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Alice C. Jiang, Sunil K Srivastava, Joseph Boss, Sumit Sharma, Jamie L. Reese, Justis P Ehlers; Evaluation of Quantitative Ultra-widefield Fluorescein Angiography Metrics and Diabetic Macular Edema Features. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2804. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetes, yet predicting the development and severity of DME remains challenging. Ultra-widefield fluorescein angiography (UWFA) provides extensive information on the disease burden in diabetic retinopathy and emerging technology enables quantification of imaging features found on UWFA. The purpose of this study is to examine the relationship between quantitative UWFA metrics and DME.
A retrospective image analysis study was conducted of eyes with diabetic retinopathy that had undergone both spectral domain-optic coherence tomography (OCT) and UWFA imaging. OCT images were analyzed to determine the presence or absence of DME, central subfield thickness (CST), and subretinal fluid (SRF). Utilizing a semi-automated analysis platform, UWFA images were segmented for various quantitative metrics, such as ischemic index, leakage index, and microaneurysm (MA) count. Clinical variables, including age, sex, race, hemoglobin A1C, blood pressure, cholesterol levels, use of blood thinners, smoking status, and lens status were also evaluated.
A total of 304 eyes (156 OD, 148 OS) from 177 diabetic patients were analyzed in the study. Eyes with DME had a significantly higher proportion of posterior pole MAs (p<0.0001) and posterior pole leakage index (p<0.0001) compared to eyes without DME. DME features, including the severity of macular thickening (i.e., CST) and the presence of SRF, were significantly associated with posterior pole leakage index (p=0.0002 and p=0.004 respectively), but not posterior pole MA count. In addition to posterior pole leakage index and MA count, DME was associated with age (p<0.01), systolic blood pressure (p<0.001), and African American race (p<0.01). Panretinal leakage index, MA count, and ischemic index were not associated with DME.
Quantitative measures of leakage index and MA count in the posterior pole on UWFA images were associated with the presence and severity of DME. Panretinal analyses, including ischemic index, were not linked to DME. Additional research is needed to determine the role of quantitative UWFA in predicting DME development and characterizing prognosis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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