A systematic study of structure and function in Diabetic Macular oedema

Abstract

Diabetic retinopathy (DR), one of the microvascular complications that occurs in diabetes mellitus (DM). Diabetic macular oedema (DMO) is a common feature of DR and is an important cause of vision loss in people with DM. The project starts with a systematic review on the role of dyslipidaemia in the development of DMO. Evidence from the cohort studies and meta-analysis of the case-control studies suggested a strong relationship between lipid levels and DMO, this was not confirmed by the meta-analysis that included only prospective randomized control trials. Therefore, given the significant public health relevance of the topic, the relationship between lipid levels and DMO deserves further investigation.

A standardized reproducible method for characterizing the morphological features of DR specifically DMO observed on high resolution spectral domain optical coherence tomography (SD-OCT) was generated and predictive markers with potential for use as functional and morphological outcomes in clinical trials and studies were identified. The construction of a lexicon for grading of OCT in DMO and the validation of unique tomographic biomarkers such as disorganization of the inner retinal layers (DRIL), and its association with severity of DR is of importance as it has the potential to change the approach to counseling and management of the ocular manifestations in patients with DM.
The prospective study identified key cut off functional points that separate normal controls from DM but no DR. While best corrected visual acuity is routinely used in clinical practice and was found to be a valuable measure that reflected the early visual deficits in DM, near visual acuity and low luminance deficit at near which represent more global assessment of macular function showed that these were more sensitive to changes that occur prior to the development of clinically visible DR and are likely to be of value in disease prognosis.

Finally our analysis showed that RNFL thickness in DM patients may be a valuable tool in the assessment of DR even before the appearance of overt clinical retinopathy and SD-OCT may serve as useful instrument to closely monitor changes in RNFL thickness in early stage of DM.

Date of Award	Jul 2017
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Usha Chakravarthy (Supervisor) & Ruth Hogg (Supervisor)