Quantitative Evaluation of Retinal Microvascular Abnormalities in Patients With Type 2 Diabetes Mellitus Without Clinical Sign of Diabetic Retinopathy

Abstract

Purpose To evaluate microvascular abnormalities in the macula and peripapillary area in diabetic patients without clinical signs of diabetic retinopathy (DR) and compare them with healthy control eyes, using optical coherence tomography angiography (OCTA). Methods A prospective study was performed of 49 eyes from 49 diabetic patients without clinical signs of DR and a control group of 52 eyes from 52 healthy normal individuals. The 3 × 3 mm macular scans and 4.5 × 4.5 mm optic disc scans were obtained with the OCTA RTVue-XR Avanti system. Angiograms from the superficial capillary plexus, the deep capillary plexus of the macula scans, and radial peripapillary capillary plexus of the optic disc scans were analyzed with MATLAB. Multivariate binary logistic regression and the least absolute shrinkage and selection operator (LASSO) regression were used to select ideal parameters that distinguish diabetic eyes without DR from normal eyes. A receiver operating characteristic (ROC) curve was generated, and sensitivity and specificity were calculated. Results Our final model identified FD-300 (foveal vessel density in a 300-µm-wide region around foveal avascular zone) as the only parameter selected by both the LASSO regression and the final multivariate logistic regression model that significantly differentiates diabetic eyes without clinical signs of DR from healthy normal eyes. The area under the ROC curve of FD-300 was 0.685, and sensitivity and specificity were 65.3% and 71.2%, respectively. Conclusions Quantitative evaluation of retinal microvascular abnormalities using OCTA identified FD-300 as a useful biomarker versus the other macular and peripapillary OCTA metrics in the early detection of preclinical diabetic retinal abnormalities. Translational Relevance OCTA may be useful in detecting early retinal microvascular abnormalities in diabetic patients before the clinical findings of DR become visible.

Perfusion Deficits in Diabetes Without Retinopathy Localize to the Perivenular Deep Capillaries Near the Fovea on OCT Angiography

“…We also found the 300 μm surrounding the FAZ to be the most important area of capillary change in our cohort, which is consistent with a recent report by Han et al 41 who found the foveal density-300 to be the most useful biomarker for distinguishing patients with DM without DR from healthy controls. By partitioning this “foveal density-300” region into perivenular, periarteriolar, and capillary zones, we were able to distinguish the central perivenular deep capillary zone as the most significant biomarker for distinguishing patients with DM without DR.…”

Early changes to retinal structure in patients with diabetic retinopathy as determined by ultrawide swept-source optical coherence tomography-angiography

“…Taken together, these findings suggested that ultra-wide SS-OCTA has advantages when compared with FFA or 12 mm × 12 mm OCTA, with the potential to be a rapid, repeatable and noninvasive method for DR screening and follow-up. Studies using 3 × 3 mm OCT and OCTA devices have found no significant differences in the VD and thickness of the superficial and deep retinal layers between DM and NC groups (25)(26)(27), findings partially consistent with the results of the present study. In contrast, other studies have found that the VD and thickness in the parafoveal and/or perifoveal layers are significantly lower in patients with DM than in NCs (28)(29)(30).…”

“…Studies using 3 × 3 mm OCT and OCTA devices have found no significant differences in the VD and thickness of the superficial and deep retinal layers between DM and NC groups ( 25 – 27 ), findings partially consistent with the results of the present study. In contrast, other studies have found that the VD and thickness in the parafoveal and/or perifoveal layers are significantly lower in patients with DM than in NCs ( 28 – 30 ).…”

Einflussnahme des Diabetes mellitus auf glaukomrelevante Untersuchungsergebnisse beim primären Offenwinkelglaukom

“…Ein gutes Beispiel ist der Diabetes mellitus. Beim Diabetes mellitus ohne diabetische Retinopathie kommt es bereits in 40,4% zu mikrovaskulären Auffälligkeiten mit Vergrößerung der fovealen avaskulären Zone (32,5%), zu nicht perfundierten Arealen und zu Mikroaneurysmen in den oberflächlichen und tiefen retinalen Schichten (7 – 13%) 58 , 59 , 60 . Mit zunehmendem Schweregrad der diabetischen Retinopathie nehmen diese mikrovaskulären Störungen zu 61 .…”

“…A good example is diabetes mellitus. Diabetes mellitus patients without diabetic retinopathy develop microvascular abnormalities in 40.4% of cases, with enlargement of the foveal avascular zone (32.5%), non-perfused areas, and microaneurysms in the superficial and deep retinal layers (7 – 13%) 58 , 59 , 60 . As the severity of diabetic retinopathy increases, these microvascular disorders increase 61 .…”