Dataset Information

Identifying Microvascular and Neural Parameters Related to the Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography.

ABSTRACT: Purpose:To identify microvascular and neural parameters related to the severity of diabetic retinopathy (DR) by using optical coherence tomography angiography in patients with type 2 diabetes. Methods:This cross-sectional study included 110 eyes (63 patients) with no DR, 46 eyes (33 patients) with mild nonproliferative DR, 36 eyes (23 patients) with moderate nonproliferative DR, 36 eyes (22 patients) with severe nonproliferative DR, and 31 eyes (19 patients) with proliferative DR. The optical coherence tomography angiography images were processed to quantify the foveal avascular zone parameters, macular vessel density (VD), retinal thickness, peripapillary VD, retinal nerve fiber layer thickness, and ganglion cell complex thickness. A LASSO-based continuation ratio model was used to select the most clinically relevant parameters for predicting the stage of DR. Results:The regression model identified a set of regional parameters for each scanning pattern that identified the DR severity, including foveal avascular zone perimeter; FD-300; temporal perifoveal superficial capillary plexus VD and retinal thickness; temporal and nasal parafoveal deep capillary plexus VD; peripapillary VD in the temporal superior, nasal inferior, and temporal inferior sectors; temporal superior and nasal inferior retinal nerve fiber layer thickness; ganglion cell complex thickness; and FLV, which changed significantly with the progression of DR. Furthermore, two combined blocks exhibited different sensitive parameters to differentiate between the groups based on DR severity. Similar results were obtained in eyes without diabetic macular edema. Conclusions:We identified microvascular and neural parameters related to the severity of DR using optical coherence tomography angiography, suggesting their potential clinical application for better screening and staging of DR.

SUBMITTER: Li X

PROVIDER: S-EPMC7405728 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Identifying Microvascular and Neural Parameters Related to the Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography.

Li Xiaoli X Xie Jie J Zhang Liang L Cui Ying Y Zhang Guanrong G Chen Xiangting X Wang Jun J Zhang Aiping A Huang Tian T Meng Qianli Q

Investigative ophthalmology & visual science 20200501 5

<h4>Purpose</h4>To identify microvascular and neural parameters related to the severity of diabetic retinopathy (DR) by using optical coherence tomography angiography in patients with type 2 diabetes.<h4>Methods</h4>This cross-sectional study included 110 eyes (63 patients) with no DR, 46 eyes (33 patients) with mild nonproliferative DR, 36 eyes (23 patients) with moderate nonproliferative DR, 36 eyes (22 patients) with severe nonproliferative DR, and 31 eyes (19 patients) with proliferative DR. ...[more]

PMID: 32441757

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Project description:ImportanceStudies have not yet determined whether the distribution of lesions in the retinal periphery alters the association between the severity of diabetic retinopathy (DR) and macular vessel density.ObjectiveTo evaluate the association of DR lesion distribution with optical coherence tomography angiography (OCTA) metrics and DR severity.Design, setting, and participantsThis cross-sectional observational study was conducted at a tertiary care center for diabetic eye disease among 225 patients with type 1 or 2 diabetes who had undergone imaging between February 15, 2016, and December 31, 2019.ExposuresOptical coherence tomography angiography 3 × 3-mm macular scans and ultra-widefield color imaging.Main outcomes and measuresOptical coherence tomography angiography vessel density in the superficial capillary plexus, intermediate capillary plexus, and deep capillary plexus and choriocapillaris flow density. The severity of DR and the predominantly peripheral lesions (PPL) were evaluated from ultra-widefield color imaging.ResultsThe study evaluated 352 eyes (225 patients; 125 men [55.6%]; mean [SD] age, 52.1 [15.1] years), of which 183 eyes (52.0%) had mild nonproliferative diabetic retinopathy (NPDR), 71 eyes (20.2%) had moderate NPDR, and 98 eyes (27.8%) had severe NPDR or proliferative diabetic retinopathy (PDR). In eyes with no PPL (209 [59.4%]), the mean (SD) vessel density in the superficial capillary plexus (mild NPDR, 38.1% [4.7%]; moderate NPDR, 36.4% [4.6%]; severe NPDR or PDR, 34.1% [4.1%]; P < .001) and the deep capillary plexus (mild NPDR, 45.8% [3.0%]; moderate NPDR, 45.8% [2.2%]; severe NPDR or PDR, 44.5% [1.9%]; P = .002), as well as the mean (SD) choriocapillaris flow density (mild NPDR, 69.7% [6.2%]; moderate NPDR, 67.6% [5.6%]; severe NPDR or PDR, 67.1% [5.6%]; P = .01), decreased with increasing DR severity. These associations remained statistically significant even after correcting for age, signal strength index, spherical equivalent, duration of diabetes, type of diabetes, and correlation between eyes of the same patient. In eyes with PPL (143 [40.6%]), mean (SD) vessel density in the superficial capillary plexus (mild NPDR, 34.1% [4.1%]; moderate NPDR, 35.2% [4.1%]; severe NPDR or PDR, 36.0% [4.3%]; P = .42) and the deep capillary plexus (mild NPDR, 44.5% [1.7%]; moderate NPDR, 45.4% [1.4%]; severe NPDR or PDR, 44.9% [1.5%]; P = .81), as well as the mean (SD) choriocapillaris flow density (mild NPDR, 67.1% [5.6%]; moderate NPDR, 69.3% [4.6%]; severe NPDR or PDR, 68.3% [5.6%]; P = .49), did not appear to change with increasing DR severity.Conclusions and relevanceThese results suggest that central retinal vessel density is associated with DR severity in eyes without, but not with, PPL. These findings suggest a potential need to stratify future optical coherence tomography angiography studies of eyes with DR by the presence or absence of PPL. If DR onset and worsening are associated with the location of retinal nonperfusion, assessment of global retinal nonperfusion using widefield angiography may improve the ability to evaluate DR severity and risk of DR worsening over time.

Project description:ImportanceQuantitative measurements based on optical coherence tomographic angiography (OCTA) may have value in managing diabetic retinopathy (DR), but there is limited information on the ability of OCTA to distinguish eyes with DR.ObjectiveTo evaluate the ability of measurements of retinal microvasculature using OCTA to distinguish healthy eyes from eyes with DR.Design, setting, and participantsIn this prospective cross-sectional study, OCTA was used to examine the eyes of participants with type 2 diabetes with or without DR and the eyes of participants without diabetes from September 17, 2015, to April 6, 2016. Density maps based on superficial retinal layer (SRL) and deeper retinal layer (DRL) images were generated after a method to remove decorrelation tails was applied to the DRL images.ExposuresBoth eyes of each participant were examined by means of a 3-mm OCTA scan and 7-field fundus photography using the Diabetic Retinopathy Severity Scale.Main outcomes and measuresTwo measures were examined: perfusion density, based on the area of vessels, and vessel density, based on a map with vessels of 1-pixel width. The size of the foveal avascular zone was also calculated automatically, and so was the area under the receiver operating characteristic curve.ResultsA total of 50 eyes from 26 participants with diabetes (10 women and 16 men; mean [SD] age, 64.9 [7.5] years) and 50 healthy eyes from 25 participants without diabetes (14 women and 11 men; mean [SD] age, 64.0 [7.1] years) were imaged. All participants were white. Vessel density measured in the SRL had the highest area under the receiver operating characteristic curve (0.893 [95% CI, 0.827-0.959]), compared with perfusion density in the SRL (0.794 [95% CI, 0.707-0.881]), foveal avascular zone area (0.472 [95% CI, 0.356-0.588]), and vessel density in the DRL (0.703 [95% CI, 0.601-0.805]). Vessel density in the SRL negatively correlated with best-corrected visual acuity (r = -0.28; P = .05) and severity of DR (r = -0.46; P = .001). Density metrics correlated with age. No correlation was detected between vascular density or foveal avascular zone metrics and hemoglobin A1C or duration of diabetes.Conclusions and relevanceVessel density measured by OCTA provides a quantitative metric of capillary closure that correlates with severity of DR and may allow staging, diagnosis, and monitoring that do not require subjective evaluation of fundus images.

Dataset Information

Identifying Microvascular and Neural Parameters Related to the Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography.

Publications

Identifying Microvascular and Neural Parameters Related to the Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography.

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