Abstract
This study was designed to determine whether a new form of treatment of diabetic retinopathy (DR) was acceptable to patients and whether reduction in the maximal activity of rods in diabetes could affect the progress of DR.
Methods
In 12 patients, trans-lid retinal illumination of one eye was employed during sleep to prevent the depolarisation of rods and thus reduce their metabolic activity.
Techniques
A headband was used to place a source of chemical light over one eye, with its fellow as a control.
Measurements
Colour contrast thresholds were measured before and after a period of treatment in treated eyes, and the changes were compared to those in untreated fellow eyes, and areas of ‘dark retinal anomalies’ (microaneurysms, dot haemorrhages) were measured at the same time points.
Results
Patients found this intervention to be acceptable, and no adverse effects were noted. In the majority of cases, and for each outcome measure, the treated eyes improved relative to their fellows. The intervention significantly reduced the tritan thresholds in treated eyes relative to their fellows (P=0.03), and the area of dark retinal anomalies decreased in treated eyes and increased in untreated eyes, with a similar probability.
Conclusions
The study showed that this intervention is safe. Although the study was not powered to study efficiacy, the results are promising and consistent with other reports that indicate the retina in DR is suffering from hypoxia; however, further trials should be undertaken.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Brownlee M . The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005; 54: 1615–1625.
Curtis TM, Gardiner TA, Stitt AW . Microvascular lesions of diabetic retinopathy: clues towards understanding pathogenesis? Eye 2009; 23: 1496–1508.
Arden GB, Wolf JE, Tsang Y . Does dark adaptation exacerbate diabetic retinopathy? Evidence and a linking hypothesis. Vision Res 1998; 38: 1723–1729.
Arden GB, Wolf JE, Collier J, Wolff C, Rosenberg M . Dark adaptation is impaired in diabetics before photopic loss can be seen. Can hypoxia contribute to diabetic retinopathy?. In: Hollyfield, JG (ed). Retinal Degenerative Disease and Experimental Therapy. Plenum Press: NY, 1999; pp 305–325.
Arden GB, Sidman RL, Arap W, Schlingemann RO . Spare the rod and spoil the eye. Br J Ophthalmol 2005; 89: 764–769.
Linsenmeier RA . Effects of light and darkness on oxygen distribution and consumption in the cat retina. J Gen Physiol 1986; 88: 521–542.
Linsenmeier RA, Braun RD, McRipley MA, Padnick LB, Ahmed J, Hatchell DL, McLeod DS, Lutty GA . Retinal hypoxia in long-term diabetic cats. Invest Ophthalmol Vis Sci 1998; 39: 1647–1657.
Haugh LM, Linsenmeier RA, Goldstick TK . Mathematical models of the spatial distribution of retinal oxygen tension and consumption in the inner and outer retina of the cat including changes on illumination. Ann Biomed Eng 1990; 18: 19–36.
Yu DY, Cringle SJ . Oxygen distribution and consumption within the retina in vascularised and avascular retinas and in animal models of retinal disease. Prog Retin Eye Res 2001; 20: 175–208.
Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 1995; 39: 367–374.
Feman SS, Leonard-Martin TC, Andrews S, Armbruster CC, Burdge TL, Debelak JD, Lanier A, Fischer AG . A quantitative system to evaluate diabetic retinopathy from fundus photographs. Invest Ophthalmol Vis Sci 1995; 36: 174–181.
Larsen N, Godt J, Grunkin M, Lund-Andersen H, Larsen M . Automated detection of diabetic retinopathy in a fundus photographic screening population. Invest Ophthalmol Vis Sci 2003; 44: 767–771.
Niemeijer M, van Ginneken B, Russell SR, Suttorp-Schulten MS, Abràmoff MD . Automated detection and differentiation of drusen, exudates, and cotton-wool spots in digital color fundus photographs for diagnosis of diabetic retinopathy. Invest Ophthalmol Vis Sci 2007; 48: 2260–2267.
Gündüz K, Arden GB, Perry S . A new test of colour vision using TV and computer graphics: results in some common acquired eye diseases. In: Kulikowski JJ, Dickinson CM, Murray IJ (eds). Seeing Contour and Colour. Pergamon Press: Pergamon, NY, 1987, pp 373–380.
Gündüz K, Arden GB . Changes in colour contrast sensitivity associated with operating argon lasers. Br J Ophthalmol 1989; 73: 241–246.
Arden GB, Hall MJ . ‘Does occupational exposure to argon laser radiation decrease colour contrast sensitivity in UK ophthalmologists?’. Eye 1995; 9: 686–696.
Hellstedt T, Immonen I . Disappearance and formation rates of microaneurysms in early diabetic retinopathy. Brit J Ophthalmol 1996; 80: 135–139.
Gaynon M . Should people with prethreshold ROP, BDR or ARMD sleep with a nightlight? Review of factors contributing to retinal hypoxia in retinal and choroidal vascular disease. Arvo Abs 2007; E-5122.
Nguyen QD, Shah SM, Van Anden E, Sung JU, Vitale S, Campochiaro PA . Supplemental oxygen improves diabetic macular oedema: a pilot study. Invest Ophthalmol Vis Sci 2004; 45: 617–624.
Dean FM, Arden GB, Dornhorst A . Partial reversal of protan and tritan colour defects with inhaled oxygen in insulin dependent diabetic subjects. Br J Ophthalmol 1997; 81: 27–30.
Arden GB . The absence of diabetic retinopathy in patients with retinitis pigmentosa: implications for pathophysiology and possible treatment. Br J Ophthalmol 2001; 85: 366–370.
Stefansson E . Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol 2006; 51: 364–380.
de Gooyer TE, Stevenson KA, Humphries P, Simpson DA, Gardiner TA, Stitt AW . Retinopathy is reduced during experimental diabetes in a mouse model of outer retinal degeneration. Invest Ophthalmol Vis Sci 2006; 47: 5561–5568.
Marsh S, Nakhoul FM, Skorecki K, Rubin A, Miller BP, Leibu R, Levy NS, Levy AP . Hypoxic induction of vascular endothelial growth factor is markedly decreased in diabetic individuals who do not develop retinopathy. Diabetes Care 2000; 23: 1375–1380.
Shiba T, Sato Y, Takahashi M . Relationship between diabetic retinopathy and sleep-disordered breathing. Am J Ophthalmol 2009; 147: 1017–1021.
Wong A, Merritt S, Butt AN, Williams A, Swaminathan R . Effects of hypoxia on circulating levels of retina–specific messenger RNA in type 2 diabetes mellitus. Ann NY Acad Sci 2008; 1137: 243–252.
Acknowledgements
This work was supported in part by a grant from Selçuk University Scientific Research Projects Funds (project no. 05401095) and has previously been communicated in part to the Selçuk University/Konya and to Yüksek Öğretim Kurumu/Ankara. Some results have been presented at the 47th symposium of ISCEV, 2009. We acknowledge the gift of modified glowpatches by Omniglow Corporation, which made the project possible. We thank Dr I White, Department of Mathematics, Imperial College London, for statistical advice and Miss S Sivaprasad for critical reading of the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Arden, G., Gündüz, M., Kurtenbach, A. et al. A preliminary trial to determine whether prevention of dark adaptation affects the course of early diabetic retinopathy. Eye 24, 1149–1155 (2010). https://doi.org/10.1038/eye.2009.328
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2009.328
Keywords
This article is cited by
-
Effects of emixustat hydrochloride in patients with proliferative diabetic retinopathy: a randomized, placebo-controlled phase 2 study
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)
-
Effect of light and diurnal variation on macular thickness in X-linked retinoschisis: a case series
Graefe's Archive for Clinical and Experimental Ophthalmology (2020)
-
Correlation of retinal vascular perfusion density with dark adaptation in diabetic retinopathy
Graefe's Archive for Clinical and Experimental Ophthalmology (2019)
-
Emerging Insights and Interventions for Diabetic Retinopathy
Current Diabetes Reports (2019)
-
Safety and acceptability of an organic light-emitting diode sleep mask as a potential therapy for retinal disease
Eye (2017)


