Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants

Ruth E. Hogg*, David M. Wright, Rosa Dolz-Marco, Calum Gray, Nadia Waheed, Michel Teussink, Timos K. Naska, Jennifer Perais, Radha Das, Nicola Quinn, George Bontzos, Constantinos Nicolaou, Kaushik Annam, Ian Young, Frank Kee, Bernadette McGuinness, Gareth McKay, Dr Tom Macgillivray, Usha Chakravarthy

*Corresponding author for this work

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Abstract

Purpose
To describe the differences in a range of quantitative OCT angiography (OCTA) metrics across early stages of diabetic retinopathy (DR), providing robust effect estimates as well as sensitivity and specificity.

Design
Cross-sectional study with population-based sampling.

Participants
Four hundred forty-one eyes from 296 individuals: 328 control eyes (no diabetes mellitus [DM] and no DR), 55 eyes with DM and no DR, and 58 eyes with early nonproliferative DR.

Methods
Multimodal retinal imaging included color fundus photography, color Optomap ultra-widefield imaging, and spectral-domain OCT (Spectralis OCT2; Heidelberg Engineering GmbH) with the OCTA module. All images were graded for the presence and severity of DR features. OCTA images were assessed manually for inclusion based on quality. Binary OCTA metrics were assessed after 3-dimensional projection artifact removal including from the nerve fiber layer vascular plexus, superficial vascular plexus (SVC), and deep vascular plexus (DVC) by Early Treatment Diabetic Retinopathy Study (ETDRS) grid, foveal avascular zone (FAZ) area, FAZ minimum and maximum diameter, perimeter length, and circularity.

Main Outcome Measures
Diabetes mellitus and DR status and presence or absence of DR in the retinal periphery.

Results
The reduction in vessel densities in participants with DM and manifest DR compared with control participants tended to be twice that of those with DM, but no DR, compared with control participants. Some evidence of spatial heterogeneity in vessel reductions was found in those yet to develop DR, whereas those with manifest DR had significant reductions across the ETDRS grid. The FAZ perimeter and circularity were impacted most significantly by DM, and those with DR showed decreased multispectral fractal dimensions compared with control participants. Eyes with peripheral DR had reduced vessel density compared with those with DM and no DR only in the superior outer, temporal inner, and temporal outer regions in the DVC and SVC. The area under the receiver operating characteristic curve ranged between 0.48 and 0.73.

Conclusions
Significant differences in OCTA metrics can be found in those with DM before manifest DR using commercially available equipment with minimal image postprocessing. Although diagnostic performance was poor, these metrics may be useful for measuring change over time in clinical trials.
Original languageEnglish
Article number100030
JournalOphthalmology Science
Volume1
Issue number2
Early online date25 May 2021
DOIs
Publication statusPublished - 01 Jun 2021

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