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.
Keywords: AUC, area under the receiver operating characteristic curve; DM, diabetes mellitus; DR, diabetic retinopathy; DVC, deep vascular plexus; Diabetes mellitus; Diabetic retinopathy; ETDRS, Early Treatment Diabetic Retinopathy Study; FAZ, foveal avascular zone; Foveal avascular zone; NFLVP, nerve fiber layer vascular plexus; NICOLA, Northern Ireland Cohort Study for the Longitudinal Study of Aging; OCT angiography; OCTA; OCTA, OCT angiography; Retinal periphery; SVC, superficial vascular plexus; Vessel density; Vessel segmentation.
© 2021 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.