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Hasanain Shikari, Jan Lammer, Mike Cheney, Lloyd B Aiello, Paolo Sandico Silva, Lloyd P Aiello, Jennifer K Sun; Foveal Disorganization of Retinal Inner Layers (DRIL) is Highly Associated with Worse Vision in Eyes with Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4418.
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To evaluate whether extent and location of disorganization of the retinal inner layers (DRIL) within the central 1 mm foveal area are related to visual acuity (VA) in eyes with center-involved DME (ciDME).
Eyes with ciDME underwent ETDRS VA testing and Spectralis SDOCT imaging (20x20°, 49 B-scans, 16 ART Mean, high res setting). The central 1mm area on 7 B-scans centered on the fovea was graded in masked fashion for presence, location and extent of DRIL (inability to distinguish boundaries between any of the inner retinal layers). Linear regression analyses adjusting for correlations between eyes of the same individual were used to assess relationships between DRIL extent and VA. Fisher’s exact t-test was used to determine null independence of 2x2 contingency tables.
Fifty-eight eyes of 49 individuals were evaluated (mean±SD: age 63±11yrs, diabetes duration 23±13yrs, HbA1c 7.6±1.3%, 49% female and 33% type 1 diabetes). Mean logMAR VA was 0.23±0.22 and central subfield thickness (CST) was 380±91µm. DRIL was present in at least 1 B-scan of all study eyes and was present in all 7 B-scans in 52% (30) of eyes. Mean DRIL extent was 617±545µm. Greater average extent of DRIL across the 7 B-scans of each eye was significantly related to worse VA (point estimate [95% CI]: 0.18 [0.07-0.30], p=0.005) as was an increase in number of B-scans per eye with any center-involved DRIL (0.03 [0.004-0.06], p=0.03). These relationships remained significant even after adjusting for CST. Eyes with DRIL in ≥3 B-scans were more likely to have logMAR VA>0.14 (Snellen equivalent VA<20/25) as compared to those with DRIL in <3 B-scans (77% vs 36%, p=0.004). Once DRIL was present in all 7 B-scans, all eyes had logMAR VA>0 (VA<20/20). DRIL present in only the central B-scan or central 3 B-scans was associated with VA decline (p=0.02 & p=0.02, respectively). Weighting DRIL presence in proportion to previously published photoreceptor density at that location was also strongly associated with VA (0.28 [0.09, 0.47], p=0.009) even when this analysis was adjusted for CST.
Disorganization of the retinal inner layers is a common finding in eyes with ciDME. DRIL extent within the central 1 mm foveal zone is strongly associated with VA independently of retinal thickness, making DRIL a promising surrogate marker of VA in eyes with center-involved DME.
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