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Microvascular retinal changes in pre-clinical diabetic retinopathy as detected by optical coherence tomographic angiography

  • Retinal Disorders
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Abstract

Purpose

To investigate microvascular abnormalities in diabetic patients without conventional clinical signs of diabetic retinopathy (DR).

Methods

In this cross-sectional observational cohort study, the study group included randomly chosen participants of a community-based cohort with diabetes type 2 without DR, and the control group consisted of non-diabetic individuals from a population-based study. All participants underwent optical coherence tomographic angiography (OCTA).

Results

Upon OCTA, 118 (40.4%) eyes of the study group (n = 292 eyes) showed microvascular abnormalities including foveal avascular zone erosion (95 (32.5%) eyes), non-perfusion areas in the superficial and deep retinal layers (39 (13.4%) eyes and 19 (6.5%) eyes, respectively), and microaneurysms in the superficial and deep retinal layers (22 (7.5%) eyes and 31 (10.6%) eyes, resp.). None of these abnormalities was detected in the control group (n = 80). The study group showed a lower vessel density in the superficial retinal vascular layer in all regions except for the foveal region (P < 0.001), and higher vessel density in the parafoveal region in the deep retinal vascular layer (P = 0.01). Higher diabetes prevalence was associated with lower superficial retinal vascular density (P = 0.005) in multivariable analysis. A lower radial peripapillary capillary flow density was correlated (regression coefficient r, 0.62) with higher fasting blood concentration of glucose (P < 0.001) in multivariable analysis.

Conclusions

OCTA revealed microvascular abnormalities in 40% of eyes of diabetic patients without ophthalmoscopically detectable diabetic fundus changes in a community-based population. The early stage of DR may be re-defined upon OCTA.

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Acknowledgements

The authors would like to thank the support from the Xinjiekou and Jinsong Community Health Service Centers for their assistance of recruiting diabetes participants and the Beijing Communities Diabetes Study for contributing systemic parameters.

Funding

This study was financially supported by the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (code: ZYLX201307), National Natural Science Foundation of China (Nr. 81272981), Beijing Natural Science Foundation (Nr. 7151003), Advanced Health Care Professionals Development Project of Beijing Municipal Health Bureau (No. 2014-2-003), The priming scientific research foundation for the junior research in Beijing Tongren Hospital Capital Medical University (2017-YJJ-ZZL-009 and NO. 2018-YJJ-ZZL-046), and Beijing Municipal Administration of Hospitals Incubating Program (Code: PX2019008).

Author information

Author notes

  1. Jing Yan Yang and Qian Wang contributed equally to this work.

Authors and Affiliations

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, 1 Dong Jiao Min Xiang, Dong Cheng District, Beijing, 100730, China

    Jing Yan Yang, Qian Wang, Yan Ni Yan, Wen Jia Zhou & Wen Bin Wei

  2. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China

    Ya Xing Wang

  3. Cardiology Department, Kailuan General Hospital, Tangshan, China

    Shou Ling Wu

  4. Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Ming Xia Yuan

  5. Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany

    Jost B. Jonas

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  1. Jing Yan Yang
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Corresponding author

Correspondence to Wen Bin Wei.

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The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Medical Ethics Committee of the Beijing Tongren Hospital, and written informed consent was obtained from all study participants, and all methods were performed in accordance with the relevant guidelines and regulations.

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Yang, J.Y., Wang, Q., Yan, Y.N. et al. Microvascular retinal changes in pre-clinical diabetic retinopathy as detected by optical coherence tomographic angiography. Graefes Arch Clin Exp Ophthalmol 258, 513–520 (2020). https://doi.org/10.1007/s00417-019-04590-x

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