Do microvascular changes occur preceding neural impairment in early-stage diabetic retinopathy? Evidence based on the optic nerve head using optical coherence tomography angiography

Li, Zijing; Xing, Wen; Zeng, Peng; Liao, Yulin; Fan, Song; Zhang, Yichi; Li, Yuanjun; Xiao, Jianhui; Lan, Yuqing

doi:10.1007/s00592-019-01288-8

Cited by 40 publications

(34 citation statements)

References 38 publications

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“…In order to find out if RPC density can serve for early detection of preclinical stage of DR, we compared RPC density between healthy controls and diabetic patients with no DR signs. RPC density was significantly decreased in diabetic patients with no DR compared with the healthy controls, which fit well with the recent publications [14,20]. Besides, our results indicated that RPC density could also be used for detection of the different degrees of DR changes in diabetic patients.…”

Section: Discussionsupporting

confidence: 92%

“…In our study, no significant difference of RNFL thickness was found among the different DR severity groups. Previous studies [14,15] had similar results to ours, but some authors found significant RNFL thickness thinning in eyes with DR compared with the healthy controls [21,22]. e lack of significant difference in RNFL thickness in the peripapillary region among the groups observed herein could possibly be attributed to the structural changes in the retinal tissue in the peripapillary region caused by intracellular and extracellular edema, exudation, or glial fibrillary degeneration around the optic disc.…”

Section: Discussionsupporting

confidence: 84%

“…Based on previous studies, we know that DR does have not only microvascular changes but also neurodegeneration [11,12]. e mostly used parameter to evaluate the neurodegeneration on OCT is retinal nerve fiber layer (RNFL) thickness, and now with the help of OCTA, we can also evaluate the microvascular impairment around the optic disc by measuring radial peripapillary capillary (RPC) density [13,14]. RPC density on OCTA can be automated divided into two different areas, the peripapillary area and the inside optic disc area.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of Microvascular Density of the Optic Nerve Head in Diabetic Retinopathy Using Optical Coherence Tomographic Angiography

Huang

Zheng

et al. 2020

Journal of Ophthalmology

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Aims. To quantify the capillary density of the optic nerve head in healthy control eyes and different stages of diabetic retinopathy (DR) eyes and identify the parameters to detect eyes with or without DR using optical coherence tomographic angiography (OCTA). Methods. In this cross-sectional study, 211 eyes of 121 participants with type 2 diabetes with different stages of DR or without DR and 73 eyes of 38 healthy age-matched controls were imaged by OCTA. Radial peripapillary capillary (RPC) plexus density and retinal nerve fiber layer (RNFL) thickness were examined. The mixed model binary logistic regression model was used to identify the parameters to detect eyes with or without DR. The area under the receiver operating characteristic (ROC) curve was calculated. Results. RPC density decreased significantly in diabetic patients without DR compared with the healthy controls, and it was negatively correlated with the severity of DR (P<0.01). RPC density was a significant parameter to distinguish diabetic eyes with or without DR (P<0.01). The area under the ROC curve was 0.743. Conclusions. Quantification of RPC density by OCTA provides evidence of microvascular changes in the optic nerve in diabetic patients. RPC density can serve as a possible biomarker in detecting eyes with DR. Larger cohort studies need to support this statement.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quantification of Microvascular Density of the Optic Nerve Head in Diabetic Retinopathy Using Optical Coherence Tomographic Angiography

Huang

Zheng

et al. 2020

Journal of Ophthalmology

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“…Developments in analytic software programs have enabled us to better evaluate the vessel density of the disc area. Previous studies have suggested that peripapillary capillary density was reduced in DM patients without DR and may be a useful parameter in the detection of early-stage DR [20][21][22]. In the present study, it was determined that the mean vessel density values of the whole disc and peripapillary area were also reduced in patients with microalbuminuria compared to patients with normoalbuminuria and controls.…”

Section: Discussionmentioning

confidence: 48%

Retinal Microcirculation in Predicting Diabetic Nephropathy in Type 2 Diabetic Patients without Retinopathy

et al. 2019

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Purpose: To evaluate retinal thicknesses and retinal microcirculation in healthy controls and in diabetic patients with or without microalbuminuria. Methods: Eighty-six diabetic patients without diabetic retinopathy (DR) (44 normoalbuminuric, 42 microalbuminuric) and 51 healthy controls were enrolled in this cross-sectional, prospective study. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed. Correlations between OCTA parameters with mean urinary albumin levels were evaluated. Results: The mean vessel densities of superficial capillary plexus (SCP), whole disc, and peripapillary area were significantly decreased in patients with microalbuminuria compared to patients with normoalbuminuria and controls (p < 0.05 for all). The mean vessel density of deep capillary plexus was significantly reduced in patients with microalbuminuria compared to controls (p < 0.05 for all). There were no significant differences in retinal thickness between groups (p > 0.05). Both duration of diabetes and urinary albumin levels were significantly and moderately correlated with mean vessel density of whole SCP in diabetic patients (r = 0.330, p = 0.021; r = 0.356, p = 0.017, respectively). Conclusion: Diabetic eyes without clinically detectable DR show impaired retinal microcirculation. Microalbuminuria is associated with alterations of retinal microcirculation in diabetic patients without DR. Evaluation of retinal microcirculation is likely useful for detecting early changes related to microvascular complications in type 2 diabetic patients.

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“…Recently, the relationship between microvascular changes and neural changes was also analyzed. A study reported that ONH perfusion in diabetic patients without DR was signi cantly lower than that of controls [4,18], and concluded that reduced ONH perfusion preceded peripapillary RNFL thinning. However, they did not include NPDR objects; therefore, they could not answer the question regarding whether microvascular changes or neural impairments occur rst in the early onset of DR. Our study comprehensively analyzed the retinal vessels of macula and ONH together with RNFL changes and demonstrated that vascular changes, speci cally the VD, occurred prior to detectable RNFL changes in both the macula and ONH.…”

Section: Discussionmentioning

confidence: 99%

Synchronous evaluation of early neurovascular changes in macula and optic nerve head in early diabetic retinopathy using combined optical coherence tomography angiography parameters

Xing

Liang

et al. 2019

Preprint

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Background This study aim to evaluate neurovascular changes in both macula and optic nerve head (ONH) in early stages of diabetic retinopathy (DR) using combined quantitative optical coherence tomography angiography (OCTA) parameters.Methods We studied 194 right eyes from 64 type 2 diabetic patients without DR (DM), 64 diabetic patients with nonproliferative diabetic retinopathy (NPDR) and 64 age-matched healthy controls. OCTA parameters were analyzed using binary logistic regression models and receiver operating characteristic (ROC) curves.Results There was significant reduction of vessel density (VD) in both macula and ONH comparing DM patients with and without NPDR to controls. The area under the curve (AUC) of the ROC curve for NPDR versus control was 0.963 ( p <0.001), with sensitivity of 93.8% and specificity of 90.6%. The ROC curves for NPDR patients versus NoDR patients (including DM and control groups) exhibited an AUC of 0.923 ( p <0.001), with sensitivity of 90.6% and specificity of 82.8%. The thickness of the retinal nerve fiber layer (RNFL) in both macula and ONH was not significantly different among these three groups.Conclusions VD in both macula and ONH was simultaneously decreased prior to RNFL thinning in DM patients through the course proceeding from preclinical DR to NPDR. Combined analysis of macula and ONH parameters was an comprehensive and accurate OCTA metric to distinguish NPDR patients from healthy controls and DM patients without DR.

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Do microvascular changes occur preceding neural impairment in early-stage diabetic retinopathy? Evidence based on the optic nerve head using optical coherence tomography angiography

Cited by 40 publications

References 38 publications

Quantification of Microvascular Density of the Optic Nerve Head in Diabetic Retinopathy Using Optical Coherence Tomographic Angiography

Quantification of Microvascular Density of the Optic Nerve Head in Diabetic Retinopathy Using Optical Coherence Tomographic Angiography

Retinal Microcirculation in Predicting Diabetic Nephropathy in Type 2 Diabetic Patients without Retinopathy

Synchronous evaluation of early neurovascular changes in macula and optic nerve head in early diabetic retinopathy using combined optical coherence tomography angiography parameters

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