Augmented asymmetrical visual field dependence in asymptomatic diabetics: evidence of subclinical asymmetrical bilateral vestibular dysfunction.

Background: Diabetes negatively affects the vestibular system in many ways, with vestibular dysfunction (VD), a co-morbidity with a high prevalence in diabetics.

Procedures: The ability to perceive subjective visual vertical (SVV), as a sign of vestibular dysfunction, and visual field dependence was measured using a computerized rod and frame test (CRAF). Alignment errors recorded from 47 asymptomatic Type II diabetics (no vertigo or falls, without peripheral neuropathy or retinopathy) were compared to 29 healthy age matched (46-69years) controls.

Findings: Visual field dependence was significantly larger and more asymmetrical in the diabetics than controls. In the absence of any visual references, or when a vertical reference frame was provided, SVV perception was accurate in both groups, with no significant difference between the controls and diabetics. During tilted frame presentations, the proportion of subjects with either SVV deviations, or an asymmetry index, larger than an upper limit derived from the control data was significantly greater in diabetics than controls.

Conclusion: These results suggest that the decreased ability to resolve visuo-vestibular conflict in asymptomatic diabetic patients (free of retinopathy and peripheral neuropathy) compared to controls may be related to diabetic complications affecting vestibular structures and thus causing a decompensation of subclinical vestibular asymmetries.