Neural Retinal Disorganization as a Robust Marker of Visual Acuity in Current and Resolved Diabetic Macular Edema

Abstract

Despite treatment advances, diabetic eye disease remains a leading cause of visual acuity (VA) loss worldwide. No methods to prospectively determine which patients will gain or lose vision exist, limiting individualized risk assessment and management. We investigated whether noninvasive, readily obtainable spectral domain optical coherence tomography parameters were correlated with VA in eyes with current or resolved center-involved diabetic macular edema (DME). Images were evaluated for disorganization of the retinal inner layers (DRIL), cysts, epiretinal membranes, microaneurysms, subretinal fluid, and outer layer disruption/reflectivity. DRIL affecting ≥50% of the 1-mm central retinal zone was associated with worse VA in all eyes, eyes with current edema, and eyes with resolved edema. Furthermore, early 4-month change in DRIL extent predicted VA change from baseline to 1 year. These data suggest that DRIL is a robust predictor of VA in eyes with present or previous DME and more highly correlated with VA than other widely used measures, such as retinal thickness. If further studies confirm DRIL as a predictive biomarker of future VA, physicians would gain a new tool of substantial clinical and investigative importance that could significantly change the approach to ophthalmic counseling and therapeutic management in patients with diabetes.

Disorganization of the Retinal Inner Layers after Anti-VEGF Treatment for Macular Edema due to Branch Retinal Vein Occlusion

“…The extent of ELM disruption, EZ disruption, and DRIL in each of the 3 scans was measured, and the average measurement was used for statistical analysis. As previously reported [3, 4], DRIL was defined as the horizontal extent in micrometers over which any boundary between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer could not be identified (Fig. 2).…”

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

“…DRIL that constituted more than 50% of the central millimeter on OCT was associ- ated with a worse BCVA score in current and resolved edema; DRIL was able to predict a worse change in BCVA score until the end of the first year of treatment if it occurred in the first 4 months of treatment [39] ( Fig. 5 ).…”

Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

“…OCT allows quantitative measurements of retinal thickness, as well as evaluation of morphologic changes in eyes with DR and DME. Potential neuroretinal biomarkers of visual acuity in eyes with DME based on OCT imaging have been suggested, including ganglion cell layer thinning, disorganization of the retinal inner layers, and photoreceptor disruption, although further validation is needed (44)(45)(46)(47). Recently, the technique of OCT angiography has also been utilized to create high-resolution perfusion maps of the central retinal vasculature (48).…”