Abstract
The visual status of 48 patients with end-stage diabetic nephropathy who were undergoing treatment either by dialysis or transplantation was assessed. At the time of starting dialysis, the vision was good in 27 (56 per cent), impaired in 7 (15 per cent) and of navigating standard only in 12 (25 per cent) while the remaining 2 (4 per cent) had no useful vision. During the time on dialysis and/or following transplantation, vision improved in 6 patients (12 per cent), deteriorated in 9 (19 per cent) and remained unchanged in 33 (69 per cent). Changes in the degree of retinopathy in the 96 eyes resulting either from treatment of the renal failure or laser therapy were noted. The reasons for any changes in vision and the effect of ophthalmic treatment will be discussed.
Similar content being viewed by others
Article PDF
References
Friedman EA and L‘Esperance FA (Eds): Diabetic Renal-Retinal Syndrome. New York: Grune and Stratton. 1980.
Amir P, Khanna R, Leibel B et al: Continuous ambulatory peritoneal dialysis in diabetics with end-stage renal disease. N. Eng. J. Med. 1982; 306: 625–30.
Rottembourg J, de Groc F, Poignet JL, Legrain M : Is continuous ambulatory peritoneal dialysis the best dialysis choice for insulin dependent diabetics? Proc. EDTA. 1982; 19: 215–26.
Joint Scandinavian Report: Renal transplantation in insulin dependent diabetics. Lancet 1978; 28: 915–17.
Katirtzoglou A : Peritoneal dialysis in diabetics. In: Diabetic Renal-Retinal Syndrome, Friedman EA and L'Esperance FA (Eds). New York: Grune and Stratton. 1980; 3090–15.
Ramsay RC, Cantrill HL, Kinyoun JL et al: Visual status in diabetic renal failure. In: Diabetic Renal-Retinal Syndrome, Friedman EA and L'Esperance FA (Eds). New York: Grune and Stratton. 1980; 309–15.
Ramsay RC, Knobloch WH, Barbosa JJ et al: The visual status of diabetic patients after renal transplantation. Am. J. Ophthalmol. 1979, 87: 305–10.
Gonzalez-Carillo M, Moloney A, Bewick M, Parsons V, Rudge CT, Watkins PJ : Renal transplantation in diabetic nephropathy. Br. Med. J. 1982; 285: 1713–16.
Najarian JS, Sutherland DER, Simmons RL et al: Ten year experience with renal transplantation in juvenile onset diabetics. Ann. Surg. 1979; 190: 487–500.
Tunbridge WMG : Factors contributing to deaths of diabetics under fifty years of age. Lancet 1981; 2: 569–72.
Watkins PJ : Diabetic nephropathy—prevalence, complications and treatment. Diabetic Medicine 1985; 2: 7–12.
Deckert T, Poulson JE, Larsen M : Prognosis of diabetics with diabetes onset before age of 31. Diabetologia 1978; 14: 463–77.
Cameron JS : The management of diabetic renal failure in the United Kingdom. Diabetic Nephropathy 1983; 2: 1–2.
Little HL : Alterations in blood elements in the pathogenesis of diabetic retinopathy. Ophthalmology 1981; 88: 647–54.
Williamson JR, Kilo C : Basement-membrane thickening and diabetic microangiopathy. Diabetes 1976; 25: 925–7.
Parving H.-H, Viberti GC, Keen H, Christiansen JS, Larssen NA : Haemodynamic factors in the genesis of diabetic microangiopathy. Metabolism 1983; 32: 943–9.
Cunha-Vaz JG : Pathophysiology of diabetic retinopathy. Br. J. Ophthalmol. 1978; 62: 351–55.
Dobbie JG, Kwaan HC, Colwell J, Suwanwela N : Role of platelets in pathogenesis of diabetic retinopathy. Arch. Ophthalmol. 1974, 91: 107–9.
Little HL : Abnormal blood rheology in the pathogenesis of diabetic retinopathy. In: Diabetic Renal-Retinal Syndrome. Friedman EA and L'Esperance FA (Eds). New York: Grune and Stratton 1980; 77–81.
Klein R, Klein BEK, Moss SE, Davis MD, De Mets DL : The Wisconsin Epidemiologic Study of diabetic retinopathy II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch. Ophthalmol. 1984; 102: 520–6.
Cahill GF, Etzwiler DD, Freinkel N : ‘Control’ and diabetes. N. Eng. J. Med. 1976; 294: 1004–5.
Friberg TR, Rosenstock J, Sanborn G, Vaghefi A, Raskin P : The effect of long-term near normal glycaemic control on mild diabetic retinopathy. Ophthalmology 1985; 92: 1051–8.
Doft BH, Kingsley LA, Archard TJ, Kuller L, Drash A, Becker D : The association between long-term diabetic control and early retinopathy. Ophthalmology 1984; 91: 763–9.
Steno Study Group: Effect of six months of strict metabolic control on eye and kidney function in insulin dependent diabetics with background retinopathy. Lancet 1982; 1: 121–4.
Steinmetz PR, Balko C : The Sorbital pathway and the complications of diabetes. N. Engl. J. Med. 1973; 288: 831–6.
Knowler WC, Bennett PH, Ballintine EJ : Increased incidence of retinopathy in diabetics with elevated blood pressure. N. Engl. J. Med. 1980; 302: 645–50.
Steinmetz PR, Balko C : Biochemistry of the renal glomerular basement membrane and its alterations in diabetes mellitus. N. Engl. J. Med. 1973; 288: 1337–42.
Schantzlin DT, Jay WM, Fritz KJ, Tripathi RC, Gonen B : Haemoglobin A, and diabetic retinopathy. Am. J. Ophthalmol. 1979; 88: 1032–8.
Palmberg P, Smith M et al: The natural history of retinopathy in insulin dependent juvenile-onset diabetes. Ophthalmology 1981; 88: 613–18.
Adnitt PI and Taylor E : Progression of diabetic retinopathy. Relationship to blood glucose. Lancet 1970; 1: 652–4.
Siperstein MD, Foster DW, Knowles HC, Levine R, Madison LL, Roth J : Control of blood glucose and diabetic vascular disease. N. Eng. J. Med. 1977; 296: 1060–3.
Dandona P, Bolger JP, Boag F, Fonesca V, Abrams JD : Rapid development and progression of pro-liferative retinopathy after strict diabetic control. Br. Med. J. 1985; 290: 895–6.
Lorenzi M, Goldbanns MH, Spencer EM, Cheney C : Improved diabetic control and retinopathy. N. Eng. J. Med. 1983; 308: 1600.
Dahl-Jorgensen K, Brinchmann-Hansen D, Hans-seen KF, Sandvik L, Aagenaes, O, Aker diabetes group: Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus—the Oslo study. Br. Med. J. 1985; 290: 811–5.
Lawitzen T, Frost-Larsen K, Larsen HW and Deckert T : Effect of 1 year of near-normal blood glucose levels on retinopathy in insulin dependent diabetics. Lancet 1983; 1: 200–4.
Barnett AH, Dallinger K, Jennings P, Fletcher J, Odugbesan O : Microalbuminuria and diabetic retinopathy. Lancet 1985; 1: 53–4.
D'Elia JA, Kaldany A, Miller PG, Abouriz KN, Weinrauch LA : Diabetic nephropathy. In: Joslin's Diabetes Mellitus. Marble A, Krall LP, Bradley RF, Christlieb AR and Soeldner JS (Eds). Philadelphia: Lea and Febiger 1985; 635–64.
Aiello LM, Rand LI, Sebestyen JG : The Eyes and Diabetes. In : Joslin's Diabetes Mellitus. Marble A, Krall LP, Bradley RF, Christlieb AR and Soeldner JS (Eds). Philadelphia: Lea and Febiger 1985; 615–22.
Junor BJR : Continuous ambulatory peritoneal dialysis. Scot. Med. J. 1986; 31: 69–71.
Tsakiris DJ, Smith WGJ, Briggs JD, Junor BJR : Continuous ambulatory peritoneal dialysis: a three year experience. Scot. Med. J. 1986; 31: 79–84.
Smith WGJ, Tsakiris DJ, Junor BJR et al: Peritonitis in continuous ambulatory peritoneal dialysis. Scot. Med. J. 1986; 31: 85–9.
Chan MK, Baillod RA, Chuah P et al: Three years experience of continuous ambulatory peritoneal dialysis. Lancet 1981; 1: 1409–12.
Flynn CT : Long-term continuous ambulatory peritoneal dialysis. Proc. EDTA 1983; 20: 700–4.
Flynn CT : Why blind diabetics with renal failure should be offered treatment. Br. Med. J. 1983; 287: 1177–8.
Challah S, Wing AJ, Baver R, Morris RW, Schroeder SA : Negative selection of patients for dialysis and transplantation in the United Kingdom. Br. Med. J. 1984; 288: 1119–22.
Hercules BL, Gayed II, Lucas SB, Jeacock J : Peripheral retinal ablation in the treatment of pro-liferative diabetic retinopathy: a three year interim report of a randomised, controlled study using the argon laser. Br. J. Ophthalmol. 1977; 61: 555–63.
The Diabetic Retinopathy Study Research Group: Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Am. J. Ophthalmol. 1977; 85: 82–104.
James WA, L'Esperance FA : Treatment of optic nerve neovascularization by extensive retinal photocoagulation. Am. J. Ophthalmol. 1974; 78: 939–47.
Little HL, Zweng HC, Jack RL, Vassiliadis A : Techniques of argon laser photocoagulation of diabetic disc new vessels. Am. J. Ophthalmol. 1976; 82: 675–83.
The Diabetic Retinopathy Study Research Group: Preliminary Report on effects of photocoagulation therapy. Am. J. Ophthalmol. 1976; 81: 383–95.
Little HL : Treatment of proliferative diabetic retinopathy. Long-term results of argon laser photocoagulation. Ophthalmology 1985; 92: 279–83.
The Diabetic Retinopathy Study Research Group: Photocoagulation treatment of proliferative diabetic retinopathy. Ophthalmology 1981; 88: 583–600.
The Diabetic Retinopathy Study Group: Photocoagulation treatment of proliferative diabetic retinopathy. The Second Report of Diabetic Retinopathy Study Findings. Ophthalmology 1978; 85: 82–106.
Aaberg TM : Pars plana vitrectomy for diabetic traction retinal detachment. Ophthalmology 1981; 88: 639–42.
Barrie T, Feretis E, Leaver P, McLeod D : Closed microsurgery for diabetic traction macular detachment. Br. J. Ophthalmol. 1982; 66: 754–8.
Aaberg TM : Clinical results in vitrectomy for diabetic traction retinal detachment. Am. J. Ophthalmol. 1979; 88: 246–53.
McLeod D, Leaver PK, Feretis E : Vitrectomy for severe diabetic eye disease. Trans. Ophthalmol. Soc. UK 1980; 100: 291–8.
Machemer R and Blankenship S : Vitrectomy for proliferative diabetic retinopathy associated with vitreous haemorrhage. Ophthalmology 1981; 88: 643–6.
Ghafour IM, Allan D, Foulds WS : Common causes of blindness and visual handicap in the West of Scotland. Br. J. Ophthalmol. 1983; 67: 209–13.
Kohner EM : The solution of the problem. Trans. Ophthalmol. Soc. UK 1978; 98: 299–302.
Foulds WS, McCuish A, Barrie T et al: Diabetic retinopathy in the West of Scotland: It's detection and prevalence and the cost effectiveness of a proposed screening programme. Health Bulletin 1983; 41/6: 318–26.
Burns-Cox CJ, Dean Hart JC : Screening of diabetics for retinopathy by ophthalmic opticians. Br. Med. J. 1985; 290: 1052–4.
Porter R, Crombie AL, Gardner PS, Uldall RP : Incidence of ocular complications in patients undergoing renal transplantation. Br. Med. J. 1972; 3: 133–6.
Berkowitz JS, David DS, Sakai S et al: Ocular complications in renal transplant recipients. Am. J. Med. 1973; 55: 492–5.
Editorial: Eyes after renal transplantation. Br. Med. J. 1972; 3: 127–8.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
MacEwen, C., Barrie, T., Junor, B. et al. The visual status of diabetics on renal replacement therapy (RRT). Eye 1, 379–385 (1987). https://doi.org/10.1038/eye.1987.57
Issue Date:
DOI: https://doi.org/10.1038/eye.1987.57