Please enter verification code
Electroretinogram and Visual Evoked Potentials in Patients with Type ll Diabetes Mellitus
American Journal of Biomedical and Life Sciences
Volume 8, Issue 6, December 2020, Pages: 212-219
Received: Jul. 7, 2020; Accepted: Jul. 22, 2020; Published: Dec. 4, 2020
Views 92      Downloads 32
Asmaa Saadoun, Ophthalmology Department, Tishreen Hospital, Faculty of Medicine, Tishreen University, Lattakia, Syria
Mahmoud Rajab, Ophthalmology Department, Tishreen Hospital, Faculty of Medicine, Tishreen University, Lattakia, Syria
Habib Yousef, Ophthalmology Department, Tishreen Hospital, Faculty of Medicine, Tishreen University, Lattakia, Syria
Article Tools
Follow on us
Background: Retinopathy is a severe and common complication of diabetes. The pathology seems to be characterized not only by the involvement of retinal micro vessels but also by a real neuropathy. Before the onset of micro vascular lesions, the retina of the eye undergoes subtle functional changes that are not detectable by fundus photography. Electrophysiological investigations allow a more detailed study of the visual function. These techniques are safe, repeatable, quick, and objective. Objective: To study pattern electroretinogram (PERG) and pattern reversal visual evoked potentials (PRVEP) in type 2 diabetic patients without diabetic retinopathy (DR) or with mild non-proliferative DR (mNPDR) to detect changes by comparing with those of healthy control. And to assess the correlation of the parameters with diabetes duration and the level of Glycosylated Haemoglobin A1c (HbA1c). Materials and Methods: It was a cross-sectional study, included two groups (diabetic patients and the healthy). Age range was preset at 40-65 years. For all the participants, a detailed clinical history was collected, a comprehensive ophthalmic examination and thorough blood investigations were performed, then {PRVEP (60', 15'), PERG} were recorded and (waveform, peak time, amplitude) of tests components were analyzed. Results: Mean (P100, N135) peak times of PRVEP were statistically significantly delayed in (50) eyes of type 2 diabetics without DR when compared to (36) eyes of control (p-value<0.01), abnormalities in waveforms like (double peaks, broad peak) were also observed in diabetics. There were alterations in other parameters (amplitudes of PRVEP, peak times and amplitudes of PERG) but the changes were not statistically significant. No statistically significant changes were found in (6) eyes of diabetic patients with mNPDR. No statistically significant correlation was obtained between diabetes duration or the level of HbA1c and delay of peak times or reduce amplitudes in patients. Conclusions: Electrophysiological tests are sensitive and useful investigations for the early identification of visual dysfunctions before the development of overt retinopathy in type 2 diabetics. PRVEP is more sensitive than PERG to monitor alterations and it may be sufficient to screen the patients in this stage.
Diabetic Retinopathy, Pattern Reversal Visual Evoked Potentials, Pattern Electroretinogram, Diabetes Duration, Glycosylated Haemoglobin A1c
To cite this article
Asmaa Saadoun, Mahmoud Rajab, Habib Yousef, Electroretinogram and Visual Evoked Potentials in Patients with Type ll Diabetes Mellitus, American Journal of Biomedical and Life Sciences. Vol. 8, No. 6, 2020, pp. 212-219. doi: 10.11648/j.ajbls.20200806.14
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Vanajarani, A. C. Evaluation of Retinal Ganglion Cell Activity by Pattern Visual Evoked Potential in Type2 Diabetic Patients. Chengalpattu Medical College, The Tamilnadu Dr. M. G. R. Medical University 2017.
Aparna, A. Role of VEPs in Early Diagnosis of Central Neuropathy in Type 2 Diabetes Mellitus. Indian Journal of Public Health Research & Development, October-December 2016; 7: 160-165.
International Diabetes Federation. IDF Diabetes Atlas, 9th Edition. Brussels 2019.
Umashankar; Gunasundarib, R. “A Review on Electrophysiology based Detection of Diabetic Retinopathy". Procedia Computer Science 2015; 48: 630-637.
Yau, J. W; Rogers, S. L; Kawasaki, R; Lamoureux, E. L; Kowalski, J. W; Bek, T; Chen, Sh. J; Dekker, J. M; Fletcher, A; Grauslund, J; Haffner, S; Hamman, R. F; Ikram, M. K; Kayama, T; Klein, B. E; Klein, R; Krishnaiah, S; Mayurasakorn, K; O'Hare, J. P; Orchard, T. J; Porta, M; Rema, M; Roy, M. S; Sharma, T; Shaw, J; Taylor, H; Tielsch, J. M; Varma, R; Wang, J. J; Wang, N. West, Sh; Xu, L; Yasuda, M; Zhang, X; Mitchell, P; Wong, T. Y. Meta-Analysis for Eye Disease (META-EYE) Study Group. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012; 35: 556-564.
Abcouwer, S. F; Gardner, T. W. “Diabetic retinopathy: loss of neuroretinal adaptation to the diabetic metabolic environment". Ann N Y Acad Sci 2014; 1311: 174-190.
Pescosolido, N; Barbato, A; Stefanucci, A; Buomprisco, G. “Role of Electrophysiology in the Early Diagnosis and Follow-Up of Diabetic Retinopathy". Journal of Diabetes Research 2015; Article ID 319692, 8 pages.
Deák, K; Fejes, I; Janáky, M; Várkonyi, T; Benedek, G; Braunitzer, G. Further Evidence for the Utility of Electrophysiological Methods for the Detection of Subclinical Stage Retinal and Optic Nerve Involvement in Diabetes. Medical Principles and Practice, Vol. 25, 2016, 282-285.
Simó, R; Hernández, C; Porta, M; Bandello, F; Grauslund, J; Harding, S. P; Aldington, S. J; Egan, C; Frydkjaer-Olsen, U; García-Arumí, J; Gibson, J; Lang, G. E; Lattanzio, R; Massin, P; Midena, E; Ponsati, B; Ribeiro, L; Scanlon, P; Lobo, C; Costa, M. Â; Cunha-Vaz, J. Effects of Topically Administered Neuroprotective Drugs in Early Stages of Diabetic Retinopathy: Results of the EUROCONDOR Clinical Trial. Diabetes 2019; 68: 457-463.
Barber, A. J; Baccouche, B. “Neurodegeneration in diabetic retinopathy: Potential for novel therapies". Vision research 2017; 139: 82-92.
Sohn, E. H; van Dijk, H. W; Jiao, C; Kok, P. H; Jeong, W; Demirkaya, N; Garmager, A; Wit, F; Kucukevcilioglu, M; van Velthoven, M. E; DeVries, J. H; Mullins, R. F; Kuehn, M. H; Schlingemann, R. O; Sonka, M; Verbraak, F. D; Abràmoff, M. D. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. PNAS 2016, 2655-2664.
American Academy of Ophthalmology. Retina and Vitreous, Basic and Clinical Science Courses Series (BCSC), San Francisco 2018-2019; 12: 303.
Odom, J. V; Bach, M; Brigell, M; Holder, G. E; McCulloch, D. L; Meigen, T; Mizota, A; Tormene, A. P. “ISCEV standard for clinical visual evoked potentials: (2016 update)". Doc Ophthalmol 2016; 133: 1-9.
Bach, M; Brigell, M. G; Hawlina, M; Holder, G. E; Johnson, M. A; McCulloch, D. L; Meigen, T; Viswanathan, S. “ISCEV standard for clinical pattern electroretinography (PERG): 2012 update”. Doc Ophthalmol 2013; 126: 1-7.
Instructions for Use and Maintenance-SISTEMA RETIMAX. retimographOPHT-06_User Manual & Service Maual.
Robson, A. G; Nilsson, J; Li, Sh; Jalali, S; Fulton, A. B; Tormene, A. P; Holder, G. E; Brodie, S. E. “ISCEV guide to visual electrodiagnostic procedures". Doc Ophthalmol 2018; 136: 1-26.
Gupta, S; Khan, T; Gupta, G; Agrawal, B. K; Khan, Z. Electrophysiological evaluation in patients with type 2 diabetes mellitus by pattern reversal visual evoked potentials. Natl J Physiol Pharm Pharmacol 2017; 7.
Heravian, J; Ehyaei, A; Shoeibi, N; Azimi, A; Ostadi-Moghaddam, H; Yekta, A; Khoshsima, M. J; Esmaily, H. Pattern Visual Evoked Potentials in Patients with Type II Diabetes Mellitus. J Ophthalmic Vis Res 2012; 7: 225-230.
Khatoon, F; Bahmed, F; Katoon. N. Visual evoked potential as an early marker of diabetic retinopathy. Indian Journal of Clinical Anatomy and Physiology 2016; 3: 200-204.
Daniel, R; Ayyavoo, S; Dass, B. Study of visual evoked potentials in patients with type 2 diabetes mellitus and diabetic retinopathy. Natl J Physiol Pharm Pharmacol 2017; 7: 159-164.
Gowri. Pattern Visual Evoked Potentials as a tool to assess the prognosis in Type 2 Diabetes Mellitus subjects attending a tertiary care hospital. University Journal of Pre and Para Clinical Sciences 2017; 3: 2455-2879.
Kothari, R; Bokariya, P; Singh, S; Hemavaishnave, T. S. Evaluation Of The Role Of Visual Evoked Potentials In Detecting Visual Impairment In Type II Diabetes Mellitus. Delhi Journal of Ophthalmology 2018; 28: 29-35.
Lanting, P; Strijers, R. L; Bos, J. E; Faes, T. J; Heimans, J. J. The cause of increased pupillary light reflex latencies in diabetic patients: the relationship between pupillary light reflex and visual evoked potential latencies. Electroencephalography and Clinical Neurophysiology 1991; 78: 111-115.
Santos, A. R; Ribeiro, L; Bandello, F; Lattanzio, R; Egan, C; Frydkjaer-Olsen, U; García-Arumí, J; Gibson, J; Grauslund, J; Harding, S. P; Lang, G. E; Massin, P; Midena, E; Scanlon, P; Aldington, S. J; Simão, S; Schwartz, Ch; Ponsati, B; Porta, M; Costa, M. Â; Hernández, C; Cunha-Vaz, J; Simó, R. Functional and Structural Findings of Neurodegeneration in Early Stages of Diabetic Retinopathy. Cross-sectional analyses of Baseline Data of the EUROCONDOR project. Diabetes 2017.
Jenkins, T. C. A; Cartwright, J. P. The electroretinogram in minimal diabetic retinopathy. British Journal of Ophthalmolology 1990; 74: 681-684.
Mermeklieva, E. A. Pattern electroretinography and retinal changes in patients with diabetes mellitus type2. Neurophysiologie Clinique/Clinical Neurophysiology 2019; 49: 209-215.
Lechner, J; O’Leary, O. E; Stitt, A. W. “The pathology associated with diabetic retinopathy". Vision Research 2017; 139: 7-14.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186