The changes of functional, structural and hemodynamic parameters of the optic disc in patients with primary open-angle glaucoma and diabetes mellitus in long-term follow-up

Purpose: to study the long-term changes of functional, structural, and hemodynamic parameters of the optic nerve in primary open-angle glaucoma (POAG) accompanied by diabetes mellitus (DM).

Material and methods. The study involved 258 patients (258 eyes), which were divided into five groups: 1st group — 58 patients with stage I POAG and DM; 2nd group — 50 patients (50 eyes) with stage I POAG; 3rd — 50 patients with stage III POAG and DM; 4th — 50 patients with stage III POAG; 5th — 50 patients with DM. In addition to a complete ophthalmological examination, the patients underwent spectral optical coherence tomography (OCT), OCT angiography of the optic nerve head and macula. The observation period was 24 months.

Results. The worst decrease in maximally corrected visual acuity was noted in patients with DM + POAG (groups 1 and 3): in 1 year of observation — stage I — 10.29%, stage III — 7.32 %, in control groups with isolated POAG stages I and III, 1.15 and 2.04%, respectively, in patients with DM, 1.39%; in 2nd year — 14.71 and 14.63% with a comorbid course of the disease and 1.15 and 4.08% in the absence of DM, respectively. The MD index in the group DM + POAG stage I after 12 months was significantly lower compared to patients with stage I POAG (by 5.05%), after 24 months by 12.12, 0.34 and 1.69%, respectively (p £ 0.05). The groups of comorbid patients showed lower average thickness levels of the retinal nerve fibers layer than in the control groups: 78.81 ± 11.39 μm at stage I and 63.08 ± 10.32 μm at stage III. A similar pattern was noted for the thickness of the neuroretinal rim and its areas as well indicators of the optic disc excavation (volume and c/d ratio).No significant difference was noted in the density of the optic nerve disc perfusion in stages I and III POAG with DM against the respective control groups during the first visit, but we noted a significantly lower vascular density in patients with the initial stage of POAG and DM (0.39 ± 0.04 / mm) than in patients with isolated glaucoma (0.42 ± 0.03 / mm). As the disease progressed, there was a further significant decrease in the average indicators of optic nerve disc perfusion and vascular density (group 3: 39.17 ± 3.43% and 0.33 ± 0.03 / mm).

Conclusion. The study of the changes of visual, functional, structural and hemodynamic parameters of the optic nerve showed a faster rate of progression of glaucomatous optic neuropathy if accompanied with DM.

1. Abe R., Gracitelli С., Medeiro F. The Use of Spectral-Domain Optical Coherence Tomography to Detect Glaucoma Progression. The Open Ophthalmol. J. 2015; 9 (Suppl. 1): 78–88. doi: 10.2174/1874364101509010078

2. Piltz-Seymour J.R. Laser Doppler flowmetry of the optic nerve head in glaucoma. Surv. Ophthalmol. 1999; 43 (Suppl. 1): 191–8. doi: 10.1016/s0039-6257(99)00053-3

3. Deokule S., Vizzeri G., Boehm A., et al. Association of visual field severity and parapapillary retinal blood flow in open-angle glaucoma. J Glaucoma. 2010; 19 (5): 293–8. doi: 10.1097/IJG.0b013e3181b6e5b9

4. Toshev A.P., Schuster A.K., Hassan S.N., et al. Optical Coherence Tomography Angiography of optic disc in eyes with primary open-angle glaucoma and normal-tension glaucoma. J. Glaucoma. 2019; 28 (3 Mar.): 243–51. doi: 10.1097/IJG.0000000000001184

5. Le P.V., Tan O., Chopra V., et al. Regional correlation among ganglion cell complex, nerve fiber layer, and visual field loss in glaucoma. Invest. Ophthalmol Vis. Sci. 2013; 54 (6): 4287–95. doi: 10.1167/iovs.12-11388

6. Fursova A.Zh., Gamza Y.A., Tarasov M.S., Vasil’eva M.А., Derbeneva A.S. A comparative study of structural and microcirculatory parameters in patients with primary open-angle glaucoma and diabetes mellitus. Russian ophthalmological journal. 2020; 13 (3): 42–50 (in Russian). https://doi.org/10.21516/2072-0076-2020-13-3-42-50

7. Komori S., Ishida K., Yamamoto T. Results of long-term monitoring of normaltension glaucoma patients receiving medical therapy: results of an 18-year follow-up. Graefes Arch. Clin. Exp. Ophthalmol. 2014; 252 (12): 1963–70. https://doi.org/10.1007/s00417-014-2767-3

8. Yoshikawa K., Santo K., Hizaki H., Hashimoto M. Long-term progression of visual field defects and related factors in medically treated normal tension glaucoma. Clin. Ophthalmol. 2018; 12: 247–53. doi: 10.2147/OPTH.S146455

9. Agafonova T.Yu., Sobyanin N.A., Gavrilova T.V. Progression of primary open-angle glaucoma n type 2 diabetes: comorbidity issue RMJ. Clinical ophthalmology. 2017; 1: 22–5 (in Russian). https://doi.org/10.21689/2311-7729-2017-17-1-22-25

10. Apreutesei N., Chiselita D., Motas O. Glaucoma evolution in patients with diabetes. Rev. Med. Chir. Soc. Med. Nat. Iasi. 2014; 118 (3): 667–74.

11. Pantalon A., Feraru C., Chiseli a D. Short term evaluation of perimetric progression in patients with open angle glaucoma and diabetes. Rev. Med. Chir. Soc. Med. Nat. Iasi. 2016; 120 (1 Jan. — Mar.): 83–9.

12. Jeong S., Park S., Chin H., Kim S., Kim N. Spectral-Domain Optical Coherence Tomography features in open-angle glaucoma with diabetes mellitus and inadequate glycemic control. Invest. Ophthalmol. Vis. Sci. 2016; 57 (7): 3024–31. doi: 10.1167/iovs.16-19457R1

13. Filek R., Hooper P., Sheidow T., et al. Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients. Clin. Ophthalmol. 2019; 13 (Jul. 1): 1087–96. https://doi.org/10.2147/OPTH.S199758

14. Hou H., Shoji T., Zangwill L.M., Moghimi S. Progression of primary open-angle glaucoma in diabetic and nondiabetic patients. Am. J. Ophthalmol. 2018; 189: 1–9. doi:10.1016/j.ajo.2018.02.002

15. Fursova A.Zh., Gamza Y.A, Derbeneva A.S., Vasil’eva M.А. AntiVEGF therapy of diabetic macular edema in patients with primary open-angle glaucoma. Vestnik oftal’mologii. 2020; 136 (6): 185–94 (In Russian). doi: 10.17116/oftalma2020136062185

16. Gardiner S., Boey P., Yang H., et al. Structural measurements for monitoring change in glaucoma: comparing retinal nerve fiber layer thickness with minimum rim width and area. Invest. Ophthalmol. Vis. Sci. 2015; 56 (11 Oct.): 6886–91. doi: 10.1167/iovs.15-16701

17. Sohn E., van Dijk H., Jiao C. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc. Natl. Acad. Sci. U S A. 2016; 113 (19): E 2655-64. doi: 10.1073/pnas.1522014113

18. Ng D., Chiang P., Tan G., et al. Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy. Clin. Exp. Ophthalmol. 2016; 44 (4): 243–50. doi: 10.1111/ceo.12724

19. Moghimi S., Zangwill L., Penteado R., et al. Macular and optic nerve head vessel density and progressive retinal nerve fiber layer loss in glaucoma. Ophthalmology. 2018; 125 (11): 1720–28. doi: 10.1016/j.ophtha.2018.05.006

20. Z boulon P., L v que P., Brasnu E., et al. A. Effect of surgical intraocular pressure lowering on peripapillary and macular vessel density in glaucoma patients: an Optical Coherence Tomography Angiography study. J. Glaucoma. 2017; 26 (5): 466–72. doi: 10.1097/IJG.0000000000000652

21. Fursova A.Zh., Gamza Y.A., Vasil’eva M.А., Derbeneva A.S. Impact of antiangiogenic therapy on the hemodinamics of the optic disk nerve and macula in patients with diabetic macular edema and glaucoma. Bulletin of Pirogov National medical surgical center. 2021; 16 (1): 93–8 (in Russian). doi: 10.25881/BPNMSC.2021.33.54.016

22. Wen J., Chen C., Rezaei K., et al. Optic nerve head perfusion before and after intravitreal antivascular growth factor injections using Optical Coherence Tomography-based Microangiography. J. Glaucoma. 2019; 28 (3): 188–93. doi: 10.1097/IJG.0000000000001142