OCTA-based assessment of diabetic macular ischemia may help assess progression of DR

Evaluation of diabetic macular ischemia (DMI) based on optical coherence tomography angiography (OCTA) may improve the assessment of diabetic retinopathy (DR) progression, retinopathy development. Diabetic macular edema (DME)A new study finds a decrease in visual acuity.¹

This analysis demonstrated that the presence of DMI in the superficial capillary plexus (SCP) or deep capillary plexus (DCP), or both, used in the study was associated with discriminatory performance of DR progression at 4-year follow-up. It was suggested that it was significantly associated with the improvement of

“Our findings may help ophthalmologists pay closer attention to patients with DMI, especially those with both SCP and DCP, because it is an additive to DR progression. ,” wrote the research team led by Carol Y. Chan. She completed her PhD at the Center for Ophthalmology, The Chinese University of Hong Kong, Hong Kong Eye Hospital.

Because early and timely intervention is effective in this disease, identifying individuals at high risk for sight-threatening DR is important to strengthen management. DMI, characterized by enlargement and irregularity of the foveal avascular zone (FAZ), has been implicated as a risk factor for DR progression and how DMI fits into the DR severity scale in current clinical trials. We aim to better define² Moreover, recent literature reports that the presence of DMI in OCTA may help predict retinal disease progression and visual loss, further enhancing the management of DR.³

In the present study, we sought to further understand previously developed deep learning-based DMI algorithms and their association with the risk of subsequent DR progression, DME development, and VA exacerbation. Additional analyzes showed that baseline SCP-DMI and DCP-DMI had incremental predictive value for diabetic retinal disease progression and VA worsening over other identified risk factors in a study cohort with diabetes investigated whether to provide

Diabetic patients were recruited from July 2015 and followed for at least 4 years. All patients underwent the same comprehensive ophthalmologic assessment and interview-based questionnaire at each visit. The analysis was conducted between He June 2022 and He December 2022.

In this study, the presence of DMI was defined as images showing disruption of the FAZ with or without additional capillary nonperfused areas within the macula, and the absence of DMI was defined as the distribution of intact FAZ and normal vasculature. defined as an image showing Study outcomes included progression of DR (increase in severity level by 2 or more grades), development of DME (development of perceptible retinal thickening in the macular region or presence of DME features during follow-up), and loss of visual acuity (compared to line reduction of more than 0.2 logMar compared to case) was included. with baseline).

A total of 321 eyes from 178 patients were included in the final analysis (85 [47.75%] females; mean age 63 years). Of all eyes included, 105 eyes (32.71%) developed DR, 33 eyes (10.28%) developed DME, and 68 eyes (21.18%) over a mean follow-up period of 50 months. decreased visual acuity was observed. In a univariate Cox proportional hazards model, the data were based on age, duration of diabetes, fasting blood glucose, HbA1c, mean arterial blood pressure, baseline DR severity, intraganglionic plexiform layer thickness, and cigarette smoking were associated with DR progression. and was significantly associated with the development of DME. study cohort.

Analysis independently revealed the presence of SCP-DMI (dangerous index). [HR]2.69; 95% CI, 1.64–4.43; P. <.001) and DCP-DMI (HR, 3.21; 95% CI, 1.94–5.30; P. <.001), and the presence of both SCP-DMI and DCP-DMI (HR, 3.69; 95% CI, 1.80–5.16) were significantly associated with DR progression after adjusting for the above risk factors. I was. Furthermore, the presence of DCP-DMI was significantly associated with the development of DME (HR, 4.60; 95% CI, 1.15 to 8.20) and decreased visual acuity (HR, 2.12; 95% CI, 1.01 to 5.22).

The researchers noted that this study may be the first longitudinal OCTA study to suggest that the presence of DMI is associated with worsening VA in a diabetic cohort.

“There is currently no specific treatment for DMI, but the implications of this study can be interpreted as follows: DMI contributes to progressive visual loss in some DR patients despite treatment. Considering the complex relationship between DMI and DR, “the results of this study suggest that a more stringent approach should be taken to moderate the progression of DMI and DR and subsequently arrest the progression of worsening VA. We may advocate early detection of DMI in the diabetic population to prompt early intervention such as metabolic control,” the researchers wrote.

References

1. Yang D, Tan Z, Lan A, et al Evaluation of parafoveal diabetic macular ischemia on optical coherence tomography angiography to predict progression and visual loss in diabetic retinal disease. JAMA Ophthalmology. Published online May 25, 2023. doi:10.1001/jamaophysicalmol.2023.1821
2. Cheung CMG, Fawzi A, Teo KY, et al. Diabetic macular ischemia: a new therapeutic target? Progressin Aires. 2022;89:101033. Doi: 10.1016/j.preteyeres.2021.101033
3. Tsai Ash, Gan ATL, Ting DSW, et al. Diabetic macular ischemia: correlation of retinal vasculature changes and functional deficits by optical coherence tomography angiography. retina. 2020;40(11):2184-2190