Retinal Vascular Caliber Association with Nonperfusion and Diabetic Retinopathy Severity Depends on Vascular Caliber Measurement Location

Ashraf, Mohamed; Shokrollahi, Siamak; Pisig, Alex Umali; Sampani, Konstantina; AbdelAl, Omar; Cavallerano, Jerry D.; Robertson, Gavin; Fleming, Alan; Hemert, Jano van; Pitoc, Cloyd M.; Sun, Jennifer K.; Aiello, Lloyd Paul; Silva, Paolo S.

doi:10.1016/j.oret.2020.09.003

Cited by 8 publications

(7 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study using UWF-CI explored the association of retinal nonperfusion index (NPI) and DR severity with the location of vascular caliber measurements [ 36 ]. Using a previously validated semi-automated software (OptomapAVR, Optos plc, Dunfermline, UK), measurements were done in two zones: an inner zone 1–1.5 optic disc diameters (DD) from the optic disc center which represented more central vascular calibers and an outer zone 3.25–4.25 DD from the optic disc center representing more peripheral vasculature.…”

Section: Arteriolar and Venular Diametersmentioning

confidence: 99%

“…Many of the studies quantifying nonperfusion on UWF-FA have used non-steered on-axis images [ 23 , 36 , 43 , 44 ]. An important finding in the study by Rageh et al was that nasal, superior, and inferior steering may be needed for more accurate quantification of NPI given the limited visibility of far peripheral retina on non-steered images [ 47 ].…”

Section: Retinal Nonperfusionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ashraf

Cavallerano

Sun

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Ultrawide field imaging (UWF) has allowed the visualization of a significantly greater area of the retina than previous standard approaches. In diabetic retinopathy (DR), significantly more lesions are seen on UWF imaging compared to the seven-standard ETDRS fields. In addition, some eyes have lesions that are located predominantly in the peripheral retina that are associated with an increased risk of DR progression. The current DR severity scales are still largely based on clinically visible retinal microvascular lesions and do not incorporate retinal periphery, neuroretinal, or pathophysiologic changes. Thus, current scales are not well suited for documenting progression or regression in eyes with very early or advanced DR, nor in the setting of vascular endothelial growth factor inhibitors (antiVEGF). In addition, the categorical system is highly subjective, and grading is variable between different graders based on experience level and training background. Recently, there have been efforts to quantify DR lesions on UWF imaging in an attempt to generate objective metrics for classification, disease prognostication and prediction of treatment response. The purpose of this review is to examine current quantitative metrics derived from UWF fluorescein angiograms and UWF color imaging to determine their feasibility in any potential future DR classification.

show abstract

Section: Arteriolar and Venular Diametersmentioning

confidence: 99%

Section: Retinal Nonperfusionmentioning

confidence: 99%

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ashraf

Cavallerano

Sun

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although the majority of eyes had concordant determination of PPL on color and FA images, a substantial minority of 36% had disparate gradings for PPL on these 2 imaging modalities. As shown in previous work, the use of UWF-FA identifies substantially more DR lesions than UWF-color . UWF-FA identifies 3- to 5-fold more microaneurysms, with 37.5% of eyes having more severe DR on UWF-FA vs UWF-color imaging .…”

Section: Discussionmentioning

confidence: 94%

Association of Predominantly Peripheral Lesions on Ultra-Widefield Imaging and the Risk of Diabetic Retinopathy Worsening Over Time

et al. 2022

Self Cite

View full text Add to dashboard Cite

ImportanceUltra-widefield (UWF) imaging improves the ability to identify peripheral diabetic retinopathy (DR) lesions compared with standard imaging. Whether detection of predominantly peripheral lesions (PPLs) better predicts rates of disease worsening over time is unknown.ObjectiveTo determine whether PPLs identified on UWF imaging are associated with increased disease worsening beyond the risk associated with baseline Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale (DRSS) score.Design, Setting, and ParticipantsThis cohort study was a prospective, multicenter, longitudinal observational study conducted at 37 US and Canadian sites with 388 participants enrolled between February and December 2015. At baseline and annually through 4 years, 200° UWF-color images were obtained and graded for DRSS at a reading center. Baseline UWF-color and UWF-fluorescein angiography (FA) images were evaluated for the presence of PPL. Data were analyzed from May 2020 to June 2022.InterventionsTreatment of DR or diabetic macular edema was at investigator discretion.Main Outcomes and MeasuresPredominantly peripheral lesions were defined as DR lesions with a greater extent outside vs inside the 7 standard ETDRS fields. Primary outcome was disease worsening defined as worsening 2 steps or more on the DRSS or receipt of DR treatment. Analyses were adjusted for baseline DRSS score and correlation between 2 study eyes of the same participant.ResultsData for 544 study eyes with nonproliferative DR (NPDR) were analyzed (182 [50%] female participants; median age, 62 years; 68% White). The 4-year disease worsening rates were 45% for eyes with baseline mild NPDR, 40% for moderate NPDR, 26% for moderately severe NPDR, and 43% for severe NPDR. Disease worsening was not associated with color PPL at baseline (present vs absent: 38% vs 43%; HR, 0.78; 95% CI, 0.57-1.08; P = .13) but was associated with FA PPL at baseline (present vs absent: 50% vs 31%; HR, 1.72; 95% CI, 1.25-2.36; P &lt; .001).Conclusions and RelevanceAlthough no association was identified with color PPL, presence of FA PPL was associated with greater risk of disease worsening over 4 years, independent of baseline DRSS score. These results suggest that use of UWF-FA to evaluate retinas peripheral to standard ETDRS fields may improve the ability to predict disease worsening in NPDR eyes. These findings support use of UWF-FA for future DR staging systems and clinical care to more accurately determine prognosis in NPDR eyes.

show abstract

“…However, this study did not delineate the relationship between the measure of obesity variability and each microvascular outcome separately. Another 5-year prospective study explored the relationship of longitudinal BMI variability with retinal changes using a sample of Chinese adults, and found a significant relationship between rising BMI trend and retinal microvascular changes, but did not find any significant relationship between BMI variability and retinal vascular caliber [ 13 ], (a potential biomarker for the development and progression of retinopathy) [ 32 ]. However, this study was not on a sample with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial

Hukportie¹,

Li²,

Zhou³

et al. 2022

Diabetes Metab J

View full text Add to dashboard Cite

Background: Obesity is associated with adverse health events among diabetic patients, however, the relationship between obesity fluctuation and risk of microvascular complications among this specific population is unclear. We aimed to examine the effect of waist circumference (WC) and body mass index (BMI) variability on the risk of diabetic microvascular outcomeMethods: Annually recorded anthropometric data in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was used to examine the association of WC and BMI variability defined as variability independent of mean, with the risk of microvascular outcomes, including neuropathy, nephropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) (Trial registration: ClinicalTrials.gov., no. NCT00000620).Results: There were 4,031, 5,369, and 2,601 cases of neuropathy, nephropathy, and retinopathy during a follow-up period of 22,524, 23,941, and 23,850 person-years, respectively. Higher levels of WC and BMI variability were associated with an increased risk of neuropathy. Compared with the lowest quartile, the fully-adjusted HR (95% CI) for the highest quartile of WC and BMI variability for neuropathy risk were 1.21 (1.05 to 1.40) and 1.16 (1.00 to 1.33), respectively. Also, higher quartiles of BMI variability but not WC variability were associated with increased risk of nephropathic events. The fully-adjusted HR (95% CI) for the highest quartile compared with the lowest quartile of BMI variability was 1.31 (1.18 to 1.46). However, the results for retinopathic events were all insignificant.Conclusion: Among participants with type 2 diabetes mellitus, WC and BMI variability were associated with a higher risk of neuropathic events, whereas BMI variability was associated with an increased risk of nephropathic events.

show abstract

Retinal Vascular Caliber Association with Nonperfusion and Diabetic Retinopathy Severity Depends on Vascular Caliber Measurement Location

Cited by 8 publications

References 35 publications

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Association of Predominantly Peripheral Lesions on Ultra-Widefield Imaging and the Risk of Diabetic Retinopathy Worsening Over Time

Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial

Contact Info

Product

Resources

About