Structure–function relationship in early diabetic retinopathy: a spatial correlation analysis with OCT and microperimetry

Montesano, Giovanni; Gervasoni, Annalisa; Ferri, Paolo; Allegrini, Davide; Migliavacca, L.; Cillà, Stefano De; Rossetti, Luca

doi:10.1038/eye.2017.27

Cited by 40 publications

(50 citation statements)

References 22 publications

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“…; Montesano et al. ). In contrast to these functional measures, VA is typically normal or only mildly affected in early‐stage DR, suggesting that standard VA measurement is not a particularly sensitive marker of neural dysfunction in these individuals.…”

Section: Introductionmentioning

confidence: 97%

“…, ; Montesano et al. ), has been associated with sensitivity losses assessed by MP (Montesano et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…), has been associated with sensitivity losses assessed by MP (Montesano et al. ). The retinal thinning observed in early‐stage DR without DME has been attributed to neurodegeneration (van Dijk et al.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are fewer reports of structural abnormalities of the retina and their correlation with functional measures in DR subjects who do not have DME, it has been shown that some retinal layers can be abnormally thin in these individuals (van Dijk et al 2010(van Dijk et al , 2012Vujosevic & Midena 2013;Bandello et al 2015;Chhablani et al 2015). Thinning of the inner retina, typically parafoveally (van Dijk et al 2010(van Dijk et al , 2012Montesano et al 2017), has been associated with sensitivity losses assessed by MP (Montesano et al 2017). The retinal thinning observed in early-stage DR without DME has been attributed to neurodegeneration (van Dijk et al 2009(van Dijk et al , 2010(van Dijk et al , 2012Barber & Baccouche 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Neurodegeneration has been shown to occur early in DR, often preceding clinically apparent vascular abnormalities, and has been characterized at both the structural and molecular level (Carrasco et al 2007;Garcia-Ramirez et al 2009;Chhablani et al 2015). Studies have characterized neural dysfunction in human subjects who have early-stage DR using several measures including the electroretinogram (Tzekov & Arden 1999;Bearse et al 2006;McAnany & Park 2018a,c, 2019, letter contrast sensitivity (CS) (Stavrou & Wood 2003;Misra et al 2010;McAnany & Park 2018c) and MP sensitivity (Verma et al 2009;Nittala et al 2012;Gella et al 2016;Montesano et al 2017). In contrast to these functional measures, VA is typically normal or only mildly affected in early-stage DR, suggesting that standard VA measurement is not a particularly sensitive marker of neural dysfunction in these individuals.…”

Section: Introductionmentioning

confidence: 99%

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Contrast sensitivity is associated with outer‐retina thickness in early‐stage diabetic retinopathy

McAnany

Park

Liu

et al. 2019

Acta Ophthalmologica

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Purpose To determine the relationship between contrast sensitivity (CS) and outer‐retina thickness (ORT) in diabetics who have minimal or no diabetic retinopathy (DR). Methods Twenty non‐diabetic control subjects and 40 type‐2 diabetic subjects participated (20 had no clinically apparent DR [NDR] and 20 had mild non‐proliferative DR [NPDR]). No subject had a history of treatment for macular oedema. Letter CS, microperimetry (MP) sensitivity and visual acuity (VA) were measured. Letter CS and MP measurements were performed over the central 6° of the visual field. Spectral domain optical coherence tomography (SD‐OCT) images were obtained at corresponding locations, outer‐retina thickness was quantified, and structure–function relationships were evaluated. Results Analysis of variance indicated significant letter CS differences among the groups (p < 0.001). Letter CS was reduced significantly for the mild NPDR group (p < 0.001; 33% reduction), but not the NDR group (p = 0.08). There were no significant differences in MP sensitivity or ORT among the groups (both p > 0.10). Nevertheless, Hoeffding's D tests indicated significant associations between ORT and letter CS (p < 0.001) and between ORT and MP sensitivity for the mild NPDR group (p = 0.01). VA was not significantly associated with ORT for either diabetic group (both p > 0.49). Conclusions Outer‐retina thickness is associated with letter CS and MP sensitivity, but not VA, in mild NPDR. This finding highlights the usefulness of simple letter CS measures and suggests neural dysfunction can occur in the absence of marked structural abnormalities in early‐stage DR.

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Section: Introductionmentioning

confidence: 97%

“…, ; Montesano et al. ), has been associated with sensitivity losses assessed by MP (Montesano et al. ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contrast sensitivity is associated with outer‐retina thickness in early‐stage diabetic retinopathy

McAnany

Park

Liu

et al. 2019

Acta Ophthalmologica

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Identifying the severity of diabetic retinopathy by visual function measures using both traditional statistical methods and interpretable machine learning: a cross-sectional study

Wright,

Chakravarthy,

Das

et al. 2023

Diabetologia

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Aims/hypothesis To determine the extent to which diabetic retinopathy severity stage may be classified using machine learning (ML) and commonly used clinical measures of visual function together with age and sex. Methods We measured the visual function of 1901 eyes from 1032 participants in the Northern Ireland Sensory Ageing Study, deriving 12 variables from nine visual function tests. Missing values were imputed using chained equations. Participants were divided into four groups using clinical measures and grading of ophthalmic images: no diabetes mellitus (no DM), diabetes but no diabetic retinopathy (DM no DR), diabetic retinopathy without diabetic macular oedema (DR no DMO) and diabetic retinopathy with DMO (DR with DMO). Ensemble ML models were fitted to classify group membership for three tasks, distinguishing (A) the DM no DR group from the no DM group; (B) the DR no DMO group from the DM no DR group; and (C) the DR with DMO group from the DR no DMO group. More conventional multiple logistic regression models were also fitted for comparison. An interpretable ML technique was used to rank the contribution of visual function variables to predictions and to disentangle associations between diabetic eye disease and visual function from artefacts of the data collection process. Results The performance of the ensemble ML models was good across all three classification tasks, with accuracies of 0.92, 1.00 and 0.84, respectively, for tasks A–C, substantially exceeding the accuracies for logistic regression (0.84, 0.61 and 0.80, respectively). Reading index was highly ranked for tasks A and B, whereas near visual acuity and Moorfields chart acuity were important for task C. Microperimetry variables ranked highly for all three tasks, but this was partly due to a data artefact (a large proportion of missing values). Conclusions/interpretation Ensemble ML models predicted status of diabetic eye disease with high accuracy using just age, sex and measures of visual function. Interpretable ML methods enabled us to identify profiles of visual function associated with different stages of diabetic eye disease, and to disentangle associations from artefacts of the data collection process. Together, these two techniques have great potential for developing prediction models using untidy real-world clinical data. Graphical Abstract

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Ocular fixation and macular integrity by microperimetry in multiple sclerosis

Gil-Casas

Piñero

Molina‐Martín

2020

Graefes Arch Clin Exp Ophthalmol

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Structure–function relationship in early diabetic retinopathy: a spatial correlation analysis with OCT and microperimetry

Cited by 40 publications

References 22 publications

Contrast sensitivity is associated with outer‐retina thickness in early‐stage diabetic retinopathy

Contrast sensitivity is associated with outer‐retina thickness in early‐stage diabetic retinopathy

Identifying the severity of diabetic retinopathy by visual function measures using both traditional statistical methods and interpretable machine learning: a cross-sectional study

Ocular fixation and macular integrity by microperimetry in multiple sclerosis

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