Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema—A novel OCT based imaging biomarker

Gupta, Charu; Tan, Roy; Mishra, Chitaranjan; Khandelwal, Neha; Raman, Rajiv; Ramasamy, Kim; Agrawal, Rupesh; Sen, Parveen

doi:10.1371/journal.pone.0207435

Cited by 65 publications

(68 citation statements)

References 30 publications

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“…In Gupta et al, we found that hypertensive patients had thinner choroid compared to non-hypertensive patients in the diabetic group. However, CVI was not affected by hypertension [17]. Moreover, in almost all studies mentioned in this article that investigated CVI, there was a significant decrease in CVI with worsening DR.…”

Section: In Diabetic Patients With and Without Dr Or Mementioning

confidence: 64%

“…Patients with hypertension were significantly found to have thinner SFCT when compared with non-hypertensive patients (319.0±54.6 μm vs. 354.0±48.8μm (P=0.01)). The presence of hypertension did not affect CVI [17].…”

Section: Studies Showing Increasing Ct In Dm Patients or With Worsenimentioning

confidence: 72%

“…contains some general information about the studies reviewed in this article. Endo et al,Wang and Tao, Gupta et al,Rewbury et al, Ohara et al, Tan et al, Hua et al, Kim et al, Sudhalkar et al, Totan et al., Gerendas et al, Lee et al, Adhi et al, Regatieri et al, and Gołębiewska et al evaluated CT measurements and some of these studies also evaluated CVI in diabetic patients with and without DR as described inTable 2[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Kim et al only investigated for CVI in these patients[29].…”

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confidence: 99%

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Choroidal Changes in Diabetic Patients With Different Stages of Diabetic Retinopathy

Hamadneh

Aftab

Sherali

et al. 2020

Cureus

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Diabetic retinopathy (DR) is one of the long-term microvascular complications of diabetes mellitus (DM) and is considered a leading cause of vision loss worldwide. Chronic hyperglycemia can cause microvascular abnormalities to the retina and the choroid as well. The vascular tissue of the choroid supplies blood to the outer retina, photoreceptors, and retinal pigment epithelium. It plays an important role in the metabolic exchange of the retina. Many experimental studies reported that choroidal pathology in diabetic patients might play a role in developing DR. Choroidal thickness (CT) can reflect changes in the vasculature of the choroid and can be used to assess the vascularity of the choroid itself. CT differs between healthy and diseased states of the eye as well as with the aging process. This means that thinner or thicker choroid may indicate an ocular disease. Choroidal vascularity index (CVI) is also used as a marker for choroidal vascularity assessment and indirectly measures choroidal vascularity quantitatively. Many studies have been conducted to evaluate the choroid in many different ocular diseases. However, the results regarding CT in DM, especially in patients with DR, are various as thickened, thinned, or no changes. Thus, the status of the choroid in patients with DM with or without DR remains controversial between researchers. In this systematic review, we reviewed 18 articles that were done to investigate the relationship between structural choroidal changes in diabetic patients with different stages of DR, focusing on CT, CVI, and some other parameters evaluating choroidal changes.

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Section: In Diabetic Patients With and Without Dr Or Mementioning

confidence: 64%

Section: Studies Showing Increasing Ct In Dm Patients or With Worsenimentioning

confidence: 72%

mentioning

confidence: 99%

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Choroidal Changes in Diabetic Patients With Different Stages of Diabetic Retinopathy

Hamadneh

Aftab

Sherali

et al. 2020

Cureus

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“…However, they analyzed a smaller group of 38 eyes. Gupta et al 25 and Kim et al 36 showed that CVI was significantly decreased in eyes with worsening DR and DME compared with controls. Our current study demonstrated that patients with diabetes with a disease duration of more than 5 years had a decreased subfoveal CVI of Sattler's layer compared with those with shorter disease duration.…”

Section: Resultsmentioning

confidence: 99%

Decrease in Choroidal Vascularity Index of Haller’s layer in diabetic eyes precedes retinopathy

Foo

Gupta

Nguyen

et al. 2020

BMJ Open Diab Res Care

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IntroductionThe study aimed to evaluate Choroidal Vascularity Index (CVI) of Haller’s and Sattler’s layers and their relationships with choroidal and retinal thickness, volumes measured on enhanced depth imaging–optical coherence tomography (OCT) scans in the eyes of patients without diabetes, patients with diabetes with no diabetic retinopathy (DR) and patients with diabetes and DR.Research design and methodsRetrospective analysis of 165 eyes from 84 Singapore Indian Eye Study-2 study participants (group 1: no diabetes, group 2: diabetes with no DR and group 3: with DR). Groups 1 and 2 were matched by age and gender from group 3.ResultsIn the eyes of patients with diabetes without DR, the macular CVI of Haller’s but not Sattler’s layer was significantly reduced compared with eyes of patients without diabetes. Eyes with >5 years of diabetes have significantly decreased CVI of Sattler’s layers (mean difference=0.06 ± 0.10, p=0.04) and also decreased subfoveal choroidal volume (mean difference=0.89 ± 0.16 mm3, p=0.02), compared with those with ≤5 years of diabetes.ConclusionDiabetic eyes without DR had significantly lower CVI of macular Haller’s layer than those of healthy controls. With a longer duration of diabetes, CVI of subfoveal Sattler’s layer and choroidal volume continue to decrease, irrespective of diabetic control, suggesting that early diabetic choroidopathy mainly affects larger choroidal veins initially before medium-sized arterioles. The CVI of macular Haller’s layer could potentially be used as a marker on spectral domain OCT imaging in newly diagnosed patients with diabetes for the onset of DR and as a possible prognostication tool in diabetic eyes. Future prospective longitudinal studies in diabetic eyes would be useful in establishing the relationship between CVIs of Haller’s and Sattler’s layer with visual acuity as a marker of photoreceptor health and visual prognosis.

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“…Gupta and associates analyzed the structural choroidal changes occurring in patients with DR, concluding that subfoveal CT and CVI are dynamic parameters affected by diabetic macular edema [73]. Unlike CVI, subfoveal CT is also affected by ocular and systemic factors like edema and hypertension [73].…”

Section: In Diabetic Retinopathymentioning

confidence: 99%

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

Iovino

Pellegrini

Bernabei

et al. 2020

JCM

167

128

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Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented.

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Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema—A novel OCT based imaging biomarker

Cited by 65 publications

References 30 publications

Choroidal Changes in Diabetic Patients With Different Stages of Diabetic Retinopathy

Choroidal Changes in Diabetic Patients With Different Stages of Diabetic Retinopathy

Decrease in Choroidal Vascularity Index of Haller’s layer in diabetic eyes precedes retinopathy

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

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