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Year 2020

Volume: 6 , Issue: 2

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Pooja H V, Gowda, and Raghavendraswamy: Color vision abnormalities in type 2 diabetes mellitus


Introduction

Color vision examination is of great clinical importance since any changes in color vision is an indication of pathological conditions. Diabetic retinopathy (DR) remains the leading cause of legal blindness despite effective treatment and moderate visual impairment among the working age group individuals.4, 3, 2, 1 Tritan like acquired color vision defects have been reported to occur in diabetes mellitus8, 7, 6, 5 Hence color vision assessment is a useful method for screening and monitoring diabetic retinopathy. The aim of our study was to assess color vision abnormalities in type 2 diabetics and to elucidate the risk factors associated.

Materials and Methods

A prospective cross- sectional study was conducted from November 2018 to July 2019. Patients aged > 45 years who is a known case of diabetes mellitus who present during the time period to our OPD was included in our study. 167 patients were screened during this time for color vision assessment and status of diabetic retinopathy. All patients underwent complete systemic examination and ophthalmologic examination which included assessing the visual acuity, color vision assessment using Pseudoisochromatic Ishihara chart, slit-lamp biomicroscopy, IOP and fundoscopy. Statistical analyses was performed using the SPSS ver. 16.0. The results were expressed as mean ± and as percentages.

The Ethical Clearance was obtained from Institutional Ethics Committee, AIMS.

Table 1
DR+ DR-
Color vision normal 51 (64%) 49 (69%)
Color vision abnormal 33 (36%) 34 (31%)
Total 84 83

Color vision impairment among diabetics with and without retinopathy

Table 2
Risk factors Number of patients Color vision normal Color vision impaired
Hba1c>7 90 31 59 (65.55%)
Anemia 33 23 10(30.33%)
Altered serum lipid profile 92 34 58(63.04%)
Hypertension 106 45 59(55.66%)
Nephropathy 20 13 7(35%)
Increased IOP 15 6 9(60%)
Neuropathy 24 17 7(29.16%)
High heart rate 68 49 19(27.9%)
CSME(clinically significant macular edema) 35 - 35(100%)

Risk factors and impaired color vision

Results

The prevalence of color vision abnormalities among diabetics and associated risk factors was assessed in our study. Of 167 cases, mean color vision loss increased in diabetes mellitus than in normal. Further degree of color vision error increased with the severity of diabetic retinopathy. Color vision was impaired among 31% of patients without diabetic retinopathy as compared to 36% with diabetic retinopathy (Table 1) Also associate risk factors were noted among the study subjects. Among the risk factors, people with HbA1c >7(65.5%), altered serum lipid profile(63%) and hypertensives (55.66%), patients with CSME(100%) had higher impaired color vision.(Table 2)

Discussion

Various studies have shown that color vision is impaired among diabetics.9, 8, 7, 6 Green et al reported prevalence of Impaired color vision (ICV) among the patients with no retinopathy (24%)6 In a study conducted by Ong et al, patients had worse tritan contrast threshold despite normal BCVA.8 Laxmi Gella et al in 2019 studied 673 eyes of 343 subjects and observed that prevalence of impaired color vision was 43%. With subjects with clinically significant macular edema had thrice the risk of having color vision impaired in them.9

We found that even with no diabetic retinopathy, patients were found to have impaired color vision.

Conclusion

We undertook this study to know the prevalence of impaired color vision among the diabetics in early stages and hence color vision testing is to be considered as a routine test in diabetics.

Source of Funding

None.

Conflict of Interest

None.

References

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A Ramachandran M V Jali V Mohan C Snehalatha M Viswanathan High prevalence of diabetes in an urban population in South IndiaBMJ1988297587590

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L Gella R Raman V Kulothungan S S Pal S Ganesan S Srinivasan Color vision abnormalities in type II diabetes: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study II report no 2Indian J Ophthalmol201765989994



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