Download karnataka, bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION
Name of the Candidate
Dr. Ali Akbar Jafarian Lari
Address of the Candidate
Vydehi Institute of Medical
Sciences & Research Centre
#82 EPIP Area, Nallurahalli,
Whitefield, Bangalore- 560066
2.
Name of the Institution
Vydehi Institute of Medical
Sciences & Research Centre
3.
Course of Study and Subject
MS-Ophthalmology
4.
Date of Admission to Course
22-04- 2011
5.
Title of the Topic
A study of the correlation of
contrast sensitivity, computerized
perimetry and fluorescein
angiographic findings in diabetic
macular edema.
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Brief Resume of the Intended Work
Need of the Study
It is predicted that the number of adults with diabetes mellitus will rise from 135 million in
1995 to 300 million in the year 2025. The major part of this numerical increase will occur in the
developing world.1
Diabetic macular edema is the most frequent microvascular complication and is responsible
for a significant degree of irreversible visual loss in diabetic patients.2
Fluorescein angiograms are used for the detection of microvascular abnormalities, severity
and extent of macular edema. It is essential to distinguish ischemic and non ischemic macular edema.
This is an integral part of treatment regimens of macular edema.
Contrast sensitivity is a measure of central visual function.3 Computerized perimetry using
Humphrey field analyzer (central 10-2 and macular program) is also an indicator of macular function.
Retinal sensitivity in macular area decreases in macular disorders.
An attempt is made to correlate the fluorescein angiographic findings with the above
functional parameters. Laser is the mainstay of the treatment of diabetic macular edema.4 Newer
treatment modalities like intravitreal triamcinolone and intravitreal ranibizumab alone or in
combination with laser are in vogue.
However it is not possible to improve the macular function in cases of macular ischemia,
refractory macular edema and post laser complications. Our study aims to determine the type of
macular edema, ischemic or non ischemic and its functional status. This enables the clinician to decide
the optimal treatment modalities.
Review of Literature
Diabetic macular edema has a wide spectrum of pathologies. Its treatment is determined by
the subtypes of macular edema. As has surveyed by a group of ophthalmologists in Samsung medical
center, South Korea, the interpretation of diabetic macular edema with fluorescein angiography would
help in selecting an appropriate treatment.5
A study done by department of ophthalmology and visual sciences, Kyoto university in
Japan, reveals that the loss of visual acuity, contrast sensitivity and perimetry is correlated
significantly with the fluorescein angiographic types of macular edema. 6
A survey done in Kuopio university hospital in Finland, showed that one-fifth of diabetic
patients developed maculopathy which deteriorated their visual acuity. Poor glycemic control was the
most important predictor of maculopathy.7
Objective of the Study
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
To correlate the contrast sensitivity, computerized perimetry and fluorescein angiographic
findings in patients with diabetic macular edema.
To determine relationship between glycosylated hemoglobin A1c levels and functional parameters
of vision
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Resources and Method
Sources of Data
All established non insulin dependent diabetes mellitus patients with diabetic retinopathy and macular
edema attending ophthalmology department of VIMS & RC.
Period: It is a period based study from January to December 2012.
Sample size: This study will attempt to take at least thirty patients into consideration.
Method of Data Collection
Informed written consent of the participant is taken.
A pre structured proforma is used to collect the baseline data.
The following measurements will be done on diagnosed cases of non insulin dependent diabetics
patients:
 Blood sampling to check fasting blood sugar, post prandial blood sugar, glycosylated
hemoglobinA1c, lipid profile and serum creatinine.
 Blood pressure recording
 Visual acuity test by using Logmar chart
 Contrast sensitivity by tumbling E chart
 Direct and indirect fundus examination
 Fundus photography by Carl Zeiss Visu-Cam lite
 Computerized perimetry, Humphrey field analyzer ( central 10 -2 and macular program)
 Fundus fluorescein angiography by Carl Zeiss Visu-Cam lite
Study Design
It is a cross sectional prospective study.
Statistical Analyses used :
Outcome of the study will be analyzed using Chi square test.
Inclusion Criteria :
 Non insulin dependent diabetes mellitus more than 5 year duration with diabetic macular
edema
 Patients who had not undergone treatment for diabetic retinopathy with macular edema
 Adults aged 40-70 Years
 Either sex
Exclusion Criteria :
 Insulin dependent diabetes mellitus
 Non insulin dependent diabetes mellitus in congestive cardiac failure, acute renal failure and
chronic renal failure
 Other ocular pathologies affecting visual acuity( glaucoma, cataract and Age related macular


degeneration)
Previous treatment for diabetic retinopathy (surgery, pharmacotherapy and laser)
Diabetic macular edema associated with vitreoretinal traction
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Required Investigations and Interventions
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Fasting blood sugar, post prandial blood sugar, glycosylated hemoglobin A1c
Serum creatinine
Lipid profile
Investigating blood pressure
Logmar visual acuity for distance and near
Contrast sensitivity by tumbling E chart(Appasamy)
Direct and indirect ophthalmoscopy
Computerized perimetry Humphrey field analyzer (central 10-2 & macular)
Fundus photography (Carl Zeiss Visu –Cam lite)
Fluorescein angiography (Carl Zeiss Visu –Cam lite)
Ethical clearance from Ethics Committee of VIMS & RC
Yes
8.
List of References
1.
Williams R, et. Al. “Epidemiology of diabetic retinopathy and macular edema: a systematic
review”. Eye 2004, 18, 963–983 http://www.nature.com/eye/journal/v18/n10/full/6701476a
(accessed on 23/09/2011)
2.
Hammes HP. “Diabetic retinopathy and maculopathy”. Internist (Berl) 2011May; 52(5):51832. http://www.ncbi.nlm.nih.gov/pubmed/21505839 (accessed on 16/09/2011)
3.
Arend O,et.Al. “Contrast sensitivity loss is coupled with capillary dropout in patients with
diabetes”. Invest Ophthalmol Vis Sci 1997 Aug; 38(9):1819-24.
http://www.ncbi.nlm.nih.gov/pubmed/9286271 (accessed on 23/09/2011)
4.
Schachat AP. “A new approach to the management of diabetic macular edema”. Am J
Ophthalmology 2010Jun;117(6):1059-63http://www.ncbi.nlm.nih.gov/pubmed/20522333
(accessed on 01/10/2011)
5.
Kang SW, Park CY, Ham DI. “The correlation between fluorescein angiographic and optical
coherence tomographic features in clinically significant diabetic macular edema”. Am J
Ophthalmology. 2004 Feb; 137(2):313-22. http://www.ncbi.nlm.nih.gov/pubmed/14962423
(accessed on 16/09/2011)
6.
Unoki Noriyuki, et.Al. “Retinal sensitivity loss and structural disturbance in areas of
capillary nonperfusion of eyes with diabetic retinopathy”. Am J Ophthalmology2007 Nov;
144(5 ): 755-760. http://www.ajo.com/article/S0002-9394(07)00633-/abstract (accessed on
15/09/2011)
7.
Voutilainen-Kaunisto R, et.Al. “Maculopathy and visual acuityin newly diagnosed type 2
diabetic patients and non diabetic subjects: a 10-year follow-up study”. Acta Ophthalmol
Scand 2001 Apr ; 79(2):163-8. http://www.ncbi.nlm.nih.gov/pubmed/11284755 (accessed on
23/09/2011)
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9.
Signature of Candidate
10.
Guide Remarks
Our study attempts to correlate macular function with fundus fluorecsein angiography
findings and glycosylated hemoglobin A1c to optimize treatment modalities.
This study is feasible and can be conducted in VIMS & RC.
11.
Name and Designation of Guide
Dr. I Vittal Nayak
MS Ophthalmology
Professor & HOD
Department of Ophthalmology
VIMS & RC
Signature
12.
Signature of Head of Department
13.
Remarks of Principal
Signature
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