Effect of panretinal photocoagulation on retinal nerve fiber layer thickness and vision-related quality of life in proliferative diabetic retinopathy patients

Yusoff Munira, Embong Zunaina, Zakariah Sakinah


The purpose of this study is to evaluate the retinal nerve fiber layer (RNFL) thickness and vision-related quality of life (VRQoL) in type 2 diabetes mellitus (T2DM) patients with proliferative diabetic retinopathy (PDR) following panretinal photocoagulation (PRP). A prospective cohort study was conducted from June 2012 until December 2013. Visual acuity was evaluated using Snellen chart (converted to LogMAR decimal notation), RNFL thickness using optical coherence tomography and VRQoL using Visual Function Questionnaire-25 (VFQ-25) before and at three months after completed PRP. A total of 44 PDR patients were enrolled into this study. There was significant reduction of mean visual acuity at three months post PRP (p < 0.001). Both mean global RNFL thickness and mean composite score of VFQ-25 showed significant reduction at three months post PRP (p < 0.001 and p < 0.001 respectively). There was significant fair negative correlation between VFQ-25 composite score and LogMAR visual acuity post PRP (r = -0.425, p = 0.004). PRP was associated with reduction of RNFL thickness and VFQ-25 composite score in T2DM patient with PDR at three months post PRP. Longer duration of follow-up is recommended to look for the long-term effect of VRQoL from laser therapy. 


Proliferative diabetic retinopathy; panretinal photocoagulation; vision-related Quality of life; retinal nerve fiber layer

Full Text:



Neubauer AS, Ulbig MW. Laser treatment in diabetic retinopathy. Ophthalmologica. 2007;221:pp.95-102.

Hendrick AM, Gibson MV, Kulshreshtha A. Diabetic retinopathy. Prim Care. 2015;42:pp.451-64.

Cheung GC, Yoon YH, Chen LJ, Chen SJ, George TM, et al. Diabetic macular edema: Evidence-based treatment recommendations for Asian countries. Clin Exp Ophthalmol. 2018;46:pp75-86.

Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, et al. Intravitreal triamcinolone for refractory diabetic macular oedema. Ophthalmology. 2002;109:pp.920-927.

Sutter FKP, Simpson JM, Gillies MC. Intravitreal triamcinolone for diabetic macular oedema that persists after laser treatment: three-month efficacy and safety results of a prospective, randomized, double-masked, placebo-controlled clinical trial. Ophthalmology. 2004;111:pp.2044-2049.

Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular oedema. ETDRS report number 1. Arch Ophthalmology. 1985;103:pp.1796-1806.

The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings. DRS report number 8. Ophthalmology. 1981;88:pp.583-600.

Kaiser RS, Maguire MG, Grunwald JE, Lieb D, Jani B, et al. One-year outcomes of panretinal photocoagulation in proliferative diabetic retinopathy. Am J Ophthalmol. 2000;129:pp.178-185.

Woodcock A, Bradley C, Plowright R, Ffytche T, Kennedy-Martin T, et al. The influence of diabetic retinopathy on quality of life: Interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL. Patient Educ Couns. 2004;53:pp.365-383.

Scanlon PH, Martin ML, Bailey C, Johnson E, Hykin P, et al. Reported symptoms and quality-of-life impacts in patients having laser treatment for sight-threatening diabetic retinopathy. Diabet Med. 2006;23:pp.60-66.

Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, et al. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001;119:pp.1050-1058.

Soman S, Ganekal S, Nair U, Nair K. Effect of panretinal photocoagulationon macular morphology and thickness in eyes with proliferative diabetic retinopathy without clinically significant macular edema. Clin Ophthalmol. 2012;6:pp.2013–2017.

Mukhtar A, Khan MS, Junejo M, Ishaq M, Akbar B. Effect of pan retinal hotocoagulation on central macular thickness and visual acuity in proliferative diabetic retinopathy. Pak J Med Sci. 2016;32:pp.221-224.

McDonald HR, Schatz H. Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1985;92:pp.388-393.

Lorusso M, Milano V, Nikolopoulou E, Ferrari LM, Cicinelli MV, et al. Panretinal photocoagulation does not change macular perfusion in eyes with proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging Retina. 2019;50:pp.174-178.

Dogru M, Nakamura M, Inoue M, Yamamoto M. Long-term visual outcome in proliferative diabetic retinopathy patients after panretinal photocoagulation. Jpn J Ophthalmol. 1999;43:pp.217-224.

Fong DS, Girach A, Boney A. Visual side effects of successful scatter laser photocoagulation surgery for proliferative diabetic retinopathy: a literature review. Retina. 2007;27:pp.816-824.

Wan-Wei L, Sakinah Z, Zunaina E. Effects of contact and non-contact laser photocoagulation therapy on ocular surface in patients with proliferative diabetic retinopathy. J of Biomed & Clin Sci. 2019;4:pp.1-6.

Muqit MMK, Wakely L, Stanga PE, Henson DB, Ghanchi FD. Effects of conventional argon panretinal laser photocoagulation on retinal nerve fibre layer and driving visual fields in diabetic retinopathy. Eye. 2010;24:pp.1136-1142.

Lieth E, Gardner TW, Barber AJ, Antonetti DA, Penn State Retina Research Group. Retinal neurodegeneration: Early pathology in diabetes. Clin Exp Ophthalmol. 2000;28:pp.3-8.

Chihara E, Matsuoka T, Ogura Y, Matsumura M. Retinal nerve fiber layer defect as an early manifestation of diabetic retinopathy. Ophthalmology. 1993;100:pp.1147-1151.

Kim HY, Cho HK. Peripapillary retinal nerve fiber layer thickness change after panretinal photocoagulation in patients with diabetic retinopathy. Korean J Ophthalmol. 2009;23:pp.23-26.

Yazdani S, Samadi P, Pakravan M, Esfandiari H, et al. Peripapillary RNFL thickness changes after panretinal photocoagulation. Optom Vis Sci. 2016;93:pp.1158-1162.

Lim MC, Tanimoto SA, Furlani BA, Lum B, Pinto LM, et al. Effect of diabetic retinopathy and panretinal photocoagulation on retinal nerve fiber layer and optic nerve appearance. Arch Ophthalmol. 2009;127:pp.857-862.

Sharma S, Oliver-Fernandez A, Liu W, Buchholz P, Walt J. The impact of diabetic retinopathy on health-related quality of life. Curr Opin Ophthalmol. 2005;16:pp.155-159.

Russell PW, Sekuler R, Fetkenhour C. Visual function after pan-retinal photocoagulation: a survey. Diabetes Care. 1985;8:pp.57-63.

Diab B, Khachman D, Farah R, Echtay A, Zein S. Type 2 Diabetes and comorbidity among Internal Medicine Lebanese Patients: A case control study. JDMC. 2019;1:pp.4-7.

Misliza A, Mas Ayu S. Sociodemographic and lifestyle factors as the risk of diabetic foot ulcer in the University of Malaya Medical Centre. JUMMEC. 2009;12:pp.15-21.

Peng PH, Laditka SB, Lin HS, Lin HC, Probst JC. Factors associated with retinal screening among patients with diabetes in Taiwan. Taiwan J Ophthalmol. 2019;9:pp.185-93.

Copyright (c) 2021 Journal of Biomedical and Clinical Sciences (JBCS)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


Flag Counter           


                                              Copyright © 2016 AMDI Publisher, Universiti Sains Malaysia.
Disclaimer : This website has been updated to the best of our knowledge to be accurate. However, Universiti Sains Malaysia shall not be liable for any loss or damage caused by the usage of any information obtained from this web site.
                                            Best viewed: Mozilla Firefox 4.0 & Google Chrome at 1024 × 768 resolution.