Evaluation of retinal microvasculature according to stable chronic obstructive pulmonary disease severity and the correlation of pulmonary parameters with optical coherence tomography angiography findings

Abstract

Purpose: To evaluate the retinal and optic disc microvascular changes according to disease severity in patients with stable chronic obstructive pulmonary disease (COPD), and the correlation of pulmonary parameters with optical coherence tomography angiography (OCTA) findings. Methods: Forty patients with COPD and 30 age- and sex-matched subjects (control group) were included in this cross-sectional prospective study. The COPD group was then divided into two subgroups according to GOLD classification and disease severity as mild-to-moderate COPD group (group 1) and severe COPD group (group 2). OCTA was performed with 6 mm × 6 mm sections for the macula and 4.5 mm × 4.5 mm sections for the optic disc. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, and vessel density in different sections of the retina and optic disc were analyzed. Results: The mean ages, gender, intraocular pressures, peripapillary RNFL thickness, FRT, and optic disc vessel densities were similar among the groups. Compared to the control group and group 1, group 2 showed significantly lower mean foveal vessel density measurements in superficial and deep capillary plexus ( P = 0.014 and P = 0.007, respectively). Cigarette packets/year, exacerbation per year, and Modified Medical Research Council showed significant negative correlations, whereas forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity showed significant positive correlations with foveal vessel densities. Conclusion: COPD severity seems to have a negative effect on OCTA measurements. OCTA may reflect the severity of inflammation and hypoxia in COPD and may provide useful detailed information on the role of retinal vascular changes in the follow-up and progression of patients with COPD.

Commentary: Applicability of optical coherence tomography angiography for imaging ocular biomarkers of systemic diseases

“…The role of OCTA is slowly evolving in other fields such as cardiology, pulmonology, nephrology, and diabetology. [ 2 3 4 5 6 7 ] Amongst them, diabetic and hypertensive patients have been extensively studied with OCTA. Using OCTA, Diabetics without diabetic retinopathy (DR) were found to have decreased superficial and deep retinal VD with increased areas of FAZ and nonperfusion when compared to healthy participants.…”

“…In some pulmonological disorders, retinal vascular changes may occur as a result of secondary changes caused by systemic inflammation and hypoxia rather than as a direct result of the original microvascular pathology. [ 6 ] In their study on evaluation of retinal and optic disc microvascular changes in patients with stable chronic obstructive pulmonary disease (COPD), Kurtul et al . [ 6 ] showed the severity of COPD to have a negative impact on OCTA parameters, including the VD in the superficial and deep retinal plexuses.…”

“…[ 6 ] In their study on evaluation of retinal and optic disc microvascular changes in patients with stable chronic obstructive pulmonary disease (COPD), Kurtul et al . [ 6 ] showed the severity of COPD to have a negative impact on OCTA parameters, including the VD in the superficial and deep retinal plexuses. Although the study is limited by a small sample size, the results presented are very interesting, and further studies with a larger sample size and longer follow-up are needed to validate the results and further explore this relationship.…”

“…Although the study is limited by a small sample size, the results presented are very interesting, and further studies with a larger sample size and longer follow-up are needed to validate the results and further explore this relationship. [ 6 ]…”

“…Presently, numerous systemic disorders are being investigated by OCTA for their potential role in diagnosis and monitoring the therapeutic response. [ 2 3 4 5 6 7 8 ] Thus, the micromorphometry of the retinal, choroidal, and optic disc vasculature, as demarcated and quantified by the OCTA, may be a valuable biomarker for the management and prognosis of diseases, not only in the field of ophthalmology but also in other branches of medicine.…”