Earliest Evidence of Preclinical Diabetic Retinopathy Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density

Rosen, Richard B.; Romo, Jorge S Andrade; Krawitz, Brian; Mo, Shelley; Fawzi, Amani A.; Linderman, Rachel E; Carroll, Joseph; Pinhas, Alexander; Chui, Toco Y. P.

doi:10.1016/j.ajo.2019.01.012

Cited by 121 publications

(118 citation statements)

References 74 publications

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“…Most reported a decrease in perifoveal perfusion parameters in the deep retinal layer, 6,7 or in the superficial layer. 8,9 However, Goudot et al 10 found no significant differences, and Rosen et al 11 described greater capillary perfusion in diabetics with no DR compared with controls.…”

mentioning

confidence: 99%

Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus

Choi

Park

Lee

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Citation: Choi EY, Park SE, Lee SC, et al. Association between clinical biomarkers and optical coherence tomography angiography parameters in type 2 diabetes mellitus. Invest Ophthalmol Vis Sci. 2020;61(3):4. https://doi.org/10.1167/iovs.61.3.4 PURPOSE.To investigate the clinical significance of the changes in the macular microvasculature in patients with diabetes mellitus type 2 without diabetic retinopathy. METHODS.Fifty-five patients with diabetes mellitus type 2 without diabetic retinopathy and 48 healthy individuals were enrolled in a prospective cross-sectional study. We identified the changes of optical coherence tomography angiography parameters (foveal avascular zone [FAZ] area and circularity, vessel density, and perfusion index) of the 6 × 6-mm macular scan. Correlation and multiple regression analyses were performed between optical coherence tomography angiography parameters and previously known diabetes mellitus type 2-related demographic and systemic characteristics, and serum biochemical markers. RESULTS. FAZ parameters and perfusion index of the superficial and deep vascular plexus showed significant correlation with serum insulin level, and homeostasis model assessment indices. In multiple linear regression analysis, low insulin levels predicted increased FAZ areas in both the superficial (β = -0.007; P = 0.030) and deep layers (β = -0.010; P = 0.018) and a decreased perfusion index in the deep layer (β = 0.003; P = 0.001). CONCLUSIONS.The expansion and loss of circularity of the FAZ and the decrease in the perfusion index may be affected by insulin resistance and secretory capacity in patients with diabetes mellitus type 2 with no diabetic retinopathy.

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mentioning

confidence: 99%

Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus

Choi

Park

Lee

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…Another fact that should be highlighted is the occurrence of variation of retinal capillary density and age-related FAZ dimensions [12,13], highlighting the importance of new findings from OCT-A. This has been reported in other ischemic diseases, such as diabetic retinopathies [11,14,18,19] and sickle cell disease [20,21], in addition to glaucoma [22], with possible involvement at the level of the deep plexus, in addition to the histological variation found in this plexus, with greater distancing of the fovea and increased dimensions compared to the superficial plexus [23]. However, such enlargement is not easily interpreted, since there is variation in the size of this area also in the general population, since in a single individual this measurement can usually be large or abnormally increased.…”

Section: Discussionmentioning

confidence: 82%

“…The foveal avascular zone (FAZ) is a structure sensitive to retinal microvasculature disorders, and may indicate events of ischemic nature [4][5][6][7][8][9][10][11][12]. The imaging gold standard investigation of the retina vascularization is fluorescein angiography, but it is limited in the depth of analyzed structures, viewing only the superficial vascular plexus [13,14].…”

Section: Introductionmentioning

confidence: 99%

Foveal Avascular Zone in Hypertension as Measured by Optical Coherence Tomography Angiography

Sá¹,

Gadelha²,

Melo³

et al. 2019

CTOY

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Purpose: To investigate the Foveal Avascular Zone (FAZ) area in patients with arterial hypertension using optical coherence tomography angiography (OCT-A).Material and methods: The study was permormed at the School Clinic of UNIFACISA and at the Eye Care Center. It was included 21 hypertensive patients (study group) and 19 individuals without hypertension (control group). It was excluded patientes with diabetes or glaucoma. The measurement of the FAZ areas was performed by the DRI OCT-1Triton/Plus. For the quantitative variables, the results were expressed by their means and standard deviations. Qualitative variables were expressed by their absolute and relative frequencies. Student’s t-test was used to verify differences between means and Fisher’s exact test for differences between frequencies. For evaluating the correlation between the superficial and deep plexus areas, the Pearson correlation test was used. P value ≤ 0.05, rejected the null hypothesis. The research was approved by the Ethics Committee of the Medical School from Campina Grande -UNIFACISA and all individuals signed the free and informed consent form.Results: The means of the superficial FAZ of both eyes was significantly higher in the study group (right eye 410.7 ± 160.7 μm2 - 319.1 ± 108.2 μm2 - p = 0.0433); (left eye: 405.4 ± 144.8 μm2 versus 309.4 ± 87.7 μm2- p = 0.0174). The means of the deep FAZ areas of the right and left eyes were similar between the study and control groups (right eye: 559.6 ± 253.28 μm2 versus 605.1 ± 226.8 μm2 - p = 0.5548); (left eye: 673.2 ± 170.8 μm2 versus 585.6 ± 171.2 μm2 - p = 0.1142). The relationships between the superficial and deep plexus areas of both eyes showed a weak correlation between the two plexuses. (r = 0.4734), left eye (r = 0.2287), study group - right eye: (r = 0.4374), left eye (r = 0.3580).Conclusion: The area of superficial FAZ of the right and left eyes was significantly higher in the hypertensive patients. The deep FAZ area of both eyes, however showed similar mean areas between the study and control groups.

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“…We also discovered that the PVD of the using group was lower than that of the without group, although it was a minimal difference. Previous studies reported a 1 0 decrease in pulsatile ocular blood flow was observed in the early stage of observable DR, and a lower PVD was related to the development and progression of DR. [33][34][35] A prior study reported that insulin could induce vascular endothelial production of nitric oxide, which leads to capillary recruitment, vasodilation, and increased blood flow. 36 However, our study demonstrated that insulin use could decrease the ocular PVD.…”

Section: Discussionmentioning

confidence: 99%

The influence of insulin therapy on measurements of optical coherence tomography parameters in diabetic patients without retinopathy

Zhou

W²,

Zhou³

et al. 2020

Preprint

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Purpose:To determine whether there was a change in the fundus of the eye in diabetic patients without retinopathy after insulin therapy. Methods:The diabetic patients without retinopathy were included in this study. A swept-source optical coherence tomography/angiography (SS-OCT/A) was used to obtain the measurements of macular retinal nerve fibre layer (mRNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, retinal thickness (RT), macular choroidal thickness (MCT), peripapillary retinal nerve fibre layer (pRNFL) thickness, peripapillary choroidal thickness (PCT), and perfused vascular density (PVD). Univariable and multivariable regression analyses were performed to explore the influence of insulin use on measurements of OCT/A. Results: A total of 1140 patients used insulin (using group), and 126 patients did not use insulin (without group). The average MCT of the using group was 171.3±67.8 μ m, which was thinner than that in the without group (190.2±74.7 μ m) (P=0.012). The average PVD of the using group (48.0±2.1 μ m) was less than that in the without group (48.7±2.1 μ m) (P<0.001). After adjusting for age, gender, axial length, duration, HbA1c, systolic blood pressure, diastolic blood pressure, cholesterol, serum creatinine, insulin use was significantly associated with thinner MCT (beta=-16.12μm; 95%CI:-29.42, -2.81μm; P= 0.018) and lower PVD (beta=-0.79; 95%CI: -1.22, -0.36; P<0.001). Conclusion:The use of insulin by diabetic patients without retinopathy might decrease the MCT and PVD compared to patients who did not use insulin, which helps to better understanding the role of insulin use on higher risk for diabetic retinopathy.

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Earliest Evidence of Preclinical Diabetic Retinopathy Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density

Cited by 121 publications

References 74 publications

Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus

Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus

Foveal Avascular Zone in Hypertension as Measured by Optical Coherence Tomography Angiography

The influence of insulin therapy on measurements of optical coherence tomography parameters in diabetic patients without retinopathy

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