Association of Fluorescein Angiographic Features With Visual Acuity and With Optical Coherence Tomographic and Stereoscopic Color Fundus Photographic Features of Diabetic Macular Edema in a Randomized Clinical Trial

Abstract

Background Fluorescein angiography (FA) has been performed as part of the management of diabetic macular edema (DME) for many years. Its current role relative to the role of optical coherence tomography (OCT) is not well defined. Purpose To evaluate the associations of FA features with visual acuity, and with OCT, and fundus photographic characteristics in eyes with DME. Methods In a clinical trial, conducted by the Diabetic Retinopathy Clinical Research Network to compare two methods of laser photocoagulation to treat DME, FA (film and digital), color photographs, OCT, and visual acuity measurements were obtained at baseline and at 1 year. Grading of morphologic features was performed at a reading center. Reproducibility of FAs was assessed and the correlations of FA features with visual acuity, OCT, and color photograph features were computed. Results From 79 clinical sites, data of 323 study eyes and 203 fellow non-study eyes were analyzed. Fluorescein leakage area at baseline was associated with reduced visual acuity, increased OCT measures of retinal thickness and volume, and color photographic measurements of retinal thickening (r = 0.33 – 0.58). No important associations were found with changes from baseline to 12 months in these parameters or with any of the other variables analyzed. Conclusions Fluorescein leakage is associated with visual acuity and some OCT and color photographic variables. We did not identify any unique FA variables that had a stronger association with visual acuity than OCT measures of retinal thickness. These data may be useful to investigators planning future DME clinical trials.

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications

“…This has been a unique and useful feature of FA, even in the era of OCT. Although OCT does not demonstrate leakage, it should be noted that qualitative OCT findings of retinal edema correlate reasonably well with FA leakage in DR (Danis, Scott et al 2010) and AMD. For example, a retrospective study comparing SD-OCT and FA images from 93 eyes of 93 patients with history of neovascular AMD and anti-VEGF treatment showed significant correlation between SD-OCT findings of retinal edema and FA leakage.…”

Clinical Classification of Age-related Macular Degeneration

“…The risk estimate would be modified up or down based on the presence or absence of other known demographic, environmental, or genetic risk factors. 15,16 For example the estimated 5-year risk for a 75-year-old with a simple score of 4 would be lower than 50% for nonsmokers (38%) and higher for smokers (58%). The risk is especially sensitive to age.…”

“…(Note: The historic measurements from film photographs using circle templates have been preserved in this manuscript to avoid confusion with earlier studies, although there has been increasing recognition that the size of the standard disc diameter, rather than the assumed 1500 m, 10 is actually closer to 1800 m based on updated measurements. [15][16][17][18][19] Using the current scaling standards, the size of the 63-m circle traditionally used at reading centers is better estimated as 75 m, whereas that of the 125-m circle is 150 m.) The committee preferred adoption of the most widely used term, AMD, as opposed to ARM or ARMD, and expressed a strong opinion that only 1 term (AMD) should be used.…”

“…The focus of the technique is on the reliability of the expert group's opinion rather than on individuals' opinions. 16 The committee agreed that development of this clinical classification was only a first step and that development of methods to collect detailed phenotype and genotype data systematically will be necessary to segregate AMD phenotypes for research purposes.…”

Advances in the management of diabetic macular oedema based on evidence from the Diabetic Retinopathy Clinical Research Network

“…(7,8) OCT and fundus photograph both provide complementary information and have moderate correlation in assessing retinal thickening in DMO. However, this cannot be a surrogate for VA, (9) as there is a wide range of acuity for a given degree of retinal oedema even following laser treatment.…”