Abstract
Retinal arterioles, venules and capillaries are differentially affected in diabetes, and studying vascular alterations may provide information on pathogenesis of diabetic retinopathy (DR). We conducted a cross-sectional study on 49 diabetic patients, who underwent fundus photography and optical coherence tomographic angiography (OCT-A). Fundus photographs were analysed using semi-automated software for arteriolar and venular parameters, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and fractal dimension (FD). Capillary parameters were measured using OCT-A, including capillary density index (CDI) and capillary FD of superficial (SVP) and deep (DVP) vascular plexuses. Severe DR was defined as severe non-proliferative DR and proliferative DR. We found that eyes with severe DR had narrower CRAE and sparser SVP CDI than eyes without. In logistic regression analysis, capillary parameters were more associated with severe DR than arteriolar or venular parameters. However, combining arteriolar, venular and capillary parameters provided the strongest association with severe DR. In linear regression analysis, eyes with poorer visual acuity had lower CRAE and FD of arterioles, venules, and DVP capillaries. We concluded that the retinal microvasculature is globally affected in severe DR, reflecting widespread microvascular impairment in perfusion. Arteriolar, venular and capillary parameters provide complementary information in assessment of DR.
Highlights
Retinal arterioles, venules and capillaries are differentially affected in diabetes, and studying vascular alterations may provide information on pathogenesis of diabetic retinopathy (DR)
We demonstrate quantitative alterations in retinal arteriolar parameters, principally central retinal arteriolar equivalent (CRAE), and retinal capillary parameters, which may be useful in global assessment of DR severity
In terms of larger arteriolar parameters quantified by SIVA, we found that narrower CRAE was associated with severe DR
Summary
Venules and capillaries are differentially affected in diabetes, and studying vascular alterations may provide information on pathogenesis of diabetic retinopathy (DR). There has been substantial research demonstrating that quantitative retinal arteriolar and venular parameters can be measured from fundus photographs using computer software (such as the Singapore I Vessel Assessment [SIVA]), and that such changes (e.g. narrower arteriolar and venular caliber, and reduced arteriolar fractal dimensions [FD]) are associated with increasing severity and progression of DR10–26 Such techniques, cannot be applied to retinal capillaries. The primary aim of this study was to quantify retinal arteriolar and venular parameters with fundus photograph analysis using SIVA software, and capillary parameters with OCT-A in eyes of diabetic patients, and to investigate the relationship between these parameters and the presence of severe DR. The secondary aims of this study included exploring the relationship between: (1) retinal vascular parameters and visual acuity (VA), and (2) OCT-A capillary parameters and fundus photograph arteriolar/venular parameters
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