Abstract
Diabetic retinopathy, the most serious ocular complication of diabetes, imposes a serious economic burden on society. Automatic and objective assessment of vessel changes can effectively manage diabetic retinopathy and prevent blindness. Optical coherence tomography angiography (OCTA) metrics have been confirmed to be used to assess vessel changes. The accuracy and reliability of OCTA metrics are restricted by vessel segmentation methods. In this study, a multi-branch retinal vessel segmentation method is proposed, which is comparable to the segmentation results obtained from the manual segmentation, effectively extracting vessels in low contrast areas and improving the integrity of the extracted vessels. OCTA metrics based on the proposed segmentation method were validated to be reliable for further analysis of the relationship between OCTA metrics and diabetes and the severity of diabetic retinopathy. Changes in vessel morphology are influenced by systemic risk factors. However, there is a lack of analysis of the relationship between OCTA metrics and systemic risk factors. We conducted a cross-sectional study that included 362 eyes of 221 diabetic patients and 1,151 eyes of 587 healthy people. Eight systemic risk factors were confirmed to be closely related to diabetes. After controlling these systemic risk factors, significant OCTA metrics (such as vessel complexity index, vessel diameter index, and mean thickness of retinal nerve fiber layer centered in the macular) were found to be related to diabetic retinopathy and severe diabetic retinopathy. This study provides evidence to support the potential value of OCTA metrics as biomarkers of diabetic retinopathy.
Highlights
Diabetic retinopathy (DR), is one of the most frequent causes of blindness in the working-age population [1]
The reliability of Optical coherence tomography angiography (OCTA) metrics based on MRVSM is not inferior to that of OCTA metrics based on Reif et al [16], Chu et al [17], and Tang et al [14]
We found eight systemic risk factors that are strongly correlated with OCTA metrics
Summary
Diabetic retinopathy (DR), is one of the most frequent causes of blindness in the working-age population [1]. DR causes expression of vascular endothelial growth factor [2], inflammation [3], upregulation of renin–angiotensin [4], oxidative stress [5], activation of protein kinase C [6], the formation of sorbitol [7], and advanced glycation end-products [8], which lead to an increased permeability of retinal vessel, capillary non-perfusion area, microaneurysm formation, and retinal endothelial cell damage. Combined with the optical coherence tomography angiography (OCTA), it allows a layered view of the vascular morphology and blood flow alterations of the retina and choroid, enabling a more in-depth study of specific retinal capillary layer lesions caused by DR [12]. The retinal vessel segmentation methods used in these studies have two glaring limitations: i) discontinuity of segmented vessels, and ii) poor and false segmentation of lowcontrast vessel regions
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