June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Relationship between distance-weighted peripheral non-perfusion and diabetic macular edema
Author Affiliations & Notes
  • Min Sagong
    Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea (the Republic of)
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
  • Jano van Hemert
    Optos plc, Dunfermline, United Kingdom
  • Charles Clifton Wykoff
    Retina Consultants of Houston, Houston, TX
    Ophthalmology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX
  • Rui Wang
    Ophthalmology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX
  • Srinivas R Sadda
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, Los Angeles, CA
  • David M Brown
    Retina Consultants of Houston, Houston, TX
    Ophthalmology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX
  • Footnotes
    Commercial Relationships Min Sagong, None; Jano van Hemert, Optos PLC (E), Optos PLC (P); Charles Wykoff, Alcon (C), Alcon (F), Allergan (F), Allergan (F), Genentech (C), Genentech (F), Regeneron (C), Regeneron (F); Rui Wang, None; Srinivas Sadda, Alcon (C), Allergan (C), Allergan (F), Allergan (R), Carl Zeiss Meditec (C), Carl Zeiss Meditec (F), Carl Zeiss Meditec (R), Genentech (C), Genentech (F), Norvatis (C), Optos (C), Optos (F), Optos (R), Roche (C); David Brown, Abbott (F), Acuceta (F), Alimera (F), Allergan (C), Ampio (F), Bayer HealthCare (C), Genentech (C), Genzyme (C), GSK (F), Heidelberg Engineering (C), Norvatis (C), Notal Vision (C), Opthotech (F), Pfizer (F), pSivida (F), QLT (C), Quark (F), Regeneron (C), Santen (F), Thrombogenetics (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 599. doi:
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    • Get Citation

      Min Sagong, Jano van Hemert, Charles Clifton Wykoff, Rui Wang, Srinivas R Sadda, David M Brown; Relationship between distance-weighted peripheral non-perfusion and diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):599.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

A new method to weight each pixel of non-perfusion reflecting its respective distance from the fovea was developed in the hopes of improving the correlation between retinal ischemia and the development of diabetic macular edema (DME). In this study, we characterize the relationship between a distance-weighted ischemic area and the extent of DME using ultra-widefield (UWF) angiography.<br /> .

 
Methods
 

40 eyes of 40 patients were enrolled in DAVE trial (NCT01552408) to assess the efficacy and safety of ranibizumab monotherapy compared with ranibizumab plus UWF fluorescein angiography (FA) -guided pan retinal photocoagulation for DME with retinal ischemia. Steered UWF FA images using the Optos 200Tx were submitted to the Doheny Image Reading Center for analysis. Images were montaged and transformed to stereographic projected images for precise quantification using spherical trigonometry. The ischemic index was computed as ratio of non-perfused to total visible retina. In addition, each pixel of non-perfused retina was linearly weighted based on the distance from the fovea and optimized using simulated annealing to produce a weighted ischemic index, which gave more importance to ischemia closer to the posterior pole (i.e. location of edema). Linear and logistic models were constructed to determine the relationship between the baseline extent of DME and various covariates including the weighted and unweighted ischemic indices.

 
Results
 

At baseline, there was no significant correlation between the extent of central macular thickness and macular volume and the unweighted ischemic index (r = 0.077, P = 0.653 and r = 0.071, P = 0.677, respectively). However, after linearly weighting each pixel based on the distance from the fovea, the correlation between the extent of central macular thickness and macular volume at baseline, and ischemic index was improved (though not significant) to r = 0.237, P = 0.147 and r = 0.239, P = 0.129, respectively.

 
Conclusions
 

In this cohort, the severity of DME was not correlated with the extent of peripheral non-perfusion. Although the correlation improved when the ischemic index was linearly weighted to emphasize more central non-perfusion, it did not achieve statistical significance. Consideration of other non-linear weighting functions may strengthen this relationship and should be the target of future studies.

 
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