Early Treatment Diabetic Retinopathy Study Areas Research Articles

Changes in choroidal and retinal thickness assessed by optical coherence tomography in type 2 diabetes mellitus patients with moderate diabetic retinopathy

AbstractPurpose: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) without diabetic macular edema (DME) and to correlate with changes in retinal thickness (RT) with swept source OCT (SS‐OCT)) compared to healthy subjects.Methods: Fifty‐four DM2 patients with moderate DR without DME and 73 age‐matched healthy subjects were evaluated using SS‐OCT to measure changes in total RT and the CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid.Results: The mean ages were 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Visual acuity (VA) with ETDRS 100% was lower in the DM2 patients (p < 0.001). In the total RT, statistically significant differences were found in the temporal inner area being thicker thickness in the DM2 group (260.70 ± 19.22 μm vs. 271.90 ± 37.61 μm with p = 0.010, in control and DM2 group, respectively). The CT did not show significant differences between both groups (p > 0.05) in any ETDRS area. There was a significant negative correlation between RT and age in all of the external ETDRS areas and a positive significant correlation in the central area for DM2 group. There was also a negative significant correlation between CT and age in all ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner: p = 0.028, central: p = 0.039 and nasal inner: p = 0.003).Conclusions: DM2 patients with moderate DR have no changes in CT. CT and RT decrease with age and show a negative correlation with RT in the central and horizontal parafoveal areas of the ETDRS grid.

Choroidal Differences between Spectral and Swept-source Domain Technologies

ABSTRACT Purpose of the study To assess differences in healthy eyes in volume (CV) and choroidal thicknesses (CT) across all macular Early Treatment Diabetic Retinopathy Study (ETDRS) areas measured by swept source (SS)-OCT and spectral domain (SD)-OCT with enhanced depth imaging (EDI). Materials and Methods One hundred and fifty healthy eyes were studied in patients aged between 21–68 years. All of these patients underwent an ophthalmic examination that included axial length (AL), a fast macula protocol with EDI by Spectralis SD-OCT, and a 3D macular cube by DRI-Triton SS-OCT. CT and CV values were measured after a manual segmentation with SD-OCT and automatically with SS-OCT. Results The values obtained by SD-OCT were statistically higher than the values obtained by SS-OCT in all ETDRS areas. To determine the differences that were related to total CV or AL, the eyes were divided depending on their total CV and AL values into two groups. There were persistent differences between the two devices that were not related to the total CV. In subjects with a higher AL, these differences were not present in either the total CV or the subfoveal CT. In longer eyes, the differences diminished, and there were no statistical differences between the devices in the subfoveal area, temporal quadrants, inferior inner ring, or CV. Conclusions The choroidal values obtained with the SD-OCT are statistically higher than those measured by SS-OCT. Both techniques are able to clearly visualize the choroidoscleral interface and provide different values that are highly correlated. These differences are smaller in eyes with a longer AL and are not related to the total CV.

Neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography

BackgroundSystemic lupus erythematosus (SLE) is a chronic, autoimmune and multisystemic disease. Recent studies with functional and structural magnetic resonance imaging and cognitive tests report an unexpectedly high frequency of central nervous system involvement, even in patients with asymptomatic SLE. The purpose of this study was to identify early signs of retinal neurodegeneration by comparing the thickness of the peripapillary retinal nerve fiber layer (pRNFL) and all macular layers between patients with SLE without ophthalmologic manifestations and healthy controls. The effect of disease duration and systemic comorbidities was also studied.MethodsCross-sectional study, in which all participants underwent a complete ophthalmologic evaluation including retinal segmentation analysis with spectral domain-optical coherence tomography. Patients with SLE also received a detailed autoimmune disease specialist evaluation to assess the disease activity state and systemic involvement. For pRNFL thickness, the global and six peripapillary sectors were determined. Each macular layer thickness was determined in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. A multiple linear regression analysis was performed to control for the effect of potential demographic, ophthalmic and systemic confounders. A second multivariable analysis, including patients with SLE only, was performed to assess the effect of disease-specific variables on the outcome measures.ResultsSixty-eight eyes of 68 patients with SLE and 50 eyes of 50 healthy controls were considered. The pRNFL was significantly thinner in the SLE group globally (p = 0.026) and in the temporal superior (p = 0.007) and temporal (p = 0.037) sectors. In patients with SLE, chronic medication for hypercholesterolemia, hypertension and anticoagulants were associated with a significant thinning of the pRNFL. Patients with SLE presented significant thinning in the photoreceptor layer in five ETDRS areas (p < 0.05). Shorter disease duration was associated with greater photoreceptor thinning in all ETDRS subfields. Neuropsychiatric SLE, higher disease activity and cardiovascular risk factors were associated with a thinner photoreceptor layer. No differences were observed in overall retinal thickness or the remaining macular layers.ConclusionPatients with SLE present early signs of retinal neurodegeneration, as evidenced by a reduction in the photoreceptor layer and pRNFL. These signs are more pronounced in patients with higher cardiovascular risk burden or neuropsychiatric involvement.

Choroidal Changes of Long-Term Type 1 Diabetic Patients without Retinopathy.

The aim of the study is to assess choroidal thickness (CT) and choroidal volume (CV) in 90 type 1 diabetes mellitus (DM1) patients with no diabetic retinopathy (DR) and 60 control eyes using spectral domain optical coherence tomography (SD-OCT) and swept source (SS)-OCT in the areas of the Early Treatment Diabetic Retinopathy Study (ETDRS). Mean ages were 42.93 ± 13.62 and 41.52 ± 13.05 years in the diabetic and control groups, respectively. Significant differences were obtained between both groups with Spectralis SD-OCT in all ETDRS areas and in the total CV, excluding the temporal perifoveal one. With Triton SS-OCT, statistically significant differences were obtained in the subfoveal CT and in the vertical areas. CT showed the same tendency with both OCTs, with greater CT and CV in the DM1 group than the mean values of the control group. To assess the influence of DM1 evolution in the CT modifications, DM1 patients were divided into Group 1, with less than 24 years of diagnosis, and Group 2, with ≥24 years of DM1 evolution. Using both OCTs, seven of the nine ETDRS areas and the CV had lower values in Group 2. CT and CV measured by OCT were higher in DM1 without DR. There is a choroidal thinning related to disease evolution in DM1. In patients with DM evolution greater than 24 years, the CT is statistically lower than in patients with less evolution of the disease.

Retinal neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography

AbstractPurposeTo find early signs of retinal neurodegeneration by comparing the thickness of peripapillary retinal nerve fiber layer (pRNFL) and of all macular layers between systemic lupus erythematosus (SLE) patients without ophthalmologic manifestations and healthy controls. The effect of disease duration and systemic comorbidities was also studied.MethodsCross‐sectional study, in which retinal segmentation analysis with spectral domain‐optical coherence tomography (SD‐OCT) was performed. For pRNFL thickness, the global and six peripapillary sectors were determined. Each retinal layer thickness was calculated in the nine early treatment diabetic retinopathy study (ETDRS) subfields. Multiple regression analysis was performed.ResultsSixty‐eight eyes of 68 SLE patients and 50 eyes of 50 healthy controls were considered. pRNFL was significantly thinner in the SLE group globally (p = 0.026), in temporal superior (p = 0.007) and temporal (p = 0.037) sectors. Multivariable analysis in the SLE group revealed that chronic medication with antihypertensives, statins and anticoagulants were associated with a thinner pRNFL in some sectors (p &lt; 0.05). SLE patients presented a significant thinning in the photoreceptor (PR) layer in five ETDRS areas (p &lt; 0.05). Shorter disease duration was associated with greater photoreceptor thinning in all ETDRS subfields. Neuropsychiatric SLE, higher disease activity index and cardiovascular risk factors were associated with a thinner PR layer. No differences were observed in the remaining macular layers.ConclusionThis was the first study to perform OCT segmentation analysis of all retinal layers in SLE patients. These patients present a significant reduction in pRNFL and macular PR layer thickness. These differences were more pronounced in patients with poor systemic disease control, neuropsychiatric SLE and higher cardiovascular risk burden. Thus, there is evidence for the presence of early signs of retinal neurodegeneration in SLE.

OPTICAL COHERENCE TOMOGRAPHY EVIDENCE ON THE CORRELATION OF CHOROIDAL THICKNESS AND AGE WITH VASCULARIZED RETINAL LAYERS IN NORMAL EYES.

To correlate choroidal thickness (CT) and age with vascularized retinal layer and outer retinal layer thickness in normal eyes. This was a prospective, cross-sectional study. Complete ophthalmological examination, biometry, and enhanced depth imaging spectral domain optical coherence tomography were performed. Choroidal and individual retinal layer thickness measurements were obtained. Thickness maps for all layers were evaluated using the 1 mm, 3 mm, and 6 mm early treatment diabetic retinopathy study (ETDRS) macular grid areas. One hundred and twenty eyes were included. Choroidal thickness correlated negatively with age in all ETDRS areas. The ganglion cell layer (GCL) in the 1 mm; the GCL and inner plexiform layer (IPL) in the 3 mm and 6 mm; and the GCL, IPL, and inner nuclear layer in the 6 mm areas correlated negatively with age and positively with CT. Retinal nerve fiber layer thickness in the 6 mm area correlated negatively with age. The retinal pigment epithelium-photoreceptor layer in all areas correlated negatively with age and positively with CT. In normal subjects, vascularized retinal layer thicknesses and outer retinal layer thickness correlate positively with CT and negatively with age. The role of neuronal versus vascular components should be considered when evaluating individual retinal layer thicknesses.

Changes in macular thickness measurements repeatability with age using Cirrus Fourier‐domain optical coherence

AbstractPurpose To test the intrassession reproducibility of retinal thickness measurements using Cirrus Fourier‐domain optical coherence tomography (OCT). To evaluate if there is any relation between macular measurements repeatability and age of the studied subject.Methods Two hundred and nine of 209 healthy subjects underwent three macular 512x128 volume cube centered on the fovea done by the same experienced examiner using Cirrus HD OCT (Carl Zeiss, USA). Descriptive statistics, analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (COV) were calculated for the 9 macular areas described by the Early Treatment Diabetic Retinopathy Study (ETDRS) in the macular protocol. Values were analysed related to other subject factors like age and VA.Results All measurements were highly reproducible. The ICCs ranged from 0.823 to 0.992 using macular volume cube. Mean COV was 1.4 ±1.09% (ranged from 0.7 to 1.9%) for the nine ETDRS areas. COV values increased with age; a significant correlation was found between them (r=0.300, p≤0.001). COVs were also related to VA.Conclusion Retinal thickness measurements obtained using Cirrus Fourier‐domain OCT show good reproducibility for healthy eyes. Repeatability is related to the subject age.

Macular thickness measurements in macular hole using Fourier domain optical coherence tomography devices

Abstract Purpose To compare new Fourier‐domain optical coherence tomographies (OCT) for measuring retinal thickness in eyes with macular hole (MH). Methods Thirty‐eight eyes from 38 patients diagnosed of MH (17 men and 21 women, aged 51‐ 82 years) without other ophthalmic diseases, were prospective and consecutively studied. All of them underwent a ophthalmic examination including best corrected visual acuity, fundus examination, three Cirrus HD‐OCT (Carl Zeiss Meditec, Inc., Ca, USA) and three Spectralis OCT (Heidelberg Engineering, Germany). Comparisons of OCT measurements were done for the nine macular areas defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Correlations between OCT measures were studied by Pearson test. Results Mean total retinal thicknesses were 347.0 ± 67.78 μm using Cirrus HD and 344.71 ± 43.63 μm with Spectralis OCT. All retinal measurements showed significant differences between the two devices (p&lt;0.05), except in superior and nasal inner ETDRS area. The mean value for retinal thickness measurements was 21.44 µm less using Cirrus HD‐OCT. Cirrus and Spectralis OCT parameters showed good correlations. Conclusion MH eyes evaluated by Cirrus and Spectralis OCT show differences in their macular measurements.

Ability of Fourier domain OCT to evaluate macula in retinitis pigmentosa patients

Abstract Purpose To evaluate the ability of Fourier domain optical coherence tomography (OCT) detecting changes in macular structure and thickness in patients diagnosed of Retinitis Pigmentosa (RP). Methods Thirty‐two eyes of 16 patients with RP and 30 eyes of 30 healthy subjects underwent a complete ophthalmic examination with best corrected visual acuity, 512x128 macular volume cube protocol using Cirrus HD‐OCT (Carl Zeiss Meditec, Inc., USA) and Spectralis OCT (Heidelberg Engineering, Germany). Macular changes as retinal schisis, macular hole (MH), epiretinal membrane (EM), retinal pigment epithelial detachment (PED) or macular drusen, were registered. Comparisons between RP and healthy eyes were done for the nine macular areas defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Results All macular thickness parameters showed a statistically significant decrease in the RP patients (p&lt;0.05, t test). The greater difference with control eyes was observed in the nasal inner ETDRS area (247.54 vs 328.99 µm with Cirrus OCT and 259.65 vs 351.74 µm using Spectralis OCT). Retinal abnormalities found in RP eyes were: 16% retinal schisis, 3.3% MH, 6.6% EM and 3.3% PED. Conclusion Retinal atrophy and structural alterations can be detected in RP patients using Fourier domain OCT.

Macular thickness measurements in epiretinal membrane using Fourier domain optical coherence tomography devices

Abstract Purpose To compare new Fourier‐domain optical coherence tomographies (OCT) for measuring retinal thickness in eyes with idiopatic epiretinal membrane (EM). Methods Forty eyes diagnosed of EM of 40 patients (24 men and 16 women, aged 37 to 81 years) without other ophthalmic diseases, were prospective and consecutively studied. All of them underwent a ophthalmic examination including best corrected visual acuity, fundus examination, three Cirrus HD‐OCT (Carl Zeiss Meditec, Inc., Ca, USA) and three Spectralis OCT (Heidelberg Engineering, Germany). Comparisons of OCT measurements were done for the nine macular areas defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Correlations between OCT measures were studied by Pearson test. Results Mean total retinal thicknesses were 425.36 ± 88.62 μm using Cirrus HD and 440.75 ± 97.02 μm with Spectralis OCT. All retinal measurements showed significant differences between the two devices (p&lt;0.05), except in inferior inner ETDRS area. The mean value for retinal thickness measurements was 15.39 µm less using Cirrus HD‐OCT. Cirrus and Spectralis OCT parameters showed good correlations. Conclusion Epirretinal membrane eyes evaluated by Cirrus and Spectralis OCT show differences in their macular measurements.

Comparison of spectral‐domain Cirrus optical coherence tomography and time‐domain Stratus optical coherence tomography for the evaluation of macular thickness in healthy subjects

Abstract Purpose to compare Cirrus Fourier‐domain optical coherence tomograph (OCT) with Stratus Time‐domain OCT for acquiring retinal images and measuring retinal thickness. Methods Eighty five eyes from 85 healthy subjects, 26 men (30.6%) and 59 women (69.4%), aged 16 to 72 years were prospective and consecutively selected. All of them underwent three macular 512x128 volume cube scans with the Cirrus HD‐OCT system (Carl Zeiss Meditec, Inc.). The average of these three scans was calculated. With the Stratus OCT system (Carl Zeiss Meditec, Inc.) a fast macular scan was recorded. The nine areas corresponding to the Early Treatment Diabetic Retinopathy Study (ETDRS) macular protocol were compared between both devices. The reproducibility of macular thickness measurements using de Cirrus HD‐OCT was studied, and the variation coefficient (COV) of each parameter was assessed. Results Cirrus HD‐OCT macular thickness measurements were approximately 64.22 µm higher than those from Stratus OCT (266.40 µm vs 202.18 µm). The measurements in all nine ETDRS areas were statistically higher using the Cirrus HD‐OCT. Nasal inner area showed the highest value. Retinal thickness measurements using the 512x128 macular cube scan were highly reproducible for the nine ETDRS areas. Mean COV was 1.45 ± 1.11% (ranged from 0.98% to 2.49%). The lowest COV was found for the temporal inner ETDRS area (COV=0.98%) and the highest for the central ETDRS area (COV=2.49%). Conclusion Macular measurements using Cirrus HD‐OCT are clearly higher than those obtained by Stratus OCT.

Repeatability of retinal nerve fiber layer and macular thickness measurements using Cirrus Fourier‐domain optical coherence.

Abstract Purpose To test intrasession, intersession, intervisit, and interoperator reproducibility of retinal nerve fiber layer (RNFL) measurements and retinal thickness using Cirrus Fourier‐domain optical coherence tomography (OCT). Methods Seventy‐two eyes of 72 healthy subjects underwent three macular 512x128 volume cube centered on the fovea and three 360° optic disc circular scans done by the same observer. This sequence was repeted by another observer on a second visit within a 2‐week period. Descriptive statistics, analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (COV) were calculated for the 9 macular areas described by the Early Treatment Diabetic Retinopathy Study (ETDRS) in the macular protocol and for quadrants and RNFL clock hour sectors. Results All measurements were highly reproducible. The ICCs ranged from 0.823 to 0.992 using macular volume cube and from 0.886 to 0.984 with optic disc cube protocol. Mean differences between both operators were lower than 3 μm in all measurements and no significant differences were found. Total retinal thickness mean was 285.17 ±15.31 μm by observer 1 and 284.20 ±12.89 μm by observer 2. Mean COV was 1.2 ±0.99% (ranged from 0.5 to 1.8%) for the nine ETDRS areas. Lowest COV was found for the nasal inner area. Mean RNFL average thickness was 95.99 ±7.67 and 95.72 ±7.87 μm by observer 1 and 2, respectively. Mean COV was 4.41 ±3.01% (ranged from 1.43 to 6.66%). Conclusion Retinal and RNFL thickness measurements obtained using Cirrus Fourier‐domain OCT show good reproducibility for healthy eyes. The device is an important tool for to the diagnosis and follow‐up of retinal and optic nerve pathologies.