Evaluation of Relationship between Contrast Sensitivity, Color Vision And Visual Acuity in Diabetic Patients with and Without Retinopathy

Document Type : Research Paper

Authors

1 Ph.D. of Optometry, Associate professor of Mashhad University of Medical Sciences, Mashhad, Iran

2 MSc in Optometry

3 Ophthalmologist, Assistant professor of Mashhad University of Medical Sciences, Mashhad, Iran

4 Epidemiolojist, Assistant professor of Mashhad University of Medical Sciences, Mashad,Iran

Abstract

Introduction
 
To investigate the discriminative ability of contrast sensitivity (CS), color vision and log MAR visual acuity (VA) in detecting functional losses in diabetic participants with and without retinopathy comparing to the control group.
Materials and Methods
 
In this cross sectional study in 1388 we examined 105 patients in Mashhad Khatam- Al-Anbia Eye Hospital including 70 diabetic patients (35 with retinopathy and 35 without retinopathy) with 35 control group. Contrast sensitivity was examined by means of CSV-1000 E at 3, 6, 12 and 18 cpd respectively. Color discrimination ability was measured with the Farnsworth D-15 test and log MAR VA by Snellen chart.
Results
Contrast sensitivity was significantly lower in the diabetic eyes with retinopathy than in the normal eyes in all spatial frequencies. Comparing to the control group, there was a statistically significant CS loss in spatial frequencies of 3, 6, 18 cpd in the diabetic eyes without retinopathy (p<0.05). The mean log MAR VA and color vision abnormalities were significantly higher in the diabetic eyes with retinopathy than in the normal eyes or the diabetic eyes without retinopathy (p<0.001). The sensitivity and specificity of the CS test in 6 cpd were 71% and 82% which were significantly higher than other spatial frequencies. The sensitivity and the specificity of the color vision test and VA (log MAR ≥ 0.05, Snellen ≤ 9/10) were 79% and 94% respectively.
Conclusion
 
There was significant difference between the visual performance of those diabetics with retinopathy and those without. There was excellent agreement between the results of these three tests

Keywords


1- Pesudovs K, Hazel CA, Doran RML, Elliott DB. The usefulness of Vitech anf FACT contrast sensitivity charts for
cataract and refractive surgery outcomes research. Br J Ophthalmol 2004; 88:11-16
2- Flynn HT J, WE S. Diabetes and ocular disease: Past ,present, and future therapies. Ophthalmology monographs 14.
San Francisco: American Academy of Ophthalmology; 2000.
3- Dileo M, Caputo S, Falsini B, Porciatti v, Minnella A, Greco A, et al. Nonselective loss of contrast sensitivity in
visual system testing in early type I diabetes. Diabetes Care. 1992;15(5):620-5.
4- Porciatti V, Falsini B. Inner retina distribution to the flicker electroretinogram: a comparison with the pattern
electroretinogram. Clin Vision Sci 1993;8:435-37.
5- Dileo M, Caputo S ,Falsini B. Presence and further development of retinal dysfunction after 3-year follow up in
IDDM patients without angiographically documented vasculopathy. Diabetologia 1994; 37:911-916.
6- Verrotti A, Lobefalo L, Petitti M, Mastropasqua L, Morgese G, Chiarelli F, et al. Relationship between contrast
sensitivity and metabolic control in diabetics with and without retinopathy. Ann Med 1998; 30:369-374.
7- Trick G, Burde R, Gordon M, Santiago J, Kilo C. The relationship between hue discrimination and contrast
sensitivity deficits in patients with diabetes mellitus. Ophthalmology 1988; 95:693-698.
8- Ivers RQ, Mitchell P. Sensitivity and specificity of tests to delet eye disease in an older population. Ophthalmology
2001; 108: 968-975
9- Stavrou E Wood JM. Letter contrast sensitivity changes in early diabetic retinopathy. Clin Exp Optom 2003; 86:152-
156.
10- Verrotti A, Lobefalo L, Chiarelli F, Mastropasqua L, Cincaglini M, Morgese G. Color vision and persistent
microalbuminuria in children with type 1 ) insulin dependent) diabetes mellitus: a longitudinal study. Diabetes Res Clin
Pract 1995; 30:125-130.
11- Olafsdó ttir E, Stefánsson E. Biennial eye screening in patients with diabetes without retinopathy: 10-year
experience. Br J Ophthalmol 2007; 91:1599-1596
12- Whited J, Datta S, Aiello L. A modeled economic analysis of a digital tele-ophthalmology system as used by three
federal health care agencies for detecting proliferative diabetic retinopathy. Telemed J E Health 2005; 11:641-651.
13- Rohan T, Frost C, Wald J. Prevention of blindness by screening for diabetic retinopathy; a quantitative assessment.
Brit Med J 1989; 299:1198-1201.
14- Beszédesová N, Budinská E. Functional integrity of neural retina in 2. type diabetics. Cesk Slov Oftalmol 2009
;65:124-130.
15- Krasny J, Cihelkova I, Dominek Z, Soucek P, Treslova L, Lebl J, Andol M. Contrast sensitivity and fluorescein
angiography in evaluating the ocular changes in the relation to the diabetes mellitus type 1 compensation in young adult
patients. Cesk Slov Ofthlmol 2007; 63:17-27
16- Sokol S, Moskowitz A, Skarf B, Evans R, Molitch M, Senior B. Contrast sensitivity in diabetics with and without
background retinopathy. Arch Ophthalmol 1985; 103:51-54.
17- Collier A, Mitchell J, Clarke B. Visual evoked potential and contrast sensitivity function in diabetic retinopathy. Br
Med J 1985: 248-291.
18- Banford D, North R, Dolben J, Butler G, Owens D. Longitudinal study of visual functions in young insulin
dependent diabetics. Ophthalmic Physiol Opt 1994; 14:339-346.
19- Scanlon PH, Foy C, Chen FK. Visual acuity mesurement and ocular co-morbidity in diabetic retinopathy screening.
Br J Ophthalmol. 2008; 108: 968-975.
20- Bresnick G. Diabetic retinopathy viewed as a neurosensory disorder. Arch Ophthalmol 1986; 10:90-94
 
21- Ismail GM, Whitakert D. Early detection of changes in visual function in diabetes mellitus. Ophthal Physiol Opt
1998;18:3-12.
22- Abrishami M, Heravian J, Derakhshan A, Mousavi M, Banaee T, Daneshvar R, et al. Abnorml Cambridge Low
contrast grating sensitivity results associted with diabetic retinopathy as a potential screening tool. East Mediterr Health
J 2007; 13:810-818.
23- Klein R, Lee K, Knudtson MD, Gangnon RE, Klein BEK. Ophthalmology 2009: 116:1937-1942.
24- Hyvärinen L, Laurinen P, Rovamo J. Contrast sensitivity in evaluation of visual impairment due to diabetes. Acta
Ophthalmol (Copenh) 1983; 61:94-101.
25- Brinchmann-Hansen O, Bangstad H, Hultgren S, Fletcher R, Dahl-Jorgensen K, Hanssen K, et al. Psychophysical
visual function, retinopathy, and glycemic control in insullin-dependent diabetics with normal visual acuity. Acta
Ophthalmol (Copenh) 1993; 71:230-237.
26- Hardy K, Scarpello J, Foster D, Moreland J. Effect of diabetes associated increases in lens optical density on colour
discrimination in insulin dependent diabetes. Br J Ophthalmol 1994; 78:754-756.
27- Holopigian K, Greenstein V, Seiple W, Hood D, Carr R. Evidence for photoreceptor changes in patients with
diabetic retinopathy. Invest Ophthalmol Vis Sci 1997; 38:2355-2365.
28- Bek T. Immunohistochemical characterization of retinal glial cell changes in areas of vascular occlusion secondary
to diabetic retinopathy. Acta Ophthalmol Scand 1997; 75:388-392.
29- Wong R, Khan J, Adewoyin T, Sivaprasad S, Arden GB, Chong V. The chroma test, a digital color contrast
sensitivity analyzer, for diabetic maculopathy: a pilot study. BMC Ophthalmology 2008; 8:15.
30- Aspinall P, Kinnear P, Duncan L, Clarke B. Prediction of diabetic retinopathy from clinical variables and color
vision data. Diabetes Care 1983; 6:144–148.