{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T23:10:04Z","timestamp":1742944204880,"version":"3.40.3"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014195","name":"Region V\u00e4rmland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014195","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009228","name":"Region \u00d6rebro l\u00e4n","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009228","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010810","name":"\u00d6gonfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010810","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>\nBackground\n<\/jats:title>\n<jats:p>A better characterization of diabetic retinopathy (DR) may be helpful to monitor early disease, predict progression of DR, and to evaluate new treatment strategies. Visual function has been suggested to complement the assessment of microvascular lesions in DR but needs to be evaluated in longitudinal studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>\nObjectives\n<\/jats:title>\n<jats:p>This prospective longitudinal cohort study investigated whether early visual field deterioration in diabetes is associated with change in DR, and whether known risk factors as diabetes duration and glycated A1c (HbA1c) affect the visual field.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>People living with diabetes, 18 to 75 years of age, were consecutively recruited from the local DR screening program. Individuals with eye diseases other than DR that could affect the visual field, and those who had received previous local eye treatment for DR, could not be included. Participants who had completed a five-year follow-up were re-examined after nine and ten years from baseline. The most important outcome was deterioration in series of visual fields as determined by an experimental model tailored for people living with diabetes. Stages of DR were evaluated according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and glycemic control by measurement of HbA1c.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>Fifty-six participants (median age 69 years at the last visit, 35 males) completed 608 out of 616 scheduled visits during ten years of follow-up. Progression and regression of DR occurred most often between no (ETDRS level 10) and minimal (ETDRS level 20) DR. The number of deteriorated test points increased annually by 11% (95% CI: 6.9\u201315.3) and were not associated with change in DR but with higher levels of HbA1c.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>\nConclusions\n<\/jats:title>\n<jats:p>Early deterioration of visual function occurred independently of DR and was associated with worse glycemic control, suggesting that the metabolic disturbances due to diabetes induced a primary deterioration of sensitivity in the visual field.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320285","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T22:19:04Z","timestamp":1742941144000},"page":"e0320285","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ten years of visual field change in people living with diabetes: A prospective longitudinal study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4273-0741","authenticated-orcid":true,"given":"Karl-Johan","family":"Hellgren","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boel","family":"Bengtsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"pone.0320285.ref001","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"H Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"11","key":"pone.0320285.ref002","doi-asserted-by":"crossref","first-page":"e0143084","DOI":"10.1371\/journal.pone.0143084","article-title":"Diabetes Prevalence in Sweden at Present and Projections for Year 2050","volume":"10","author":"T Andersson","year":"2015","journal-title":"PLoS One"},{"issue":"11","key":"pone.0320285.ref003","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis","volume":"128","author":"ZL Teo","year":"2021","journal-title":"Ophthalmology"},{"issue":"2","key":"pone.0320285.ref004","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/aos.12095","article-title":"The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus","volume":"92","author":"E Olafsdottir","year":"2014","journal-title":"Acta Ophthalmol"},{"issue":"6","key":"pone.0320285.ref005","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.1111\/aos.16659","article-title":"Diabetic retinopathy among the elderly with type 2 diabetes: A Nationwide longitudinal registry study","volume":"102","author":"A Sharif","year":"2024","journal-title":"Acta Ophthalmol"},{"issue":"13","key":"pone.0320285.ref006","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1056\/NEJMra1005073","article-title":"Diabetic retinopathy","volume":"366","author":"DA Antonetti","year":"2012","journal-title":"N Engl J Med"},{"key":"pone.0320285.ref007","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.preteyeres.2015.08.001","article-title":"The progress in understanding and treatment of diabetic retinopathy","volume":"51","author":"AW Stitt","year":"2016","journal-title":"Prog Retin Eye Res"},{"issue":"4","key":"pone.0320285.ref008","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.ophtha.2020.10.008","article-title":"Updating the Staging System for Diabetic Retinal Disease","volume":"128","author":"JK Sun","year":"2021","journal-title":"Ophthalmology"},{"issue":"2","key":"pone.0320285.ref009","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.survophthal.2020.08.003","article-title":"A critical review: Psychophysical assessments of diabetic retinopathy","volume":"66","author":"XD Chen","year":"2021","journal-title":"Surv Ophthalmol"},{"issue":"5","key":"pone.0320285.ref010","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1755-3768.1994.tb07180.x","article-title":"Visual fields at different stages of diabetic retinopathy","volume":"72","author":"M Henricsson","year":"1994","journal-title":"Acta Ophthalmol (Copenh)"},{"issue":"12","key":"pone.0320285.ref011","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1007\/s00125-005-0001-x","article-title":"Visual fields correlate better than visual acuity to severity of diabetic retinopathy","volume":"48","author":"B Bengtsson","year":"2005","journal-title":"Diabetologia"},{"issue":"2","key":"pone.0320285.ref012","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1600-0420.2007.01019.x","article-title":"Test-retest variability for standard automated perimetry and short-wavelength automated perimetry in diabetic patients","volume":"86","author":"B Bengtsson","year":"2008","journal-title":"Acta Ophthalmol"},{"issue":"5","key":"pone.0320285.ref013","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1136\/bjophthalmol-2011-300467","article-title":"Inner retinal visual dysfunction is a sensitive marker of non-proliferative diabetic retinopathy","volume":"96","author":"GR Jackson","year":"2012","journal-title":"Br J Ophthalmol"},{"issue":"4","key":"pone.0320285.ref014","doi-asserted-by":"crossref","first-page":"383","DOI":"10.4103\/0301-4738.126986","article-title":"Short wavelength automated perimetry can detect visual field changes in diabetic patients without retinopathy","volume":"62","author":"OA Zico","year":"2014","journal-title":"Indian J Ophthalmol"},{"issue":"6","key":"pone.0320285.ref015","doi-asserted-by":"crossref","first-page":"BIO277","DOI":"10.1167\/iovs.17-21863","article-title":"Multidimensional Functional and Structural Evaluation Reveals Neuroretinal Impairment in Early Diabetic Retinopathy","volume":"58","author":"KA Joltikov","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"7","key":"pone.0320285.ref016","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1097\/01.iae.0000244263.98642.61","article-title":"Influence of clinical factors on blue-on-yellow perimetry for diabetic patients without retinopathy: comparison with white-on-white perimetry","volume":"26","author":"K Nitta","year":"2006","journal-title":"Retina"},{"issue":"12","key":"pone.0320285.ref017","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1136\/bjo.2008.143057","article-title":"The role of Humphrey Matrix testing in the early diagnosis of retinopathy in type 1 diabetes","volume":"92","author":"M Parravano","year":"2008","journal-title":"Br J Ophthalmol"},{"issue":"9","key":"pone.0320285.ref018","doi-asserted-by":"crossref","first-page":"3104","DOI":"10.2337\/db13-1628","article-title":"Progression of early retinal dysfunction in diabetes over time: results of a long-term prospective clinical study","volume":"63","author":"K-J Hellgren","year":"2014","journal-title":"Diabetes"},{"issue":"7","key":"pone.0320285.ref019","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/j.1755-3768.2012.02508.x","article-title":"Functional and structural change in diabetic eyes. Interim results from an ongoing longitudinal prospective study","volume":"91","author":"K-J Hellgren","year":"2013","journal-title":"Acta Ophthalmol"},{"issue":"5","key":"pone.0320285.ref020","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0161-6420(13)38014-2","article-title":"Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12","volume":"98","author":"Early Treatment Diabetic Retinopathy Study Research Group","year":"1991","journal-title":"Ophthalmology"},{"issue":"1_suppl","key":"pone.0320285.ref021","first-page":"23","article-title":"Monitoring Diabetic Subjects with No or Early Stages of Retinopathy Using Perimetry and an Improved Model Defining Limits for Significant Change. [Poster Abstract] 28th Meeting of the European Association for the Study of Diabetes Eye Complications Study Group (EASDec): Belfast Northern Ireland 24th\u201326th May 2018","volume":"28","author":"KJ Hellgren","year":"2018","journal-title":"Eur J Ophthalmol"},{"key":"pone.0320285.ref022","first-page":"79","article-title":"Statpac Analysis of Single Fields.","volume-title":"The Field Analyzer Primer: Excellent Perimetry","author":"A Heijl","year":"2021"},{"issue":"3","key":"pone.0320285.ref023","doi-asserted-by":"crossref","first-page":"556","DOI":"10.2337\/dc11-1909","article-title":"Global prevalence and major risk factors of diabetic retinopathy","volume":"35","author":"JWY Yau","year":"2012","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0320285.ref024","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s005920170021","article-title":"Static perimetry and diabetic retinopathy: a long-term follow-up","volume":"38","author":"A Verrotti","year":"2001","journal-title":"Acta Diabetol"},{"issue":"2","key":"pone.0320285.ref025","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1167\/iovs.10-5931","article-title":"Multifocal electroretinograms predict onset of diabetic retinopathy in adult patients with diabetes","volume":"52","author":"WW Harrison","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"2","key":"pone.0320285.ref026","doi-asserted-by":"crossref","first-page":"457","DOI":"10.2337\/db18-0682","article-title":"Effects of Topically Administered Neuroprotective Drugs in Early Stages of Diabetic Retinopathy: Results of the EUROCONDOR Clinical Trial","volume":"68","author":"R Sim\u00f3","year":"2019","journal-title":"Diabetes"},{"issue":"14","key":"pone.0320285.ref027","doi-asserted-by":"crossref","first-page":"4711","DOI":"10.1167\/iovs.19-28063","article-title":"Visual Field Loss in Patients With Diabetes in the Absence of Clinically-Detectable Vascular Retinopathy in a Nationally Representative Survey","volume":"60","author":"YK Bao","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"5","key":"pone.0320285.ref028","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S2213-8587(18)30051-2","article-title":"Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables","volume":"6","author":"E Ahlqvist","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"pone.0320285.ref029","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/2251-6581-11-17","article-title":"The importance of hypoglycemia in diabetic patients","volume":"11","author":"G Shafiee","year":"2012","journal-title":"J Diabetes Metab Disord"},{"issue":"6","key":"pone.0320285.ref030","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1042\/cs0690673","article-title":"The effect of hypoglycaemia on visual function: a clinical and electrophysiological study","volume":"69","author":"RA Harrad","year":"1985","journal-title":"Clin Sci (Lond)"},{"issue":"2","key":"pone.0320285.ref031","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/0002-9394(89)90006-8","article-title":"Test-retest variability in glaucomatous visual fields","volume":"108","author":"A Heijl","year":"1989","journal-title":"Am J Ophthalmol"},{"issue":"9","key":"pone.0320285.ref032","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1007\/s00125-018-4692-1","article-title":"Neurodegeneration in diabetic retinopathy: does it really matter?","volume":"61","author":"R Sim\u00f3","year":"2018","journal-title":"Diabetologia"},{"issue":"4","key":"pone.0320285.ref033","doi-asserted-by":"crossref","first-page":"e0231552","DOI":"10.1371\/journal.pone.0231552","article-title":"The spatial relation of diabetic retinal neurodegeneration with diabetic retinopathy","volume":"15","author":"JA van de Kreeke","year":"2020","journal-title":"PLoS One"},{"issue":"11","key":"pone.0320285.ref034","doi-asserted-by":"crossref","first-page":"5846","DOI":"10.1167\/iovs.09-4803","article-title":"Digital versus film Fundus photography for research grading of diabetic retinopathy severity","volume":"51","author":"HK Li","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T22:20:33Z","timestamp":1742941233000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320285"}},"subtitle":[],"editor":[{"given":"Daisuke","family":"Nagasato","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320285","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]}}}