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Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy

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Abstract

Aims

To evaluate the effect of early screening with OCTA in type 2 diabetes mellitus (T2DM) patients without clinical DR (NDR).

Methods

This was a cross-sectional case–control clinical study. Eighty-four eyes of 84 patients (44 T2DM and 40 control subjects) were included. Images were obtained using AngioVue software 2.0 of the OCTA device. Foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), choriocapillary flow area (CCF), acircularity index (AI), foveal vessel density in a 300-µm-wide region around FAZ (FD), macular-associated vessel density (VD) and optic disc-associated capillary density (CD) were compared between the T2DM and control groups. In the T2DM group, the correlations between the above parameters and best-corrected visual acuity (BCVA) were assessed.

Results

Enlarged FAZ, increased PERIM, reduced CCF, reduced parafoveal VD and decreased CD inside the disc were significantly more obvious in the NDR subjects than in the control subjects (FAZ 0.43 ± 0.13 versus 0.37 ± 0.08 mm2, p = 0.02; PERIM 2.60 ± 0.45 versus 2.41 ± 0.28 mm, p = 0.04; CCF 1.94 ± 0.28 versus 2.05 ± 0.11 mm2, p = 0.02; superficial parafoveal VD 48.01 ± 3.41 versus 50.74 ± 3.67%, p = 0.003; deep parafoveal VD 51.60 ± 3.52 versus 54.45 ± 4.19%, p = 0.004; CD inside disc 49.75 ± 4.84 versus 53.19 ± 4.04%, p = 0.003). In the NDR subjects, logMAR BCVA (β = − 0.55, p < 0.01) and FAZ (r = − 0.62, p < 0.01) showed a significant negative correlation with superficial total VD, respectively.

Conclusions

Preclinical DR can be detected by OCTA. Parameters such as FAZ, PERIM, CCF, VD and CD may be useful for early detection of microvascular impairments in DM patients with NDR. Superficial VD and FAZ are possible sensitive visual acuity predictors in NDR subjects. OCTA may be a promising non-invasive tool in daily DR screening.

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Acknowledgements

The research was funded by the National Natural Science Foundation of China 81570845 and the Natural Science Foundation of Guangdong Province 2015A030313019. The authors wish to acknowledge Dr. David Huang, Ph.D., Casey Eye Institute, Oregon Health and Science University, who gave an excellent speech in Portland and inspired our research.

Funding

National Natural Science Foundation of China 81570845; Natural Science Foundation of Guangdong Province 2015A030313019.

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Authors and Affiliations

  1. Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510000, People’s Republic of China

    Zijing Li, Mohammad Alzogool, Jianhui Xiao, Si Zhang, Peng Zeng & Yuqing Lan

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  1. Zijing Li
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  2. Mohammad Alzogool
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Correspondence to Yuqing Lan.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Li, Z., Alzogool, M., Xiao, J. et al. Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy. Acta Diabetol 55, 1075–1082 (2018). https://doi.org/10.1007/s00592-018-1202-3

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