Progression of Early Retinal Dysfunction in Diabetes Over Time: Results of a Long-term Prospective Clinical Study

  1. Boel Bengtsson1
  1. 1Department of Clinical Sciences, Ophthalmology, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
  2. 2Department of Ophthalmology, Karlstad, County Council of Värmland, Karlstad, Sweden
  1. Corresponding author: Karl-Johan Hellgren, karl-johan.hellgren{at}


We explored signs of retinal dysfunction over time in diabetic subjects before or early in the course of retinopathy. Patients with no, mild, or moderate retinopathy were consecutively recruited and underwent standard automated perimetry, visual acuity measurement, and fundus photography. These examinations and measurements of HbA1c and blood pressure were repeated for up to 5 years from baseline. Visual field improvement/deterioration in diabetic subjects was evaluated using significance limits for change. Progression or regression of retinopathy was defined as a two-step change on the Early Treatment Diabetic Retinopathy Study final severity scale. Seventy-four subjects completed at least 3 years of follow-up, and 22% showed visual field worsening, defined as repeated significant deterioration at ≥10% of the test points, whereas only 1% showed field improvement. Worsening occurred in subjects both with and without vascular lesions. The degree of retinopathy was stable throughout the observation period in 68 of 74 eyes, improved in 4, and worsened in 2. Visual field deterioration was not correlated with a change in retinopathy. By using perimetry with an analysis tailored for monitoring diabetic subjects, we were able to demonstrate progression of retinal dysfunction over time, which may represent early signs of retinal neurodegeneration.

  • Received October 21, 2013.
  • Accepted March 31, 2014.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.

Articles citing this article