Comparison of diabetic retinopathy lesions identified using ultrawide field color photography, ultrawide field fluorescein angiography and optical coherence tomography angiography

Abstract

AbstractPurposeTo determine the correlation of diabetic retinopathy (DR) findings identified on ultrawide field (UWF) color photos, ultrawide field fluorescein angiograms (UWF‐FA) and optical coherence tomography (OCT) angiograms (OCTA).MethodsThis was a cross‐sectional study. Images taken on the same visit were prospectively collected from adult patients with diabetes at a tertiary center in the Philippines. Patients underwent imaging with UWF and UWF‐FA (Optos plc, Dunfermline, Scotland, UK), and OCT with OCTA (Carl Zeiss Meditec Inc, Dublin, CA, USA). Images were evaluated for the presence of DR lesions and center‐involving diabetic macular edema (ciDME). Ischemia was identified on UWF‐FA using Image J Fiji software (National Institutes of Health, Bethesda, MD, USA) and nonperfusion index (NPI) was determined using previously validated protocols. Automated measurements of the macular vessel density (VD), vessel perfusion (VP) and foveal avascular zone (FAZ) metrics were obtained on OCTA.ResultsImages from 69 eyes were included in the analysis. Increasing DR severity was associated with higher NPI (r = 0.55944, p < 0.001) and remained significant after distinguishing between cones (Cone Nonperfusion Index [CPI]: r = 0.55617, p < 0.0001) and rods (Rod Nonperfusion Index [RPI]: r = 0.55285, p < 0.0001). In eyes with NPDR, higher NPI is correlated with the presence of ciDME (r = 0.51156, p 0.0017). Furthermore, macular nonperfusion on UWF‐FA was correlated with higher NPI (r = 0.42899, p 0.0101), CPI (r = 0.50028, p 0.0022) and RPI (r = 0.49027, p 0.0028). Central VD and VP were correlated with the presence of ciDME (r = 0.52456, p < 0.0001; r = 0.51952, p < 0.0001) on OCT. A larger FAZ area was correlated with decreased central VD (r = −0.60089, p 0.0001) and decreased central VP (r = −0.59224, p 0.0001).ConclusionsThe collective findings of UWF, UWF‐FA and OCTA provide complementary information on diabetic eyes, and may offer insights on the pathogenesis and progression of DR.