Severity of Disorganization of Retinal Layers and Visual Function Impairment in Diabetic Retinopathy

Stela Vujosevic; Camilla Alovisi; Gabriele Piccoli; Marco Brambilla; Emanuele Torti; Elisa Marenzi; Francesco Leporati; Livio Luzi; Paolo Nucci

doi:10.1016/j.oret.2024.04.005

Severity of Disorganization of Retinal Layers and Visual Function Impairment in Diabetic Retinopathy

Ophthalmol Retina. 2024 Apr 9:S2468-6530(24)00179-9. doi: 10.1016/j.oret.2024.04.005. Online ahead of print.

Authors

Stela Vujosevic¹, Camilla Alovisi², Gabriele Piccoli³, Marco Brambilla⁴, Emanuele Torti⁵, Elisa Marenzi⁵, Francesco Leporati⁵, Livio Luzi⁶, Paolo Nucci⁷

Affiliations

¹ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy. Electronic address: stela.vujosevic@unimi.it.
² Eye Clinic, Ospedale Oftalmico, Turin, Italy.
³ Eye Clinic, IRCCS MultiMedica, Milan, Italy.
⁴ Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy.
⁵ Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy.
⁶ Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 38604502
DOI: 10.1016/j.oret.2024.04.005

Abstract

Purpose: To evaluate best corrected visual acuity (BCVA), retina sensitivity (RS) and fixation impairment by microperimetry (MP) due to the presence and severity of disorganization of inner and outer retinal layers (DRIL/DROL) and ischemia in OCT/OCT-Angiography(OCT-A) in diabetic retinopathy (DR).

Design: Retrospective case-control study.

Subjects: Seventy-six eyes (65 patients) with DR were analyzed. Major exclusion criteria were: center-involving diabetic macular edema (DME), significant media opacity, nondiabetic macular pathology, active proliferative DR. Patients with DRIL and DROL within central 3 mm were enrolled as cases. Patients with DR and no retina disorganization were considered as controls.

Methods: A detailed grading of microperimetry and OCT/OCT-A images using Image J software, and specific Image Manipulation Program was applied to co-localize the presence of retina disorganization and RS. BCVA and RS were correlated with the disorganization of retina layers' characteristics and grading (Grade 1-DRIL; Grade 2-DROL; Grade 3-DROL plus, with involvement of the ellipsoid zone). The same procedure of co-localization was applied to the vascular layers on OCT-A using Matlab.

Main outcome: Correlation between BCVA and microperimetry parameters with disorganization of retina layers grading and OCT-A parameters.

Results: BCVA, mean RS within 1mm and central 3mm (overall RS-oRS), perfusion density, vessel density and geometric perfusion deficit in intermediate and deep capillary plexuses were lower in cases versus controls (p<.001). Mean RS within 1mm (21.4dB±2.4 vs 13.8dB±5.4, p=.002), oRS (22.0dB±2.1 vs 14.4dB ±4.6, p<.001), and BCVA (76.1±7.4 vs 61.2±20.4 ETDRS letters; p=.02), had a significant decrease from grade 1 to grade 3 retina disorganization.Choriocapillaris flow-voids (CC-FV) increased from grade 1 to grade 3 (DROL plus) (p=.004). oRS and CC-FV were identified as significant predictors of retina disorganization grade with an adjusted coefficient of determination, R²=0.45. Cases had more dense scotomas(p=.03) than controls with a positive correlation between the worsening of fixation stability and the severity of DRIL/DROL(p=.04).

Conclusion: MP and BCVA documented a reduction in visual function in patients with DR and disorganization of retina layers at different grades, with greater functional impairment when outer retina layers and photoreceptors are involved. The severity of retina disorganization and the presence of ischemia could serve as a potential biomarker of functional impairment.

Keywords: Diabetic Retinopathy; Disorganization of retina layers; Optical coherence tomography; Optical coherence tomography angiography; biomarkers; macular ischemia; microperimetry.