facultad de Óptica y Optometría, Departamento de Óptica II (Optometría y Visión), leída el 10/11/2017