Quantitative analysis of retinal and choroid capillary ischaemia using optical coherence tomography angiography in type 2 diabetes

Abstract

Purpose: To perform a quantitative analysis of retinal and choroid capillary ischaemia in diabetic patients by using optical coherence tomography angiography (OCTA). Methods: A total of 97 type 2 diabetic patients and 48 controls were included in this cross-sectional study. Diabetic patients without diabetic retinopathy (DR) were categorized as no DR (NDR) group; DR was classified into mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). Quantitative parameters included foveal and parafoveal vascular density (VD) in superficial, deep and choroid capillary plexus (SCP, DCP and CCP), and foveal flow area in CCP. Stepwise comparisons between groups were performed in the adjacent stages. Results: Diabetic patients had significantly lower flow area in CCP and VD in all three layers compared with controls. In NDR group, foveal flow area in CCP significantly decreased compared with controls. In mild NPDR, parafoveal VD significantly decreased in all three layers compared with NDR, especially in temporal and nasal areas. In moderate NPDR, VD reduction extended to the inferior area in SCP and DCP compared with mild NPDR. In severe NPDR, progressive losses of VD were presented in all layers compared with moderate NDPR. In PDR, the superior VD in SCP significantly increased compared with severe NPDR. Conclusion: In diabetic patients, the microvascular ischaemia originated in choroid layer and extended inward affecting the deep and superficial layer. OCTA can serve as a reliable method for early detection and to monitor progressions in diabetic retinopathy.

Quantitative Assessment of Retinal Capillary Vessel Density and Foveal Avascular Zone Area in Central Serous Chorioretinopathy Using OCTA

“…Previous OCTA studies have shown that vessel density (VD) and FAZ were correlated with the course of disease and visual results in some retinal diseases. Along with the severity of diabetic retinopathy and the decline of visual acuity (VA), Li et al [8] revealed a chronological development of microvascular ischemia, from the choroid layer toward DCP and SCP with a gradually decreased VD. Nelis et al [9] found that the VD ratio based on OCTA could serve as an indicator of capillary architecture changes, which was associated with the degree of epiretinal membrane extraction.…”

Vascular changes precede tomographic changes in diabetic eyes without retinopathy and improve artificial intelligence diagnostics

“…Several studies showed reduced perfusion in the retinal vessels and choriocapillaris in diabetic eyes with and without retinopathy and this reduced perfusion originated from the choroid and spread to the retinal vessels 33–36 . A recent study showed that in diabetic patients, the change in retinal vasculature preceded the tomographic changes 37 .…”

“…Several studies showed reduced perfusion in the retinal vessels and choriocapillaris in diabetic eyes with and without retinopathy and this reduced perfusion originated from the choroid and spread to the retinal vessels. [33][34][35][36] A recent study showed that in diabetic patients, the change in retinal vasculature preceded the tomographic changes. 37 The study showed that choroidal thickness, vessel density of superficial and deep OCTA layer indicated early changes in DWR Note: Median and its 95% confidence interval is provided below.…”

Differentiation of Diabetic Status Using Statistical and Machine Learning Techniques on Optical Coherence Tomography Angiography Images

“…There have been a number of excellent studies that have highlighted the potential power of OCT-A in discriminating diabetic status. [17][18][19][20][21] In particular, pioneering work by Durbin et al 7 demonstrated the ability of measuring retinal microvasculature to distinguish diabetic status in patients. In their albeit small cohort they demonstrated highest area under the ROC curve (i.e., AUC) of 0.893 for measures of the vessel density in the superficial capillary network.…”