Journal of Ophthalmology

Journal of Ophthalmology / 2013 / Article

Clinical Study | Open Access

Volume 2013 |Article ID 752186 | https://doi.org/10.1155/2013/752186

Mehmet Demir, Dilek Guven, Arzu Koc, Savas Ozdemir, Efe Can, "Retinal Nerve Fiber Layer Thickness in Women with Polycystic Ovary Syndrome", Journal of Ophthalmology, vol. 2013, Article ID 752186, 3 pages, 2013. https://doi.org/10.1155/2013/752186

Retinal Nerve Fiber Layer Thickness in Women with Polycystic Ovary Syndrome

Academic Editor: Michel Eid Farah
Received24 Jul 2013
Accepted30 Oct 2013
Published26 Nov 2013

Abstract

Aim. To compare the retinal nerve fiber layer (RNFL) thickness between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 88 eyes of 44 women (group 1) with PCOS and 84 eyes of 42 healthy women (group 2). In all subjects, the RNFL and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT). In addition, visual acuity (VA), intraocular pressure (IOP), refractive errors, central macular thickness (CMT), central corneal thickness (CCT), and excavation of optic disc were evaluated in all subjects. Results. Mean values of GCC, IOP, VA, CMT, CCT, and refractive errors were similar between the 2 groups. The average RNFL, superior average RNFL, and inferior average RNFL thicknesses were higher in subjects with PCOS than in healthy subjects ( , , and ), respectively. Conclusion. The average RNFL, superior average RNFL, and inferior average RNFL thicknesses in women with PCOS were significantly higher than in healthy women.

1. Introduction

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies among women in the reproductive age, and it affects 5–7% of this group [1]. It is characterized by an irregular menstrual cycle, ovulatory dysfunction, and hyperandrogenism [2, 3]. Metabolic alterations, insulin resistance, and obesity are often in the patient with PCOS [4]. More than 40% of women with PCOS might develop impaired glucose tolerance or type 2 diabetes mellitus [5, 6]. Optical coherence tomography (OCT) is a noninvasive, noncontact technique that utilizes near infrared, low coherence light passing through a Michelson interferometer to obtain two-dimensional images of the retina, the resolution of which is approximately 5–10 μm in the axial plane [7].

2. Materials and Methods

This study included 88 eyes of 44 women (group 1) with PCOS and 84 eyes of 42 healthy women (group 2). The women with PCOS were recruited from among those who visited the Department of Obstetrics and Gynecology. The women with PCOS were selected according to the Androgen Excess and PCOS Society (AES 2006) criteria that included hyperandrogenism, ovulatory dysfunction, and/or polycystic ovary morphology [8]. The women who had a systemic problem other than PCOS were not included in the study. The control group included healthy women who had no ophthalmologic and systemic disorders. Informed consent was obtained from all included subjects, and the study protocol was approved by the local Ethical Committee. Further, all procedures were performed in accordance with the Declaration of Helsinki. The anterior-posterior segments, visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT), central corneal thickness (CCT), and cup/disc ratio (c/d) were examined for all patients in the ophthalmology clinic (Table 1). In addition, superior nasal (SN) RNFL, nasal upper (NU) RNFL, nasal lateral (NL) RNFL, inferior nasal (IN) RNFL, inferior temporal (IT) RNFL, temporal lateral (TL) RNFL, temporal upper (TU) RNFL, superior temporal (ST) RNFL, average (Avg.) RNFL, superior (Sup.) Avg. RNFL, inferior (Inf.) Avg. RNFL, Avg. ganglion cell complex (GCC), Sup. GCC and Inf. GCC were measured (Table 2).


Study group
(44 patients; 88 eyes)
Control group
(42 patients; 84 eyes)

Age (mean ± SD) 0.173
VA (logMAR)0.000.00>0.999
IOP (mm Hg) 0.423
CMT ( m) 0.165
CCT ( m) 0.556
C/D 0.673*

Independent t-test, Mann-Whitney U test, VA: visual acuity, logMAR: logarithm of the minimum angle of resolution, IOP: intraocular pressure, CMT: central macular thickness, CCT: central corneal thickness, and C/D: cup/disc ratio.

Study group
(88 eyes)
Control group
(84 eyes)

SN RNFL126.18 ± 21.34115.39 ± 18.850.032
NU RNFL84.93 ± 18.1381.14 ± 170.379
NL RNFL73.8 ± 13.0671.36 ± 15.150.471
IN RNFL130.25 ± 23.32118.25 ± 21.190.031
IT RNFL150.43 ± 14.78145.39 ± 14.260.157
TL RNFL79.14 ± 16.1475.57 ± 10.450.303
TU RNFL88.16 ± 13.3788.54 ± 12.620.906
ST RNFL145 ± 16.07135.96 ± 15.730.022
Avg. RNLF109.98 ± 8.19103.96 ± 8.280.003
Sup. Avg. RNFL111.55 ± 10.36105.39 ± 9.110.012
Inf. Avg. RNFL 108.32 ± 8.49102.64 ± 9.080.009
Avg. GCC98.09 ± 7.3395.68 ± 5.110.133
Sup. GCC 97.34 ± 7.6895.36 ± 5.30.236
Inf. GCC98.84 ± 7.3396.11 ± 5.160.09

Independent t-test, RNFL: retinal nerve fiber layer, GCC: ganglion cell complex, SN: superior nasal, UN: nasal upper, NL: nasal lateral, IN: inferior nasal, IT: inferior temporal, TL: temporal lateral, TU: temporal upper, ST: superior temporal, Avg: average, Sup: superior, Inf: inferior, RNFL: retinal nerve fiber layer, GCC: ganglion cell complex, and UP: upper.

Exclusion criteria for both groups included presence of glaucoma, ocular hypertension (IOP > 21 mmHg), diabetes mellitus, retinal vasculitis or dystrophy, and history of intraocular surgery, amblyopia, or refractive errors more than ±1.00 diopter spherical equivalent. RNFL, CMT, CCT, and GCC thicknesses were measured using OCT (RTVue-100; Optovue, Fremont, CA). CCT was measured by ultrasonic pachymeter in all patients. Independent t-test and Mann-Whitney U test were used for statistical evaluation. A value of <0.05 was considered statistically significant.

3. Results

The mean age (mean ± SD) of the PCOS group was (range: 18–34) years and that of the control group was (range: 18–33) years ( ).

Mean VA, IOP, CMT, CCT, and C/D were similar in both groups (Table 1). The RNFL average was μm in the study group and in the control group ( ). The average superior RNFL thickness was μm in the study group and μm in the control group ( ); the average inferior RNFL thickness was μm in the study group and μm in the control group ( ). Also mean SN RNFL, IN RNFL, and ST RNFL were thicker in women with PCOS than in healthy women (Table 2).

4. Discussion

We aimed to compare the measurements of RNFL, IOP, CCT, and GCC in women with PCOS and healthy women.

In this study, which is the first of its kind, we have analyzed the thicknesses of RNFL, GCC, CCT, CMT, and the IOP in women with PCOS and compared it with healthy women. It is known that in patients with PCOS, the eye also gets affected. Typically, the tear function, drainage and osmolarity [9, 10], meibomian gland function [11], and ocular surface [12] were affected by PCOS. OCT has been used for estimation of RNFL and GCC thicknesses [1318]. High nerve fiber density was found in PCOS patients [18]. High level of nerve growth factor (NGF) was reported in women with PCOS [19]. Androgens and nerve growth factor have trophic actions on nerves [2022]. Insulin resistance that can cause diabetic eye changes in women with PCOS. RNFL thickness was thicker in women with PCOS than in healthy women in superior nasal, inferior nasal and superior temporal quadrants. Also average RNFL thickness and average superior and average inferior quadrants RNFL thicknesses were significantly thicker in women with PCOS than in healthy women. The limitations of this study were small sample size, lack of pathologic examination, and inability to reason the results. Studies with larger numbers of participants are required to clarify the clinical and pathophysiological significance of RNFL thickness in women with PCOS. The results of this study can be taken into account in evaluating patients who had PCOS and glaucoma or multiple sclerosis.

In summary, we found that the average RNFL, average superior and inferior RNFL, SN RNFL, IN RNFL, and ST RNFL thicknesses were significantly higher in women with PCOS than in healthy women. We have interpreted that excess androgens and NGF cause an increase in RNFL thickness in women with PCOS.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

  1. D. A. Ehnnann, “Polycystic ovary syndrome,” The New England Journal of Medicine, vol. 352, pp. 1223–1236, 2005. View at: Publisher Site | Google Scholar
  2. R. J. Norman, D. Dewailly, R. S. Legro, and T. E. Hickey, “Polycystic ovary syndrome,” The Lancet, vol. 370, no. 9588, pp. 685–697, 2007. View at: Publisher Site | Google Scholar
  3. P. Acién, F. Quereda, P. Matallín et al., “Insulin, androgens, and obesity in women with and without polycystic ovary syndrome: a heterogeneous group of disorders,” Fertility and Sterility, vol. 72, no. 1, pp. 32–40, 1999. View at: Publisher Site | Google Scholar
  4. R. Pasquali and A. Gambineri, “Glucose intolerance states in women with the polycystic ovary syndrome,” Journal of Endocrinological Investigation, vol. 36, pp. 648–653, 2013. View at: Google Scholar
  5. D. A. Ehrmann, R. B. Barnes, R. L. Rosenfield, M. K. Cavaghan, and J. Imperial, “Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome,” Diabetes Care, vol. 22, no. 1, pp. 141–146, 1999. View at: Publisher Site | Google Scholar
  6. K. Lakhani, G. M. Prelevic, A. M. Seifalian, W. U. Atiomo, and P. Hardiman, “Polycystic ovary syndrome, diabetes and cardiovascular disease: risks and risk factors,” Journal of Obstetrics and Gynaecology, vol. 24, no. 6, pp. 613–621, 2004. View at: Publisher Site | Google Scholar
  7. T. Pedut-Kloizman, H. M. Pakter, J. S. Schuman, J. C. Szwartz, and M. R. Hee, “Ophthalmic diagnosis using optical coherence tomography,” Ophthalmology Clinics of North America, vol. 11, no. 3, pp. 465–486, 1998. View at: Publisher Site | Google Scholar
  8. J. Johansson and E. Stener-Victorin, “Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 762615, 16 pages, 2013. View at: Publisher Site | Google Scholar
  9. H. Coksuer, F. Ozcura, F. Oghan, B. Haliloglu, and S. Karatas, “Effects of hyperandrogenism on tear function and tear drainage in patients with polycystic ovary syndrome,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 56, no. 1-2, pp. 65–70, 2011. View at: Google Scholar
  10. T. Gonen, C. Celik, M. Oznur et al., “Tear osmolarity and ocular surface changes in patient with polycystic ovary syndrome,” Current Eye Research, vol. 38, no. 6, pp. 621–625, 2013. View at: Publisher Site | Google Scholar
  11. G. F. Yavas, F. Ozturk, T. Kusbeci et al., “Meibomian gland alterations in polycystic ovary syndrome,” Current Eye Research, vol. 33, no. 2, pp. 133–138, 2008. View at: Publisher Site | Google Scholar
  12. S. Bonini, F. Mantelli, C. Moretti, A. Lambiase, S. Bonini, and A. Micera, “Itchy-dry eye associated with polycystic ovary syndrome,” American Journal of Ophthalmology, vol. 143, no. 5, pp. 763–771, 2007. View at: Publisher Site | Google Scholar
  13. T. Redmond, R. S. Anderson, R. A. Russell, and D. F. Garway-Heath, “Relating retinal nerve fiber layer thickness and functional estimates of ganglion cell sampling density in healthy eyes and in early glaucoma,” Investigative Ophthalmology & Visual Science, vol. 54, no. 3, pp. 2153–2162, 2013. View at: Publisher Site | Google Scholar
  14. G. Wollstein, L. Kagemann, R. A. Bilonick et al., “Retinal nerve fibre layer and visual function loss in glaucoma: the tipping point,” British Journal of Ophthalmology, vol. 96, no. 1, pp. 47–52, 2012. View at: Publisher Site | Google Scholar
  15. M. V. Davydovskaia, M. A. Tsysar', A. N. Boĭko et al., “Damage of macular ganglion cell complex and peripapillary retinal nerve fiber layer in multiple sclerosis,” Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova, vol. 112, no. 2, part 2, pp. 47–51, 2012. View at: Google Scholar
  16. D. C. DeBuc and G. M. Somfai, “Early detection of retinal thickness changes in diabetes using optical coherence tomography,” Medical Science Monitor, vol. 16, no. 3, pp. MT15–MT21, 2010. View at: Google Scholar
  17. H. L. Rao, J. G. Babu, U. K. Addepalli, S. Senthil, and C. S. Garudadri, “Retinal nerve fiber layer and macular inner retina measurements by spectral domain optical coherence tomograph in Indian eyes with early glaucoma,” Eye, vol. 26, no. 1, pp. 133–139, 2012. View at: Publisher Site | Google Scholar
  18. A. M. Shahidi, G. P. Sampson, N. Pritchard et al., “Retinal nerve fibre layer thinning associated with diabetic peripheral neuropathy,” Diabetic Medicine, vol. 29, no. 7, pp. e106–e111, 2012. View at: Publisher Site | Google Scholar
  19. G. A. Dissen, C. Garcia-Rudaz, A. Paredes, C. Mayer, A. Mayerhofer, and S. R. Ojeda, “Excessive ovarian production of nerve growth factor facilitates development of cystic ovarian morphology in mice and is a feature of polycystic ovarian syndrome in humans,” Endocrinology, vol. 150, no. 6, pp. 2906–2914, 2009. View at: Publisher Site | Google Scholar
  20. J. S. Perrin, P. Y. Hervé, G. Leonard et al., “Growth of white matter in the adolescent brain: role of testosterone and androgen receptor,” Journal of Neuroscience, vol. 28, no. 38, pp. 9519–9524, 2008. View at: Publisher Site | Google Scholar
  21. M. Białek, P. Zaremba, K. K. Borowicz, and S. J. Czuczwar, “Neuroprotective role of testosterone in the nervous system,” Polish Journal of Pharmacology, vol. 56, no. 5, pp. 509–518, 2004. View at: Google Scholar
  22. J. Pérez and D. B. Kelley, “Trophic effects of androgen: receptor expression and the survival of laryngeal motor neurons after axotomy,” Journal of Neuroscience, vol. 16, no. 21, pp. 6625–6633, 1996. View at: Google Scholar

Copyright © 2013 Mehmet Demir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


More related articles

4748 Views | 650 Downloads | 3 Citations
 PDF Download Citation Citation
 Download other formatsMore
 Order printed copiesOrder

Related articles

We are committed to sharing findings related to COVID-19 as quickly as possible. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Review articles are excluded from this waiver policy. Sign up here as a reviewer to help fast-track new submissions.