Abstract
Ophthalmologists sometimes face difficulties in identifying the origin of visual acuity (VA) loss in a retinitis pigmentosa (RP) patient, particularly before cataract surgery: cataract or the retinal disease state. Therefore, it is important to identify the significant factors correlating with VA. Nowadays, retinal blood flow in superficial and deep layers can be estimated non-invasively using optical coherence tomography angiography (OCTA). We estimated blood flow per retinal layer by using OCTA; investigated the correlation between VA and other parameters including blood flow and retinal thickness; and identified the most associated factor with VA in patients with RP. OCTA images in 68 of consecutive 110 Japanese RP patients were analysable (analysable RP group). Thirty-two age- and axial length-matched healthy eyes (control group) were studied. In the analysable RP group, the parafoveal flow density in superficial and deep layers was 47.0 ± 4.9% and 52.4 ± 5.5%, respectively, which was significantly lower than that in controls. Using multivariate analysis, we found that the parafoveal flow density in the deep layer and superficial foveal avascular area were the factors associated with VA. Non-invasive estimation of retinal blood flow per retinal layer using OCTA is useful for predicting VA in RP patients.
Highlights
Ophthalmologists sometimes face difficulties in identifying the origin of visual acuity (VA) loss in an RP patient before cataract surgery: cataract or the retinal disease state
Using univariate analysis, we found that logarithm of the minimal angle of resolution (logMAR) VA was significantly correlated with parafoveal flow density in the superficial and deep layers; superficial and deep foveal avascular zone (FAZ) areas; parafoveal retinal thickness of internal limiting membrane (ILM)–inner plexiform layer (IPL) and of IPL–retinal pigment epithelium (RPE); and inner segment ellipsoid band (ISe) length (P < 0.001, r = 0.56; P < 0.001, r = −0 .72; P < 0.001, r = 0.51; P = 0.001, r = 0.39; P < 0.001, r = −0 .54; P = 0.002, r = −0 .37; P < 0.001, r = −0 .58, respectively), but not with age and blood flow area rate of the choriocapillaris layer (P = 0.17 and P = 0.07, respectively)
We confirmed that the factors strongly associated with VA in RP patients were the parafoveal flow density in the deep layer and the superficial FAZ area
Summary
Ophthalmologists sometimes face difficulties in identifying the origin of visual acuity (VA) loss in an RP patient before cataract surgery: cataract or the retinal disease state. To overcome these difficulties, ophthalmologists have been seeking preoperative factors that might predict VA following cataract surgery. No studies have analysed the correlation between visual function and retinal blood flow of the individual retinal layers in RP patients. A study using OCTA found that retinal blood flow density was lower in RP patients than in controls;[17] the sample size was small (14 patients), and the investigators did not evaluate consecutive RP patients. The correlation between VA and retinal blood flow per retinal layer has not been investigated in RP patients
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