Visual Acuity and Contrast Sensitivity Association Among Hemodialysis Patients
Article Sidebar
- hemodialysis, visual acuity, contrast sensitivity, diabetes mellitus, good health and well-being
Abstract
Introduction: This study aimed to assess the association between visual acuity (VA) and contrast sensitivity (CS) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD), stratified by diabetes mellitus (DM) status. Methods: A cross-sectional study with a total of 100 HD patients was enrolled. Based on their HbA1c levels, they were categorized as having DM or as normal. They received a thorough eye examination, and those with corneal disease, cataracts, and macular disease were excluded. Best-corrected VA (BCVA) was evaluated using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, and CS was assessed using the MARS numeral CS chart. Fisher’s exact test was employed to compare VA and CS based on DM status. Results: We analyzed 100 patients (185 eyes), consisting of 51 (51%) males and 49 (49%) females. The mean age of the study group was 47±12.8 (15-76) years. The BCVA in DM and non-DM was mostly in the 0.50-0.00 LogMAR category. CS values in DM and non-DM were mostly in >1.52 LogCS category. VA and CS were significantly different in both DM and non-DM groups (p=0.03; p=0.00, respectively). A strong correlation between VA and CS was also observed in both groups (r=0.644; r=0.573, respectively). Conclusion: Visual acuity and CS in ESRD patients with DM undergoing HD had significant differences from those without DM. BCVA was strongly correlated with CS in both groups. Monitoring VA and CS in HD patients with DM provides early detection of vision-threatening changes, helps prevent severe visual impairment and improves patients’ quality of life.
Full text article
References
1. Rout P, Aslam A. End-Stage Renal Disease. Encyclopedia of Immigrant Health. 2025 Jun 22;609–11. doi:10.1007/978-1-4419-5659-0_244 PubMed PMID: 29763036.
2. Noviana CM, Zahra AN. Social support and self-management among end-stage renal disease patients undergoing hemodialysis in Indonesia. J Public Health Res. 2021;11(2). doi:10.4081/JPHR.2021.2733 PubMed PMID: 35238191.
3. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020 Oct 1;98(4):S1–115. doi:10.1016/j.kint.2020.06.019 PubMed PMID: 32998798.
4. Bodaghi B, Massamba N, Izzedine H. The eye: a window on kidney diseases. Clin Kidney J. 2014;7(4):337. doi:10.1093/CKJ/SFU073 PubMed PMID: 25852906.
5. Okolo OE, Omoti AE. Ocular manifestations of chronic kidney disease among adult patients receiving hemodialysis. Expert Rev Ophthalmol. 2012;7(6):517–28. doi:10.1586/EOP.12.64
6. Chen H, Zhang X, Shen X. Ocular changes during hemodialysis in patients with end-stage renal disease. BMC Ophthalmol. 2018 Aug 23;18(1):208. doi:10.1186/S12886-018-0885-0 PubMed PMID: 30139333.
7. Jung S, Bosch A, Ott C, Kannenkeril D, Dienemann T, Harazny JM, et al. Retinal neurodegeneration in patients with end-stage renal disease assessed by spectral-domain optical coherence tomography. Sci Rep. 2020 Dec 1;10(1):5255. doi:10.1038/S41598-020-61308-4 PubMed PMID: 32210247.
8. Wong CW, Lamoureux EL, Cheng CY, Cheung GCM, Tai ES, Wong TY, et al. Increased Burden of Vision Impairment and Eye Diseases in Persons with Chronic Kidney Disease - A Population-Based Study. EBioMedicine. 2016 Mar 1;5:193–7. doi:10.1016/J.EBIOM.2016.01.023 PubMed PMID: 27077127.
9. Zhu Z, Liao H, Wang W, Scheetz J, Zhang J, He M. Visual Impairment and Major Eye Diseases in Chronic Kidney Disease: The National Health and Nutrition Examination Survey, 2005-2008. Am J Ophthalmol. 2020 May 1;213:24–33. doi:10.1016/j.ajo.2020.01.002 PubMed PMID: 31945332.
10. Dougherty BE, Flom RE, Bullimore MA. An evaluation of the Mars Letter Contrast Sensitivity Test. Optom Vis Sci. 2005 Nov;82(11):970–5. doi:10.1097/01.OPX.0000187844.27025.EA PubMed PMID: 16317373.
11. Estrella ML, Allen-Meares P, Ricardo AC, Fischer MJ, Gordon EJ, Carmona-Powell E, et al. Prospective associations of health literacy with clinical outcomes in adults with CKD: findings from the CRIC study. Nephrology Dialysis Transplantation. 2022 Apr 1;38(4):904. doi:10.1093/NDT/GFAC201 PubMed PMID: 35746879.
12. Kafle PA, Chaudhary NP, Goyal N, Lamar N. Ocular Manifestations in Patients Undergoing Maintenance Hemodialysis - A Cross Sectional Study. Journal of Universal College of Medical Sciences. 2025 Sep 10;13(02):37–41. doi:10.3126/JUCMS.V13I02.83774
13. Widjaja SA, Ono K, Hiratsuka Y, Yustiarini I, Widodo W, Murakami A. Major Ocular Abnormalities Among Hemodialysis Patients in Indonesia. Acta Med Indones. 2022 Apr 8;54(1):52–52. doi:10.4103/IJPVM.IJPVM
14. Lupión Durán T, García-Ben A, Rodríguez Méndez V, Gálvez Alcázar L, García-Ben E, García-Campos JM. Study of visual acuity and contrast sensitivity in diabetic patients with and without non-proliferative diabetic retinopathy. Int Ophthalmol. 2021 Nov 1;41(11):3587–92. doi:10.1007/S10792-021-01930-X PubMed PMID: 34176010.
15. Gajdowska A, Jurowski P. Disturbances of functional parameters of the visual system in conservatively treated and haemodialysed patients with non-diabetic chronic kidney disease. Klinika Oczna / Acta Ophthalmologica Polonica. 2019;121(1):11–7. doi:10.5114/KO.2019.84559
16. Sun G, Hao R, Zhang L, Shi X, Hei K, Dong L, et al. The effect of hemodialysis on ocular changes in patients with the end-stage renal disease. Ren Fail. 2019 Jan 1;41(1):629–35. doi:10.1080/0886022X.2019.1635494 PubMed PMID: 31269848.
17. Chiu E, Markowitz SN, Cook WL, Jassal S V. Visual Impairment in Elderly Patients Receiving Long-term Hemodialysis. American Journal of Kidney Diseases. 2008 Dec;52(6):1131–8. doi:10.1053/j.ajkd.2008.05.032 PubMed PMID: 18706752.
18. Chande PK, Raman R, John P, Srinivasan S. Contrast-Sensitivity Function and Photo Stress–Recovery Time in Prediabetes. Clin Optom (Auckl). 2020;12:151. doi:10.2147/OPTO.S259397 PubMed PMID: 32982530.
19. Misra S, Saxena S, Kishore P, Bhasker SK, Misra A, Meyer CH. Association of contrast sensitivity with LogMAR visual acuity and glycosylated hemoglobin in non-insulin dependent diabetes mellitus. J Ocul Biol Dis Infor. 2010 Jun;3(2):60–3. doi:10.1007/S12177-010-9056-0 PubMed PMID: 22049303.
20. Safi S, Rahimi A, Raeesi A, Safi H, Amiri MA, Malek M, et al. Contrast sensitivity to spatial gratings in moderate and dim light conditions in patients with diabetes in the absence of diabetic retinopathy. BMJ Open Diabetes Res Care. 2017 Aug 1;5(1):e000408. doi:10.1136/BMJDRC-2017-000408 PubMed PMID: 28878937.
Authors
Copyright (c) 2026 Muhammad Firmansjah, Togar Erkasan Sitorus, Wimbo Sasono, Sauli Ari Widjaja, Ima Yustiarini, Ady Dwi Prakosa, Widodo, Ria Sandy Deneska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.