Full Text:   <1086>

Summary:  <1372>

Suppl. Mater.: 

CLC number: R587.1

On-line Access: 2020-11-05

Received: 2020-04-30

Revision Accepted: 2020-08-05

Crosschecked: 2020-10-15

Cited: 0

Clicked: 1955

Citations:  Bibtex RefMan EndNote GB/T7714


Xia-hong Lin


-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2020 Vol.21 No.11 P.911-920


Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy

Author(s):  Xiao-hong Wu, Jing-wen Fang, Yin-qiong Huang, Xue-feng Bai, Yong Zhuang, Xiao-yu Chen, Xia-hong Lin

Affiliation(s):  Department of Endocrinology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China; more

Corresponding email(s):   linxiahongdr@fjmu.edu.cn

Key Words:  Type 2 diabetes, Peripheral neuropathy, Retinal nerve fiber layer thickness, Optical coherence tomography, Diagnosis

Share this article to: More <<< Previous Article|

Xiao-hong Wu, Jing-wen Fang, Yin-qiong Huang, Xue-feng Bai, Yong Zhuang, Xiao-yu Chen, Xia-hong Lin. Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy[J]. Journal of Zhejiang University Science B, 2020, 21(11): 911-920.

@article{title="Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy",
author="Xiao-hong Wu, Jing-wen Fang, Yin-qiong Huang, Xue-feng Bai, Yong Zhuang, Xiao-yu Chen, Xia-hong Lin",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy
%A Xiao-hong Wu
%A Jing-wen Fang
%A Yin-qiong Huang
%A Xue-feng Bai
%A Yong Zhuang
%A Xiao-yu Chen
%A Xia-hong Lin
%J Journal of Zhejiang University SCIENCE B
%V 21
%N 11
%P 911-920
%@ 1673-1581
%D 2020
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B2000225

T1 - Diagnostic value of optic disc retinal nerve fiber layer thickness for diabetic peripheral neuropathy
A1 - Xiao-hong Wu
A1 - Jing-wen Fang
A1 - Yin-qiong Huang
A1 - Xue-feng Bai
A1 - Yong Zhuang
A1 - Xiao-yu Chen
A1 - Xia-hong Lin
J0 - Journal of Zhejiang University Science B
VL - 21
IS - 11
SP - 911
EP - 920
%@ 1673-1581
Y1 - 2020
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2000225

Objective: To investigate the value of optic disc retinal nerve fiber layer (RNFL) thickness in the diagnosis of diabetic peripheral neuropathy (DPN). Methods: Ninety patients with type 2 diabetes, including 60 patients without DPN (NDPN group) and 30 patients with DPN (DPN group), and 30 healthy participants (normal group) were enrolled. optical coherence tomography (OCT) was used to measure the four quadrants and the overall average RNFL thickness of the optic disc. The receiver operator characteristic curve was drawn and the area under the curve (AUC) was calculated to evaluate the diagnostic value of RNFL thickness in the optic disc area for DPN. Results: The RNFL thickness of the DPN group was thinner than those of the normal and NDPN groups in the overall average ((101.07± 12.40) µm vs. (111.07±6.99) µm and (109.25±6.90) µm), superior quadrant ((123.00±19.04) µm vs. (138.93±14.16) µm and (134.47±14.34) µm), and inferior quadrant ((129.37±17.50) µm vs. (143.60±12.22) µm and (144.48±14.10) µm), and the differences were statistically significant. The diagnostic efficiencies of the overall average, superior quadrant, and inferior quadrant RNFL thicknesses, and a combined index of superior and inferior quadrant RNFL thicknesses were similar, and the AUCs were 0.739 (95% confidence interval (CI) 0.635–0.826), 0.683 (95% CI 0.576–0.778), 0.755 (95% CI 0.652–0.840), and 0.773 (95% CI 0.672–0.854), respectively. The diagnostic sensitivity of RNFL thickness in the superior quadrant reached 93.33%. Conclusions: The thickness of the RNFL in the optic disc can be used as a diagnostic method for DPN.




Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Alasil T, Wang KD, Keane PA, et al., 2013. Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography. J Glaucoma, 22(7):532-541.

[2]Binns-Hall O, Selvarajah D, Sanger D, et al., 2018. One-stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high-risk foot. Diabet Med, 35(7):887-894.

[3]Botsford B, Vuong LN, Hedges TR III, et al., 2017. Characterization of Charcot-Marie-Tooth optic neuropathy. J Neurol, 264(12):2431-2435.

[4]Boulton AJM, Malik RA, 2010. Neuropathy of impaired glucose tolerance and its measurement. Diabetes Care, 33(1):207-209.

[5]Breiner A, Lovblom LE, Perkins BA, et al., 2014. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes Care, 37(5):1418-1424.

[6]Chatzikosma G, Pafili K, Demetriou M, et al., 2016. Evaluation of sural nerve automated nerve conduction study in the diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Arch Med Sci, 12(2):390-393.

[7]Cho NH, Shaw JE, Karuranga S, et al., 2018. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 138: 271-281.

[8]Dyck PJ, Overland CJ, Low PA, et al., 2010. Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial. Muscle Nerve, 42(2):157-164.

[9]Feng L, Hu JH, Chen J, et al., 2018. An efficacy analysis of anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to multifocal choroiditis and comparison with wet age-related macular degeneration. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(4):327-332.

[10]Forsblom CM, Sane T, Groop PH, et al., 1988. Risk factors for mortality in Type II (non-insulin-dependent) diabetes: evidence of a role for neuropathy and a protective effect of HLA-DR4. Diabetologia, 41(11):1253-1262.

[11]Gordois A, Scuffham P, Shearer A, et al., 2003. The health care costs of diabetic peripheral neuropathy in the U.S. Diabetes Care, 26(6):1790-1795.

[12]International Diabetes Federation, 2019. IDF Diabetes Atlas, 9th Ed. International Diabetes Federation, Brussels, Belgium.

[13]Jonas JB, Mardin CY, Schlötzer-Schrehardt U, et al., 1991. Morphometry of the human lamina cribrosa surface. Invest Ophthalmol Vis Sci, 32(2):401-405.

[14]Jonas JB, Schmidt AM, Müller-Bergh JA, et al., 1992. Human optic nerve fiber count and optic disc size. Invest Ophthalmol Vis Sci, 33(6):2012-2018.

[15]Kim JH, Lee MW, Byeon SH, et al., 2018. Associations between individual retinal layer thicknesses and diabetic peripheral neuropathy using retinal layer segmentation analysis. Retina, 38(11):2190-2196.

[16]Kim K, Yu SY, Kwak HW, et al., 2016. Retinal neurodegeneration associated with peripheral nerve conduction and autonomic nerve function in diabetic patients. Am J Ophthalmol, 170:15-24.

[17]Kim K, Kim ES, Rhee SY, et al., 2017. Clinical characteristics and risk factors for retinal diabetic neurodegeneration in type 2 diabetes. Acta Diabetol, 54(11):993-999.

[18]Lakshmikantha HT, Ravichandran NK, Jeon M, et al., 2018. Assessment of cortical bone microdamage following insertion of microimplants using optical coherence tomography: a preliminary study. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(11):818-828.

[19]Li H, Yu XB, Chen Q, et al., 2016. Relationship between retinal nerve fibre layer thickness and peripheral neuropathy in patients with type 2 diabetes. Chin J Diabetes Mellitus, 8(7):418-421 (in Chinese).

[20]Lin YC, Shen ZR, Song XH, et al., 2018. Comparative transcriptomic analysis reveals adriamycin-induced apoptosis via p53 signaling pathway in retinal pigment epithelial cells. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(12):895-909.

[21]Liu F, Bao YQ, Hu RM, et al., 2010. Screening and prevalence of peripheral neuropathy in type 2 diabetic outpatients: a randomized multicentre survey in 12 city hospitals of China. Diabetes Metab Res Rev, 26(6):481-489.

[22]Luu CD, Szental JA, Lee SY, et al., 2010. Correlation between retinal oscillatory potentials and retinal vascular caliber in type 2 diabetes. Invest Ophthalmol Vis Sci, 51(1):482-486.

[23]Ni CM, Ling BY, Xu X, et al., 2020a. CX3CR1 contributes to streptozotocin-induced mechanical allodynia in the mouse spinal cord. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 21(2):166-171.

[24]Ni CM, Sun HP, Xu X, et al., 2020b. Spinal P2X7R contributes to streptozotocin-induced mechanical allodynia in mice. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 21(2):155-165.

[25]Perkins BA, Olaleye D, Zinman B, et al., 2001. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care, 24(2):250-256.

[26]Pirart J, 1977. Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973 (author’s transl). Diabète Métab, 3(2):97-107 (in French).

[27]Pop-Busui R, Boulton AJ, Feldman EL, et al., 2017. Diabetic neuropathy: a position statement by the American Diabetes Association. Diab Care, 40(1):136-154.

[28]Seferovic JP, Pfeffer MA, Claggett B, et al., 2018. Three-question set from Michigan Neuropathy Screening Instrument adds independent prognostic information on cardiovascular outcomes: analysis of ALTITUDE trial. Diabetologia, 61(3):581-588.

[29]Shahidi AM, Sampson GP, Pritchard N, et al., 2012. Retinal nerve fibre layer thinning associated with diabetic peripheral neuropathy. Diabetic Med, 29(7):e106-e111.

[30]Smith AG, Lessard M, Reyna S, et al., 2014. The diagnostic utility of Sudoscan for distal symmetric peripheral neuropathy. J Diabetes Complications, 28(4):511-516.

[31]Srinivasan S, Pritchard N, Vagenas D, et al., 2016. Retinal tissue thickness is reduced in diabetic peripheral neuropathy. Curr Eye Res, 41(10):1359-1366.

[32]Srinivasan S, Pritchard N, Sampson GP, et al., 2017. Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy. J Optom, 10(4):215-225.

[33]Verma A, Rani PK, Raman R, et al., 2009. Is neuronal dysfunction an early sign of diabetic retinopathy? Microperimetry and spectral domain optical coherence tomography (SD-OCT) study in individuals with diabetes, but no diabetic retinopathy. Eye (London), 23(9):1824-1830.

[34]Wang BH, Xu YS, Xie WJ, et al., 2018. Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(11):863-870.

[35]WHO (World Health Organization), ‎1999. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. WHO, Geneva. Available from https://apps.who.int/iris/handle/10665/66040

[36]Xie WJ, Xu YS, Zhang X, et al., 2018. Assessments of tear meniscus height, tear film thickness, and corneal epithelial thickness after deep anterior lamellar keratoplasty. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 19(3):218-226.

[37]Yu JG, Feng YF, Xiang Y, et al., 2014. Retinal nerve fiber layer thickness changes in Parkinson disease: a meta-analysis. PLoS ONE, 9(1):e85718.

[38]Zhang X, Yu H, Zhang Y, et al., 2018. The application of RNFL thickness detection in early differential diagnosis among various types of idiopathic optic neuritis. J Clin Neurosci, 55:82-85.

[39]List of electronic supplementary materials

[40]Table S1 Complete nerve electromyography data of the DPN and NDPN groups

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2022 Journal of Zhejiang University-SCIENCE