INTRODUCTION
Diabetes
(DM) is a widespread and significant health concern that can lead to various
complications (Papatheodorou et al. 2018). Among its many effects,
ocular problems are among the most prevalent and rapidly growing causes of
morbidity worldwide. Even after cataract surgery with intraocular lens (IOL)
implantation, vision can still be affected in diabetic patients, and the progression
of retinopathy may worsen as a result of the surgical procedure (Sayin et al.
2015).
Diabetes is a complex disorder in which the body may not
produce enough insulin or do not effectively use the insulin it produces.
Insulin is vital for regulating blood sugar levels and ensuring that glucose is
transported into cells for energy. The two main types of diabetes are Type 1
and Type 2, which were previously referred to as insulin-dependent and
non-insulin-dependent, or juvenile onset and adult onset, respectively (Taware 2012).
Globally, over 285 million people are diabetic. The
utmost difficulty is diabetic retinopathy; this is because of harm to the blood
vessels within the retina because of diabetes-caused microangiopathy. In
addition to retinopathy, diabetes can result in cataracts, glaucoma,
nephropathy, and neuropathy (Krepler et al. 2002). The risk of growing
retinopathy will increase with age and is similarly enhanced by poorly
controlled blood sugar degrees, high blood pressure, excessive cholesterol, and
relatives records of intense diabetic retinopathy (Kelkar et al. 2018).
Color vision testing is a powerful way to know about the status of retinal
damage. In diabetic people, visual function can be considerably altered
depending on the severity of the disorder. Color vision defects are often an
early sign of retinopathy and continues changes in color interpretations of
patient can precede declines in visual acuity. Color deficiencies also can be
as a result of other situations, together with glaucoma, macular degeneration,
Alzheimer's disorder, Parkinson's disease, and even chronic alcohol use (Male et
al. 2022). Studies have proven that the outcomes of cataract surgical
treatment are frequently worse in diabetic sufferers, especially people with
diabetic retinopathy (Hwang et al. 2015). High glucose levels can cause
the development of cataracts through glycosylation procedures, contributing to
ocular complications (Hassan et al. 2010).
MATERIALS AND METHODS
A cross-sectional study was conducted
at the Ophthalmology Department of Madinah Teaching Hospital, Faisalabad. Total
58 participants, both male and female, were enrolled in the study using a
convenient sampling method. The study was carried out between September 2018
and February 2019. Pseudophakic diabetic patients and without diabetes were
included in the study, with both Type 1 and Type 2 diabetes patients aged 35–75
years, with reliable mental and systemic health.
Exclusion criteria included patients with a history of laser treatment,
ocular conditions that might alter color vision, systemic diseases unrelated to
diabetes, intraocular pressure more than normal ranges, posterior capsule
opacities, clinically significant macular edema, and proliferative retinopathy.
The conventional Farnsworth D-15 color vision test was used to assess
color perception. In this test, participants were asked to arrange 15 color
caps according to hue, which were placed randomly on a white background. The
test was performed in a well-lit room at a distance of 50 cm, both monocularly
and binocularly, and each subject was tested three times. To assess the
severity of retinopathy, a slit-lamp examination and +70D lens were used after
obtaining informed consent from patients. Data was analyzed using SPSS software
version 20, and the association between color vision defects and pseudophakic
diabetic patients with background retinopathy was evaluated using Pearson’s
Chi-Square test. Ethical approval was obtained prior to conducting the study.
RESULTS
About 58 participants were
enrolled. Depending on age criteria two groups formed. The distribution of
color vision defects in the group was calculated, with the most common color
defect being blue (61%), followed by red-green defects (10.2%). The mean score
for color vision on the D-15 test was 2.17 ± 1.05 for the general population,
whereas the pseudophakic diabetic group had a mean score of 1.05 ± 0.116. A
Chi-Square test was used to assess the relationship between color vision
defects and pseudophakic diabetic patients, with P = 0.05 indicating
statistical significance. This result suggests that color vision declines as
diabetes progresses. The most common color vision defect in patients with
retinopathy was observed in the blue axis, rather than the red-green axis (Fig.
1).
In the study, we categorized
participants into two age groups: Group 1 (35–55 years) and Group 2 (56–75
years). In Group 1, there were 7 non-diabetic individuals, 10 with Type 2
diabetes, and 1 with Type 1 diabetes. In Group 2, there were 14 non-diabetic
participants, 1 with Type 2 diabetes, and 10 with Type 1 diabetes. Notably,
Type 2 diabetes was more prevalent in older age group (Fig. 2).
DISCUSSION
A
previous study by Gella et al. (2015) explored the
impact of cataract surgery on color vision in both diabetic and non-diabetic
pseudophakes. The study found that color vision declined after cataract surgery
in both groups, but the severity of the decline was more pronounced in diabetic
individuals. In this study,
22 diabetic pseudophakes with no retinopathy, 23 with background retinopathy,
and 34 non-diabetic pseudophakes were examined. The results revealed that
red-green perception sensitivity was significantly worse in the diabetic
pseudophakes (normal versus retinopathy: P = 0.057), with tritan
discrimination sensitivity being worse in those with retinopathy (Gella et
al. 2015).
In
another study conducted by Gella et al. (2017), color vision defects
were examined in 21 diabetic patients (16 with insulin-dependent diabetes
mellitus, IDDM, and 5 with non-insulin-dependent diabetes mellitus, NIDDM) and
19 non-diabetic individuals. All subjects had undergone cataract surgery, and
their color vision was tested using the Farnsworth-Munsell 100 hue test.
Diabetic patients had significantly higher error scores, particularly in the
tritan axis (P = 0.02). The study also excluded participants with
secondary cataracts, glaucoma, or diabetic macular edema, as these conditions
specifically affect foveal vision.
Our
study aimed to evaluate color vision in pseudophakic diabetics with background
retinopathy in the age group 35–75 years. A total of 58 participants were
included, divided into two groups: Group 1 (35–55 years, n=20) and Group 2 (56–75
years, n=38). The study included 26 males and 32 females, with 21 non-diabetic
individuals, 13 IDDM diabetics, and 24 NIDDM diabetics. NIDDM diabetes was more
prevalent (40.68%) compared to IDDM (22.03%). Females had a higher prevalence
of diabetes than males.
Visual
acuity for all participants was measured, and those with clinically significant
macular edema (CMO) or pre-proliferative/proliferative retinopathy were
excluded from the study. Color vision impairment was most pronounced along the
tritan axis, particularly in diabetic pseudophakes with background retinopathy.
A significant association was found between color vision defects and the
presence of background retinopathy (P = 0.05). The distribution of color
vision defects in the study population was as follows: 16.9% with normal color
vision, 10.2% with red-green defects, and 61% with tritan defects. Tritan
discrimination sensitivity changes were determinant for figuring out patients
liable to excessive retinopathy. The poorer color changes following cataract
surgical operation in diabetic pseudophakes can be due to extended short-+24010102+Final+Approved+10.06.2025+Optometery+Nimra%20(1)_files/image003.png)
wavelength transmission thru the
intraocular lenses, that could lead to retinal damage. This is mainly true
inside the case of phacoemulsification, in which there's a shorter period of
exposure to radiation all through lens removal, probably aggravating retinal
harm.
CONCLUSIONS
There was great effect on color vision for pseudophakic
diabetics. The color vision declines more seriously alongside the tritan axis, particularly
in patients with retinopathy. These consequences spotlight the importance of
incorporating color vision evaluation as an everyday part of pre-operative and
submit-operative tests for diabetic sufferers encountering the process of
cataract surgical procedure. Early detection of color impairment could assist
within the management and tracking of diabetic retinopathy.
AUTHOR CONTRIBUTIONS
NG: Concept, data collection, write up; RS: Formatting
CONFLICTS OF INTEREST
The authors affirm that they possess no conflicts of
interest.
DATA AVAILABILITY
The data will be made available on a fair request to
the corresponding author
ETHICS APPROVAL
Approved by Institutional Ethical Review Board at its
meeting held on May 23, 2019.
FUNDING SOURCE
This project is not funded by any agency.
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