Abstract
To investigate if there are differences in macular capillaries between black and white subjects using optical coherence tomography angiography (OCTA) and identify potential factors underlying the epidemiologically-based higher vulnerability of black populations to diabetic retinopathy (DR). This prospective, observational cross-sectional study included 93 eyes of 47 healthy subjects with no medical history and ocular history who self-identified as black or white and were matched for age, sex, refractive error, and image quality. Subjects underwent OCTA imaging (RTVue-XR Avanti) of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris. AngioAnalytics was used to analyze vessel density (VD) and choriocapillaris % blood flow area (BFA) in the 1mm-diameter fovea, parafovea, and 3mm-diameter circular area including the fovea and parafovea (3x3mm image). Foveal avascular zone (FAZ) was also analyzed. Linear mixed models were used to evaluate for differences between the study groups. Compared to the white subjects in this study, black subjects were found to have: lower foveal VD in the SCP (p<0.05); lower VD in the parafovea and in the 3x3mm image in the DCP (p<0.05); larger FAZ in SCP and DCP (p<0.05); and decreased choriocapillary BFA in the area underlying the fovea, parafovea, and 3x3mm image (p<0.05). In our study, our black subjects had decreased macular capillary vasculature compared to matched white subjects, even in early adulthood and the absence of any systemic or ocular conditions. To our knowledge, this is the first report showing that retinal and choriocapillary vascular differences may contribute to racial disparities in vulnerability to DR.
Highlights
Diabetes mellitus (DM) is a serious epidemic disease in the United States, with 9.4% of the population afflicted with the chronic disease [1]
Black populations face a larger risk of developing debilitating complications from DM, including diabetic retinopathy (DR), kidney failure, and lower-extremity amputation [2]
Our data show that black subjects had lower macular vessel density (VD) in the DCP, lower macular VD at the fovea in the SCP, larger Foveal avascular zone (FAZ) in both the SCP and DCP, and lower choriocapillary blood flow area (BFA) compared to white subjects (Table 2, Fig 2)
Summary
Diabetes mellitus (DM) is a serious epidemic disease in the United States, with 9.4% of the population afflicted with the chronic disease [1]. Studies that have attempted to identify the medical and genetic factors underlying the higher vulnerability to DR in black populations are limited and have had conflicting results [4,5,12,14,15,18,19]. While these factors may have varying effects on the total risk of developing DR, the retinal vasculature has not yet been directly studied in different populations to further investigate the existing race-based disparities of DR
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