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Retinal Microperimetry as a Novel Tool for Early Detection of Subclinical Cognitive Dysfunction and Brain Damage in
Manel Mateu-Salat1, Nicole Stanton-Yonge2, Frederic Sampedro Santaló3
1Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.
Context:
Retinal microperimetry (MPR) is a non-invasive method that measures retinal light sensitivity (RS) and gaze fixation stability (GFS). MPR has been described as a marker of cognitive impairment in people with Type 2 diabetes, but it has never been assessed in people with Type 1 diabetes (T1D). Our group described subclinical cognitive alterations, structural brain differences, and increased levels of light chain neurofilament (NfL) in people with T1D and impaired awareness of hypoglycaemia.
Objective:
To measure RS and GFS using MPR in individuals with T1D and evaluate its correlation with neuropsychological assessment, plasma NfL levels and CGM-derived glucometric parameters.
Secondary Objectives:
to evaluate the possible differences of RS and GFS in people with T1D depending on hypoglycaemia awareness.
Design, Setting And Participants:
Pilot observational study, people with T1D without clinical cognitive impairment, moderate-severe retinopathy or glaucoma. MPR was performed with MAIA3.
Results:
A total of 30 subjects were studied: 40% women, age 58 ± 11 years; T1D duration 31 ± 9 years, mild retinopathy 33%. RS was 27.5 dB (26.1-28.3) and GFS(%) 97.6% (93.5%-99.5%). We found a correlation between RS and memory alteration tests (p = 0.016) and between GFS(%) and a composite of attention and executive neuropsychological tests (p = 0.025). An inverse correlation between GFS and time below range was found. No correlation was found with NfL.
Conclusion:
This first exploratory study in people with T1D supports the potential utility of MPR as a screening tool for subclinical neurocognitive alterations in this population.
Insights
Retinal microperimetry (MPR) shows potential for detecting early neurocognitive changes in people with Type 1 diabetes (T1D). This method assesses retinal light sensitivity and gaze fixation stability, correlating with cognitive function tests.
Area of Science:
- Ophthalmology
- Neurology
- Endocrinology
Background:
- Retinal microperimetry (MPR) measures retinal light sensitivity (RS) and gaze fixation stability (GFS).
- MPR is a known marker for cognitive impairment in Type 2 diabetes but unstudied in Type 1 diabetes (T1D).
- Previous research in T1D identified subclinical cognitive issues, brain structure differences, and elevated neurofilament light chain (NfL) levels.
Purpose of the Study:
- To measure RS and GFS using MPR in individuals with T1D.
- To evaluate correlations between MPR measures, neuropsychological assessments, plasma NfL, and continuous glucose monitoring (CGM) data.
- To explore differences in RS and GFS based on hypoglycemia awareness in T1D.
Main Methods:
- Pilot observational study involving individuals with T1D without clinical cognitive impairment, moderate-severe retinopathy, or glaucoma.
- Retinal microperimetry (MPR) was conducted using the MAIA3 device.
- Data collected included RS, GFS, neuropsychological test results, plasma NfL levels, and CGM-derived glucometrics.
Main Results:
- Thirty T1D subjects (mean age 58±11 years, T1D duration 31±9 years) were studied; 33% had mild retinopathy.
- Significant correlations were found between RS and memory tests (p=0.016), and GFS and attention/executive function tests (p=0.025).
- An inverse correlation was observed between GFS and time below range; no correlation with NfL was found.
Conclusions:
- This exploratory study suggests MPR may be a valuable screening tool for subclinical neurocognitive alterations in people with T1D.
- MPR's ability to assess RS and GFS offers a novel approach to understanding cognitive health in T1D.
- Further research is warranted to confirm MPR's utility in T1D management and cognitive screening.
