Optical Coherence Tomographic Angiography in Type 2 Diabetes and Diabetic Retinopathy.

Published on Apr 1, 2017in JAMA Ophthalmology6.198
· DOI :10.1001/JAMAOPHTHALMOL.2016.5877
Daniel Shu Wei Ting21
Estimated H-index: 21
(NUS: National University of Singapore),
Gavin Tan30
Estimated H-index: 30
(NUS: National University of Singapore)
+ 7 AuthorsTien Yin Wong178
Estimated H-index: 178
(NUS: National University of Singapore)
Importance Optical coherence tomographic angiography (OCT-A) is able to visualize retinal microvasculature without the need for injection of fluorescein contrast dye. Nevertheless, it is only able to capture a limited view of macula and does not show leakage. Objectives To evaluate the retinal microvasculature using OCT-A in patients with type 2 diabetes as well as the association of OCT-A characteristics with diabetic retinopathy (DR) and systemic risk factors. Design, Setting, and Participants A prospective, observational study was conducted from January 1 to June 30, 2016, at medical retina clinics at the Singapore National Eye Center among 50 patients with type 2 diabetes with and without DR (n = 100 eyes). We examined the retinal microvasculature with swept-source OCT-A and a semiautomated software to measure the capillary density index (CDI) and fractal dimension (FD) at the superficial vascular plexus (SVP) and deep retinal vascular plexus (DVP). We collected data on histories of patients’ glycated hemoglobin A 1c , hypertension, hyperlipidemia, smoking, and renal impairment. Main Outcomes and Measures The CDI and FD at the SVP and DVP for each severity level of DR and the association of systemic risk factors vs the CDI and FD. Results The mean (SD) glycated hemoglobin A 1c of the 50 patients (26 men and 24 women; 35 Chinese; mean [SD] age, 59.5 [8.9] years) was 7.9% (1.7%). The mean (SD) CDI at the SVP decreased from 0.358 (0.017) in patients with no DR to 0.338 (0.012) in patients with proliferative DR ( P P  = .04). The mean (SD) FD at the SVP increased from 1.53 (0.05) in patients with no DR to 1.60 (0.05) in patients with proliferative DR ( P P  = .02). For systemic risk factors, hyperlipidemia (odds ratio [OR], 9.82; 95% CI, 6.92-11.23; P P P  = .05) were associated with reduced CDI, while increased glycated hemoglobin A 1c (≥8%) (OR, 8.77; 95% CI, 5.23-10.81; P P Conclusions and Relevance Optical coherence tomographic angiography is a novel imaging modality to quantify the retinal capillary microvasculature in patients with diabetes. It can be potentially used in interventional trials to study the effect of systemic risk factors on the microvasculature that was previously not accessible in a noninvasive manner. The relevance of these findings relative to visual acuity, however, remains largely unknown at this time.
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