Monica Lövestam-Adrian

Retinopathy in subjects with impaired fasting glucose: the NANSY-Eye baseline report.

Aims:  Network for Pharmacoepidemiology (NEPI) Antidiabetes Study‐Eye is a randomized placebo‐controlled Swedish trial investigating if treatment with sulphonylurea, in addition to dietary regulation and increased exercise, delays the development of retinopathy in subjects with impaired fasting glucose (IFG).

The temporal development of retinopathy and nephropathy in type 1 diabetes mellitus during 15 years diabetes duration

In this prospective study, the 10- and 15-year incidence and course of retinopathy were examined in relation to medical risk indicators from 3.1 +/- 1.9 (mean -/+ SD) years diabetes duration and onwards in 29 adult type 1 diabetic patients treated under routine care. A total of 28 patients were followed for 10 years and 20 patients for 15 years diabetes duration. After 10 years diabetes duration, 11 patients had developed any retinopathy (ten patients background retinopathy and one patient clinically-significant macular oedema). After 15 years diabetes duration, 16 patients had developed any retinopathy (12 patients developed background retinopathy and four patients developed potentially sight-threatening retinopathy, i.e. clinically significant macular oedema (n = 2) or severe non-proliferative retinopathy (n = 2)). None of the patients developed proliferative retinopathy. No differences were seen in mean HbA1c values between patients without any retinopathy and patients with background retinopathy, whereas patients who developed potentially sight-threatening retinopathy had higher mean HbA1c levels than patients without any retinopathy. Patients who developed potentially sight-threatening retinopathy had higher levels of mean HbA1c both after 10 (9.7 +/- 1.6 vs 6.9 +/- 1.5%; P < 0.05) and 15 years diabetes duration (9.3 +/- 1.2 vs 7.1 +/- 1.3%; P < 0.05), compared to patients without any retinopathy. They also had higher levels of mean HbA1c than patients with background retinopathy after 15 years diabetes duration (9.3 +/- 1.2 vs 7.7 +/- 1.1%; P < 0.05). There were no differences in blood pressure levels between patients who developed retinopathy and those who did not. Only two patients developed clinical signs of nephropathy (urinary albumin 320-1590 mg/l) after 12 and 13 years diabetes duration, respectively. At those time points, both patients had already developed background retinopathy since 2 years. In conclusion, the present study shows that the incidence of retinopathy is associated with the duration of diabetes and that there is a strong association between the degree of metabolic control and development of potentially sight-threatening retinopathy. The study also indicates that the development of retinopathy does not seem to be associated with hypertension or clinical signs of nephropathy.

The incidence of nephropathy in type 1 diabetic patients with proliferative retinopathy: a 10-year follow-up study

Patients with type 1 diabetes mellitus and with proliferative retinopathy often have a concomitant diabetic nephropathy. However, in cross-sectional studies it has been shown that 35% of patients with proliferative retinopathy do not show signs of diabetic nephropathy. The aim of the present study was to examine the incidence of diabetic nephropathy in type 1 diabetic patients with proliferative retinopathy but without signs of nephropathy. To that end, out of 102 consecutive patients with proliferative retinopathy attending the University Hospital, Lund, in 1986, 24 patients did not show any clinical signs of nephropathy, and were followed for 10 years regarding the development of nephropathy. Their age was 36.7 +/- 9.8 years, age at onset 11.8 +/- 7.5 years, diabetes duration 25.7 +/- 6.9 years and duration of proliferative retinopathy 4.6 +/- 3.8 years (mean +/- S.D.). At entry, no patient had albuminuria (< 30 mg/l), and albumin creatinine clearance ratio was < 0.01 x 10(-3). During the 10-year follow-up period, two of the patients showed isolated higher peaks of elevated urinary albumin, but none of the 24 patients developed persistent microalbuminuria (> or = 30 mg/l). Two patients died before follow-up, but none of these had developed microalbuminuria at the time for death. Based on mean annual measurements, there were no increases in HbA1c, systolic and diastolic blood pressure, and serum creatinine levels. At entry, seven of the patients were treated with antihypertensive drugs and another three patients received such treatment during the study period. In conclusion, in a subgroup of patients with proliferative retinopathy, i.e. without clinical signs of diabetic nephropathy, no patient developed persistent microalbuminuria during a 10-year follow-up period. These results indicate further evidence for at least partly different pathogenic mechanisms behind diabetic retinopathy and nephropathy.

Three-year follow-up of visual outcome and quality of life in patients with age-related macular degeneration

Background The purpose of this study was to evaluate the visual outcome and self-reported vision-targeted health status in patients treated with intravitreal ranibizumab for wet age-related macular degeneration (AMD). Methods A total of 51 eyes from 50 patients aged 76 ± 7 years, with wet AMD not previously treated, were included in this prospective study. Best corrected visual acuity was examined using Early Treatment Diabetic Research Study charts and near vision reading. All patients underwent an ophthalmological examination, including fluorescein and indocyanine green angiography (occult cases) and optical coherence tomography. The Visual Function Questionnaire test was completed before and 37 ± 7 months after the start of intravitreal injections. Results The patients received a mean number of 7.8 ± 5.0 (range 2–22) injections. One month after the third intravitreal injection, significant improvement was seen in both visual acuity (53 ± 14 to 61 ± 14 letter, P = 0.001) and near vision (17 ± 9 to 11 ± 8 points, P = 0.001). During follow-up, mean visual acuity decreased from 53 ± 14 to 44 ± 24 letters (P = 0.011), and near vision decreased from 17 ± 9 to 20 ± 11 points (P = 0.048). Despite visual impairment, the quality of life test revealed no significant decrease in mental health (P = 0.529) or ability to read a newspaper (P = 0.21), but a decrease in distance activities (reading street signs, steps, going to the theater) from 57 ± 27 to 46 ± 31 points (P = 0.007) was documented. Conclusion Decreased visual acuity was related to a decrease in self-reported visual function for distance activities, while mental health items, such as worrying, were not influenced.

Electrophysiological evaluation and visual outcome in patients with central retinal vein occlusion, primary open‐angle glaucoma and neovascular glaucoma

Purpose:  To evaluate patients with central retinal vein occlusion (CRVO) and neovascular glaucoma (NVG) using electrophysiology in order to gain better understanding of visual outcome and risk factors, such as previously diagnosed primary open‐angle glaucoma (POAG).

Multifocal electroretinography amplitudes increase after photocoagulation in areas with increased retinal thickness and hard exudates

Purpose:  This study aimed to evaluate local response on multifocal electroretinography (mfERG) and to assess retinal thickness with optical coherence tomography (OCT) after focal laser treatment in areas with retinal oedema and exudates in patients with diabetic retinopathy.

Macular dysfunction in drusen maculopathy assessed with multifocal electroretinogram and optical coherence tomography

Purpose To study the relationship between macular function assessed by multifocal electroretinogram (mfERG) and morphological changes evaluated with optical coherence tomography (OCT) and fundus photography in patients with drusen maculopathy. Methods Ten patients (age 71 ± 5 years) with drusen maculopathy were compared to fifteen healthy control patients (age 67 ± 7 years). One eye per patient was examined with OCT, color fundus pictures, and mfERG (103 hexagons) recorded in nine areas corresponding to the nine areas of the OCT retinal map. Drusen density for every separated area was registered. Results All nine areas in the maculopathy group demonstrated prolonged implicit time compared to healthy controls; the mean value for the maculopathy group was 31.3 milliseconds (95% confidence intervals [CI]: 30.9–31.6) vs 27.9 milliseconds (95% CI: 27.5–28.2; P = 0.006) for the control group. The amplitude in the foveal area was lower in the maculopathy group; the mean value for the maculopathy group was 25.1 nV/deg2 (95% CI: 18.4–31.7) vs 33.9 nV/deg2 (95% CI: 27–40.9; P = 0.03) for the control group. mfERG in the maculopathy group demonstrated no differences in areas with or without drusen. There was no correlation between the retinal thickness assessed with OCT and the mfERG response. Conclusion Eyes with drusen maculopathy demonstrated functional changes compared to healthy controls evaluated with mfERG. Drusen seems to be associated with general macular dysfunction.

Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration : a population- and register-based study from northern Sweden

To study the occurrence of severe visual impairment (SVI) and treatment outcome at 12 months in patients treated for wet age‐related macular degeneration (AMD) by use of data from the Swedish Macula Register (SMR) and referrals to the regional low vision clinics in five northern counties.

Multifocal Visual Evoked Potentials (mfVEP) in Diabetic Patients with and without Polyneuropathy

Previously not shown this study support that mfVEP is an indicator of optic nerve neuropathy in diabetic patients and there could be a correlation between the optic nerve dysfunction and diabetic poly neuropathy. The early optic nerve involvement might explain some of the visual complain in this group of diabetic patients. Purpose: To investigate the function of the visual pathway measured by mfVEP (multifocal Visual Evoked Potentials) in patients with diabetic retinopathy and neurophysiologically verified polyneuropathy Subjects and Methods: Thirty-two diabetic patients with the same degree of diabetic retinopathy were classified with neurography regarding polyneuropathy and further examined with mfVEP. The mfVEPs of eighteen patients with polyneuropathy were compared to those of fourteen diabetic patients without polyneuropathy and to those of ten nondiabetic subjects. Results: Diabetic duration, and the number of patients who had undergone panretinal photocoagulation for proliferative diabetic retinopathy were similar in the two patient groups, 29±13 vs 25±7 years, p=0.3. Both groups of patients with diabetic retinopathy had significantly lower amplitudes in the mfVEP than the healthy subjects. In addition the mfVEP amplitudes, which reflect selected areas of the visual function, were significantly reduced in the lower nasal quadrant in patients with neuropathy compared to patients without neuropathy. Conclusion: The results indicate that mfVEP could be an indicator of optic nerve neuropathy in patients with diabetic retinopathy. The early optic nerve involvement might explain some of the visual complaints in this group of diabetic patients.

Treatment for neovascular age‐related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register

To present Swedish Macula Register (SMR) data regarding treatment of neovascular age‐related macular degeneration (AMD) in clinical practice since 2008.