Macular Choroidal Thickness and the Risk of Referable Diabetic Retinopathy in Type 2 Diabetes: A 2-Year Longitudinal Study

Abstract

Purpose The purpose of this study was to evaluate the associations between choroidal thickness (CT) and the 2-year incidence of referable diabetic retinopathy (RDR). Methods This was a prospective cohort study. Patients with type 2 diabetes in Guangzhou, China, aged 30 to 80 years underwent comprehensive examinations, including standard 7-field fundus photography. Macular CT was measured using a commercial swept-source optical coherence tomography (SS-OCT) device (DRI OCT Triton; Topcon, Tokyo, Japan). The relative risk (RR) with 95% confidence intervals (CIs) was used to quantify the association between CT and new-onset RDR. The prognostic value of CT was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results A total of 1345 patients with diabetes were included in the study, and 120 (8.92%) of them had newly developed RDR at the 2-year follow-up. After adjusting for other factors, the increased RDR risk was associated with greater HbA1c (RR = 1.35, 95% CI = 1.17–1.55, P < 0.001), higher systolic blood pressure (SBP; RR = 1.02, 95% CI = 1.01–1.03, P = 0.005), lower triglyceride (TG) level (RR = 0.81, 95% CI = 0.69–0.96, P = 0.015), presence of diabetic retinopathy (DR; RR = 8.16, 95% CI = 4.47–14.89, P < 0.001), and thinner average CT (RR = 0.903, 95% CI = 0.871–0.935, P < 0.001). The addition of average CT improved NRI (0.464 ± 0.096, P < 0.001) and IDI (0.0321 ± 0.0068, P < 0.001) for risk of RDR, and it also improved the AUC from 0.708 (95% CI = 0.659–0.757) to 0.761 (95% CI = 0.719–0.804). Conclusions CT thinning measured by SS-OCT is an early imaging biomarker for the development of RDR, suggesting that alterations in CT play an essential role in DR occurrence.

Longitudinal Changes in Choroidal Structure Following Repeated Low-Level Red-Light Therapy for Myopia Control: Secondary Analysis of a Randomized Controlled Trial

“…In terms of the proportional increase in choroidal structure, we demonstrate 11.54% increase in LA, 7.91% increase in SA, 10.26% increase in TCA, and 1.05% increase in CVI over 12 months in the RLRL group as compared with the control group. Given the fact that previous studies have demonstrated that the choroid was 16% thinner among the patients who developed diabetic retinopathy in comparison with who did not in a 2-year follow-up study 40 and 32% thinner among those who developed macular atrophy in comparison with who did not among treatment-naive neovascular age-related macular degeneration patients in an 18month follow-up study, 41 an overall 10% increase in LA and TCA observed after RLRL therapy would likely provide significant clinical benefits to other ocular diseases such as diabetic retinopathy and age-related macular degeneration if a similar level of increase in choroidal thickness and lumen area can be achieved in both children and adults.…”

Association of Hypertension Defined by the 2017 ACC/AHA Guideline and Choroidal Thickness Changes in Type 2 Diabetes: A 2-Year Longitudinal Study

“…Further, our previous longitudinal studies of the same population have revealed an accelerated decline trend of macular CT with the progression of diabetes in two years follow-up, however, these studies adjusted HTN as a confounder or excluded participants with uncontrolled HTN 19,28 . Given the potential pathological impact of HTN on the choroid, we herein considered BP as an independent impact factor and adjusted other possible confounders, nding that stage 2-HTN was associated with a faster macular CT decline rate, especially in males, patients with higher BMI, HbA1C, and shorter duration of diabetes.…”

“…A high-resolution SS-OCT device equipping with a max scanning speed of 100000 A-scans/s and a wavelength of 1050 nm scanning light source was used for choroidal imaging (DRI OCT Triton; Topcon, Tokyo, Japan). The speci c methodology has been elaborated in our previous study 19,20 . Brie y, the macular area was scanned by a 3D Macular Cube 7 × 7 mm scan mode, with a scan density of 512 Ascans × 512 B-scans.…”

Vascular changes of the choroid and their correlations with visual acuity in diabetic retinopathy

“…There was a certain relationship between DR and choroidal thickness (CT) (8). Research conducted by Wang et al (9) revealed that CT plays a crucial role in the development of DR. Optical coherence tomography (OCT), widely recognized as a valuable noninvasive imaging technique, can be utilized for choroid imaging (10). OCT-derived CT has been proposed as a quantitative index for evaluating choroidal structure and function.…”