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Retinal structure–function correlation in type 2 diabetes



To examine the relationship of visual function as assessed by visual acuity, contrast sensitivity, and multifocal electroretinography (mfERG) to macular structural and microvascular measures on optical coherence tomography (OCT) and angiography (OCTA) in individuals with diabetes.


This is a prospective observational study conducted at a tertiary eye care centre in India. Right eyes of 121 adults with type 2 diabetes with no diabetic retinopathy (DR), mild or moderate nonproliferative DR (NPDR) were examined. Severe NPDR, proliferative DR and diabetic macular oedema were excluded. Participants underwent assessment of glycated haemoglobin (HbA1C), blood pressure, best corrected visual acuity (LogMAR), contrast sensitivity (CS), mfERG, ultrawide field fundus photography, OCT and OCTA. Correlations were assessed by Spearman’s rank correlation (rho).


Of the total of 121 eyes, 89 had No DR, 32 had mild to moderate NPDR. In the No DR group, the LogMAR acuity was significantly and negatively correlated to central subfoveal thickness (CST) (rho = −0.420), macular vessel density (rho = −0.270) and perfusion (rho = −0.270). (ii) Contrast sensitivity correlated to foveal avascular zone circularity (rho = 0.297); (iii) mfERG P1 response densities were better with higher macular perfusion index (rho = 0.240). In the NPDR group, the LogMAR acuity also showed a significant negative correlation to CST (rho = −0.379). Other correlations were not significant.


Retinal and visual functional changes are evident in diabetic patients with No DR and are correlated to subclinical retinal structural changes detectable using multimodal imaging.

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This work was supported by the DBT/Wellcome Trust India Alliance Fellowship [grant number IA/CPHE/16/1/502670] awarded to Dr Sangeetha Srinivasan.

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SS and RRN were responsible for designing the study; SS obtained funding, screened, examined patients, performed data analysis, interpreted results, wrote the paper; SS, SSD, MB interpreted the results, critically reviewed the manuscript. SS, SSD, RRN, RR, AM, RAM, VK, MB approved the content of the manuscript.

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Correspondence to Muna Bhende.

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Srinivasan, S., Sobha Sivaprasad, Rajalakshmi, R. et al. Retinal structure–function correlation in type 2 diabetes. Eye 36, 1865–1871 (2022).

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