Abstract
Purpose To characterize hallmark diabetic retinopathy (DR) lesions utilizing adaptive optics scanning laser ophthalmoscopy (AOSLO) and to compare AOSLO findings with those on standard imaging techniques. Methods Cross-sectional study including 35 eyes of 34 study participants. AOSLO confocal and multiply scattered light (MSL) imaging were performed in eyes with DR. Color fundus photographs (CF), infrared images of the macula (Spectralis, Heidelberg), and Spectralis spectral domain optical coherence tomography SDOCT B-scans of each lesion were obtained and registered to corresponding AOSLO images. Main Outcome Measures Individual lesion characterization by AOSLO imaging. AOSLO appearance was compared with CF and SDOCT imaging. Results Characterized lesions encompassed 52 microaneurysms (MA), 20 intraretinal microvascular abnormalities (IRMA), 7 neovascularization (NV), 11 hard exudates (HE), 5 dot/blot hemorrhages (HEM), 4 cotton wool spots (CWS), and 14 intraretinal cysts. AOSLO allowed assessment of perfusion in vascular lesions and enabled the identification of vascular lesions that could not be visualized on CF or SDOCT. Conclusions AOSLO imaging provides detailed, noninvasive in vivo visualization of DR lesions enhancing the assessment of morphological characteristics. These unique AOSLO attributes may enable new insights into the pathological changes of DR in response to disease onset, development, regression, and response to therapy.
Highlights
Diabetic retinopathy (DR) is characterized by hallmark retinal lesions including microaneurysms (MA), hard exudates (HE), cotton wool spots (CWS), intraretinal hemorrhages, and retinal neovascularization (NV) which are present in over 77–90% of individuals after 15 or more years of diabetes [1,2,3]
DR severity grading of the 35 eyes that were included was as follows: 2 mild, 9 moderate, 8 severe nonproliferative DR, and 16 proliferative DR
This study provides the first detailed, systematic description of multiple vascular and nonvascular retinal lesions of diabetic retinopathy as imaged using noninvasive confocal and multiply scattered light adaptive optics scanning laser ophthalmoscopy (AOSLO) technology
Summary
Diabetic retinopathy (DR) is characterized by hallmark retinal lesions including microaneurysms (MA), hard exudates (HE), cotton wool spots (CWS), intraretinal hemorrhages, and retinal neovascularization (NV) which are present in over 77–90% of individuals after 15 or more years of diabetes [1,2,3]. Color fundus photography is the standard method by which DR severity is assessed for clinical and research purposes [1] Alternative imaging methods such as spectral domain optical coherence tomography (SDOCT), scanning laser ophthalmoscopy (SLO), and fluorescein angiography (FA) allow evaluation of specific aspects of retinal pathology such as neural retinal layer thickening, disorganization or disruption, and vascular leakage, respectively, and have . International Journal of Endocrinology been utilized to assess individual DR lesions in detail [9,10,11,12,13,14] All these imaging modalities are limited by a lateral resolution of approximately 10–15 μm and are unable to resolve structural details at the cellular level. There are numerous histological studies of DR lesions at the cellular level in human postmortem tissues, detailed in vivo evaluation has been limited [15,16,17]
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