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Temporal variation in diabetic macular edema measured by optical coherence tomography.
Ophthalmology. 2004 Feb; 111(2):211-7.O

Abstract

PURPOSE

To determine, by optical coherence tomography (OCT), whether there is a quantitative decrease in macular edema in diabetic subjects over the course of a day.

STUDY DESIGN

Observational case series.

PARTICIPANTS

Ten subjects with diabetic macular edema in 1 or both eyes.

METHODS

Subjects were admitted to the hospital the evening before the study so that they would remain in the recumbent position until immediately before study measurements began. They then underwent 4 OCT measurements of macular thickness in both eyes, at 8:00 am, 11:00 am, 2:00 pm, and 5:00 pm. At each of these times, they also had refractions and visual acuity measurements using the Early Treatment Diabetic Retinopathy Study protocol. Macular thickness measurements determined by the Zeiss-Humphrey (Dublin, CA) optical coherence tomograph for each eye of each subject were plotted as a function of time.

MAIN OUTCOME MEASURES

Temporal changes in retinal thickness in each of the 9 macular sectors defined by the OCT protocol and in the entire macula of each eye, averaged from all 9 sectors; temporal changes in refractive error and visual acuity.

RESULTS

Four of the 10 subjects showed consistent decreases in macular thickness over the course of the day in 1 or more of the retinal sectors in 1 or both eyes. When macular thickness values were averaged over all 9 sectors for all subjects, both eyes showed consistent declines in mean thickness throughout the day. By t test, the 8 am value in each eye was significantly higher (P<0.0005) than any of the 3 later values, which did not differ significantly from each other. However, comparison of all 4 values by analysis of variance showed no significant differences. With the exception of 1 subject, there were no consistent changes in refractive error or in best-corrected visual acuity over the course of the study.

CONCLUSIONS

This study, using quantitative OCT determinations, seems to confirm the much earlier report by Sternberg et al, which used more subjective methods, that macular edema might vary over the day. That the 8 am value, obtained just after waking, was higher than the 3 later values (highly significant by 1 test) suggests that the decrease in macular thickness is most likely due to the shift from recumbent to upright body position, although our study protocol did not exclude other possible mechanisms. Although changes in macular thickness over the course of the day did not occur in all subjects, therapeutic studies for macular edema that use OCT as an outcome measure should control for time of day when these measurements are carried out.

Authors+Show Affiliations

Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. rnfrank@med.wayne.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15019364

Citation

Frank, Robert N., et al. "Temporal Variation in Diabetic Macular Edema Measured By Optical Coherence Tomography." Ophthalmology, vol. 111, no. 2, 2004, pp. 211-7.
Frank RN, Schulz L, Abe K, et al. Temporal variation in diabetic macular edema measured by optical coherence tomography. Ophthalmology. 2004;111(2):211-7.
Frank, R. N., Schulz, L., Abe, K., & Iezzi, R. (2004). Temporal variation in diabetic macular edema measured by optical coherence tomography. Ophthalmology, 111(2), 211-7.
Frank RN, et al. Temporal Variation in Diabetic Macular Edema Measured By Optical Coherence Tomography. Ophthalmology. 2004;111(2):211-7. PubMed PMID: 15019364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporal variation in diabetic macular edema measured by optical coherence tomography. AU - Frank,Robert N, AU - Schulz,Laura, AU - Abe,Kyohei, AU - Iezzi,Raymond, PY - 2002/12/02/received PY - 2003/05/20/accepted PY - 2004/3/17/pubmed PY - 2004/3/24/medline PY - 2004/3/17/entrez SP - 211 EP - 7 JF - Ophthalmology JO - Ophthalmology VL - 111 IS - 2 N2 - PURPOSE: To determine, by optical coherence tomography (OCT), whether there is a quantitative decrease in macular edema in diabetic subjects over the course of a day. STUDY DESIGN: Observational case series. PARTICIPANTS: Ten subjects with diabetic macular edema in 1 or both eyes. METHODS: Subjects were admitted to the hospital the evening before the study so that they would remain in the recumbent position until immediately before study measurements began. They then underwent 4 OCT measurements of macular thickness in both eyes, at 8:00 am, 11:00 am, 2:00 pm, and 5:00 pm. At each of these times, they also had refractions and visual acuity measurements using the Early Treatment Diabetic Retinopathy Study protocol. Macular thickness measurements determined by the Zeiss-Humphrey (Dublin, CA) optical coherence tomograph for each eye of each subject were plotted as a function of time. MAIN OUTCOME MEASURES: Temporal changes in retinal thickness in each of the 9 macular sectors defined by the OCT protocol and in the entire macula of each eye, averaged from all 9 sectors; temporal changes in refractive error and visual acuity. RESULTS: Four of the 10 subjects showed consistent decreases in macular thickness over the course of the day in 1 or more of the retinal sectors in 1 or both eyes. When macular thickness values were averaged over all 9 sectors for all subjects, both eyes showed consistent declines in mean thickness throughout the day. By t test, the 8 am value in each eye was significantly higher (P<0.0005) than any of the 3 later values, which did not differ significantly from each other. However, comparison of all 4 values by analysis of variance showed no significant differences. With the exception of 1 subject, there were no consistent changes in refractive error or in best-corrected visual acuity over the course of the study. CONCLUSIONS: This study, using quantitative OCT determinations, seems to confirm the much earlier report by Sternberg et al, which used more subjective methods, that macular edema might vary over the day. That the 8 am value, obtained just after waking, was higher than the 3 later values (highly significant by 1 test) suggests that the decrease in macular thickness is most likely due to the shift from recumbent to upright body position, although our study protocol did not exclude other possible mechanisms. Although changes in macular thickness over the course of the day did not occur in all subjects, therapeutic studies for macular edema that use OCT as an outcome measure should control for time of day when these measurements are carried out. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/15019364/Temporal_variation_in_diabetic_macular_edema_measured_by_optical_coherence_tomography_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(03)01206-5 DB - PRIME DP - Unbound Medicine ER -