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Retinal Nerve Fiber Layer Thickness Decrease in Obesity as a Marker of Neurodegeneration

  • Laiginhas, Rita1, 2
  • Guimarães, Marta3, 4, 5
  • Cardoso, Pedro6
  • Santos-Sousa, Hugo7, 8
  • Preto, John7
  • Nora, Mário3, 5
  • Chibante, João2
  • Falcão-Reis, Fernando6, 9
  • Falcão, Manuel6, 9
  • 1 Faculty of Medicine of Porto University (FMUP), PDICSS, Porto, Portugal , Porto (Portugal)
  • 2 Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal , Santa Maria da Feira (Portugal)
  • 3 University of Porto, Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, Porto, Portugal , Porto (Portugal)
  • 4 University of Porto, Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), Porto, Portugal , Porto (Portugal)
  • 5 Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal , Santa Maria da Feira (Portugal)
  • 6 Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal , Porto (Portugal)
  • 7 Department of Surgery, Centro Hospitalar e Universitário de São João, Porto, Portugal , Porto (Portugal)
  • 8 Faculty of Medicine of Porto University (FMUP), Department of Surgery, Porto, Portugal , Porto (Portugal)
  • 9 Faculty of Medicine of Porto University (FMUP), Department of Surgery and Physiology, Porto, Portugal , Porto (Portugal)
Published Article
Obesity Surgery
Publication Date
Mar 12, 2019
DOI: 10.1007/s11695-019-03806-7
Springer Nature


BackgroundIdiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obese women. Our aims were to screen subclinical IIH in obese patients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population.MethodsThis study included 111 eyes from 36 obese patients (86% female, body mass index > 35 kg/m2) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m2) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments.ResultsNo patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex).ConclusionsRoutine screening asymptomatic obese patients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.

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