A Central Role for Ischemia and OCTA Metrics to Follow DR Progression

Cunha‐Vaz, José

doi:10.3390/jcm10091821

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…These examinations are easy to perform and can be repeated easily without major inconvenience to the patient. This study confirms their value for improved characterization of individual disease progression allowing better identification of eyes at risk for progression and development of vision-threatening complications [14,16]. The characterization of specific phenotypes is also an essential step when looking for genotype characterization of the eyes at risk [23].…”

Section: Discussionsupporting

confidence: 67%

“…Retinal neurodegeneration appears to function as a trigger for the deficient microvascular response and development of microvascular closure in phenotype C and for the alteration of the blood-retinal barrier and edema (increased CRT) that characterizes phenotype B. The differ- ent phenotypes appear, indeed, to be the result of a different microvascular response in different patients to the neurodegenerative changes occurring in the retina as a result of chronic hyperglycemia and diabetes [14]. Phenotype C is characterized by more advanced microvascular changes well identified by OCTA metrics.…”

Section: Discussionmentioning

confidence: 99%

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Characterization of 2-Year Progression of Different Phenotypes of Nonproliferative Diabetic Retinopathy

et al. 2022

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Introduction: To characterize the two-year progression of risk phenotypes of nonproliferative diabetic retinopathy (NPDR) in type 2 diabetes (T2D) Phenotype C, or ischemic phenotype, identified by decreased skeletonized retinal vessel density (VD), ≥ 2 SD over normal values, and Phenotype B, or edema phenotype, identified by increased retinal thickness, i.e. subclinical macular edema, and no significant decrease in VD. Methods: A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with 4 visits (baseline, 6-months, one-year and two-year). Ophthalmological examinations included best corrected visual acuity, color fundus photography (CFP) and optical coherence tomography (OCT) and OCT Angiography. Early Treatment Diabetic Retinopathy Study grading was performed at the baseline and last visits based on 7-fields CFP. Results: One hundred and twenty-two eyes from T2D individuals with NPDR fitted in the categories of phenotype B and C and completed the two-years follow-up. Sixty-five (53%) of the eyes were classified as phenotype B and 57 (47%) eyes as phenotype C. Neurodegeneration represented by thinning of the ganglion cell layer and inner plexiform layer was present in both phenotypes and showed significant progression over the two-year period (p<0.001). In phenotype C, significant progression in the two-year period was identified in decreased skeletonized VD (p=0.01), whereas in phenotype B microvascular changes involved preferentially decreases in perfusion density (PD, p=0.012). Phenotype B with changes in VD and PD (flow) and preferential involvement of the deep capillary plexus (p<0.001) is associated with development of center-involved macular edema. Discussion: In the two-year period of follow-up both phenotypes B and C showed progression in retinal neurodegeneration, with changes at the microvascular level characterized by decreases in PD in phenotype B and decreases in VD in phenotype C.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Characterization of 2-Year Progression of Different Phenotypes of Nonproliferative Diabetic Retinopathy

et al. 2022

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“…This capillary nonperfusion appears to be the precursor alteration that leads to collateral formation and development of the thoroughfare channels proposed by Cogan and Kuwabara [ 20 ]. These microvascular changes lead to progressive increase in the areas of retinal nonperfusion which characterize the ischemic phenotype associated with progression to the major vision-threatening complications of diabetes [ 21 ]. Retinal capillary nonperfusion of the SCP in preclinical retinopathy may therefore be the biomarker that identifies the eyes at risk of progression to clinical retinopathy and potential vision loss.…”

Section: Discussionmentioning

confidence: 99%

Retinal Capillary Nonperfusion in Preclinical Diabetic Retinopathy

Santos,

Almeida

et al. 2023

Ophthalmic Res

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Introduction: To identify retinal microvascular changes using optical coherence tomography angiography (OCTA) in type 2 diabetic (T2D) patients with preclinical retinopathy identified by Ultra-Widefield Fundus Photography (UWF-FP). Methods: A cross-sectional observational study. All patients underwent UWF-FP 200° examinations with OPTOS California (Optos, Dunfermline, UK) and Cirrus AngioPlex® spectral-domain (SD)-OCT Angiography 3x3mm acquisitions (ZEISS, Dublin, CA, USA). The absence of visible lesions was identified using UWF-FP. Results: One hundred ninety-three eyes of individuals with T2D with no visible lesions in the fundus and identified in a screening setting were included in the study. Skeletonized vessel density (SVD), perfusion density (PD) and areas of capillary nonperfusion (CNP) values on SD-OCTA were significantly decreased when compared with healthy population (p<0.001). SVD and CNP values of the superficial capillary plexus (SCP) were more frequently decreased (35% and 45%, respectively) than SVD values of the deep capillary plexus (DCP) (9% and 15%), demonstrating that diabetic microvascular changes occur earlier in the SCP than in the DCP. The ischemic phenotype, identified by a definite decrease in SVD or CNP in the SCP may, therefore, be identified in the preclinical stage of diabetic retinal disease. Conclusions: Retinal capillary nonperfusion detected by OCTA metrics of SVD and CNP can be identified in the central retina in eyes with T2D before development of visible lesions in the retina. Our findings confirm the relevance of OCTA to identify macular microvascular changes in the initial stages of DR allowing the identification of its ischemic phenotype very early in the disease process.

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Zone-wise examination of optical coherence tomography features and their correspondence to multifocal electroretinography in eyes with nonproliferative diabetic retinopathy

Srinivasan

Sivaprasad

Munusamy

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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A Central Role for Ischemia and OCTA Metrics to Follow DR Progression

Abstract: Diabetic retinopathy (DR) is a frequent complication of diabetes and through its vision-threatening complications, i [...]

Cited by 5 publications

References 14 publications

Characterization of 2-Year Progression of Different Phenotypes of Nonproliferative Diabetic Retinopathy

Characterization of 2-Year Progression of Different Phenotypes of Nonproliferative Diabetic Retinopathy

Retinal Capillary Nonperfusion in Preclinical Diabetic Retinopathy

Zone-wise examination of optical coherence tomography features and their correspondence to multifocal electroretinography in eyes with nonproliferative diabetic retinopathy

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