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. 2024 May 1;13(5):22.
doi: 10.1167/tvst.13.5.22.

Patterns of Progression of Nonproliferative Diabetic Retinopathy Using Non-Invasive Imaging

Inês Pereira Marques  1   2   3   4 , Maria Luísa Ribeiro  1   3   4 , Torcato Santos  1 , Débora Reste-Ferreira  1 , Luís Mendes  1 , António Cunha-Vaz Martinho  1   5 , Ana Rita Santos  1   2   3   4   6 , João Figueira  1   3   7 , Conceição Lobo  1   2   3   4   7 , José Cunha-Vaz  1   3   4
Affiliations

Patterns of Progression of Nonproliferative Diabetic Retinopathy Using Non-Invasive Imaging

Inês Pereira Marques et al. Transl Vis Sci Technol. .

Abstract

Purpose: To identify progression of nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes by combining optical coherence tomography angiography (OCTA) metrics and color fundus photography (CFP) images.

Methods: This study was a post hoc analysis of a prospective longitudinal cohort study (CORDIS, NCT03696810) with 2-year duration. This study enrolled 122 eyes. Ophthalmological examinations included OCTA and CFP. OCTA metrics included skeletonized vessel density (SVD) and perfusion density (PD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Microaneurysm turnover analysis and Early Treatment Diabetic Retinopathy Study (ETDRS) grading for diabetic retinopathy (DR) severity assessment were performed on 7-field CFP.

Results: Eyes graded as ETDRS level 20 showed significant capillary nonperfusion predominantly in the inner ring area in the SCP (P < 0.001), whereas eyes graded as ETDRS level 35 and ETDRS levels 43 and 47 showed significant capillary nonperfusion in both the SCP and DCP in both inner and outer rings (P < 0.001). When evaluating rates of progression in capillary nonperfusion for the 2-year period of follow-up, changes were found predominantly in the DCP for SVD and PD and were better identified in the outer ring area. Microaneurysm turnover contributes to the characterization of NPDR progression by discriminating ETDRS level 35 from ETDRS levels 43 and 47 (P < 0.001), which could not be achieved using only OCTA metrics.

Conclusions: Patterns of progression of NPDR can be identified combining OCTA examinations of the superficial and deep retinal capillary plexi of central retina and determination of microaneurysm turnover from fundus photographs.

Translational relevance: Our study reports results from a registered clinical trial that advances understanding of disease progression in NPDR.

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Conflict of interest statement

Disclosure: I.P. Marques, None; M.L. Ribeiro, None; T. Santos, None; D. Reste-Ferreira, None; L. Mendes, None; A. Cunha-Vaz Martinho, None; A.R. Santos, None; J. Figueira, None; C. Lobo, None; J. Cunha-Vaz, Alimera Sciences (C), Bayer (C, R), Boehringer Ingelheim (C, R), Carl Zeiss Meditec (C, R), Roche (C)

Figures

Figure.
Figure.
Example of retinal vascular patterns in a healthy volunteer and in diabetic retinopathy patients. (A) OCTA 3 × 3 mm acquisition of the left eye of an healthy volunteer. (B) As reference, a postmortem digested retina, injected with India ink, from a diabetic individual shows vascular patterns characterized by capillary nonperfusion and enlarged preferential vessels (shunts). (C) OCTA 3 × 3 mm acquisition of the left eye of a diabetic retinopathy patient (ETDRS level 35). (D) Highlighted area. (E) OCTA 6 × 6 mm acquisition of the left eye of a diabetic retinopathy patient (ETDRS level 43). (F) Highlighted area. (D) and (F) show similar vascular patterns of capillary nonperfusion and enlarged preferential vessels, as seen in (B).
See this image and copyright information in PMC

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