Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. 1. 1 6. 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 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 2 7. 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 3 Required Investigations and Interventions 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) 4 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 5