Abstract
Early microvascular damage in diabetes (e.g. capillary nonperfusion and ischemia) can now be assessed and quantified with optical coherence tomography-angiography (OCT-A). The morphology of vascular tissue is indeed affected by different factors; however, there is a paucity of data examining whether OCT-A metrics are influenced by ocular, systemic and demographic variables in subjects with diabetes. We conducted an observational cross-sectional study and included 434 eyes from 286 patients with diabetes. Foveal avascular zone (FAZ) area, FAZ circularity, total and parafoveal vessel density (VD), fractal dimension (FD), and vessel diameter index (VDI) from the superficial capillary plexus OCT-angiogram were measured by a customized automated image analysis program. We found that diabetic retinopathy (DR) severity was associated with increased FAZ area, decreased FAZ circularity, lower VD, lower FD, and increased VDI. Enlarged FAZ area was correlated with shorter axial length and thinner central subfield macular thickness. Decreased FAZ circularity was correlated with a reduction in visual function. Decreased VD was correlated with thinner macular ganglion-cell inner plexiform layer. Increased VDI was correlated with higher fasting glucose level. We concluded that the effects of ocular and systemic factors in diabetics should be taken into consideration when assessing microvascular alterations via OCT-A.
Highlights
Microvascular damage in diabetes can be assessed and quantified with optical coherence tomography-angiography (OCT-A)
The morphology of vascular tissue is affected by different factors and there is a paucity of data examining whether OCT-A metrics are influenced by ocular, systemic and demographic variables in subjects with diabetes
We first quantified the retinal microvasculature from OCT-angiograms generated by a swept-source based OCT-A device, in terms of Foveal avascular zone (FAZ) area, FAZ circularity, vessel density (VD), fractal dimension (FD), and vessel diameter index (VDI) using a customized program and assessed its intra-session and inter-session reliability in patients with diabetes
Summary
Microvascular damage in diabetes (e.g. capillary nonperfusion and ischemia) can be assessed and quantified with optical coherence tomography-angiography (OCT-A). A couple of publications have reported that microvascular changes (e.g. foveal avascular zone [FAZ] enlargement, microaneurysms, capillary dropout, neovascularization) can be detected in diabetic eyes using OCT-A with good agreement with fluorescein angiography[5,6,7,8,9,10,11,12,13,14,15,16] Some of these studies have measured FAZ size and vessel density and correlated with diabetic macular ischemia severity, demonstrating that the microvascular changes, and in particular, quantitative metrics derived from OCT-A have great potential to serve as biomarkers of DR. We examined the influences of a range of ocular (e.g. DR severity, axial length [AL], visual acuity [VA], macular thickness, subfoveal choroidal thickness), systemic (e.g. HbA1c, fasting glucose, blood pressure, body mass index [BMI], history of stroke) and demographic factors (e.g. age, duration of diabetes) on the OCT-A metrics in a cohort of patients with diabetes
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