July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Blood Flow Parameters from Computational Fluid Dynamics Modeling Associated with Clotting and Local Neural Retinal Disorganization in Diabetic Microaneurysms
Author Affiliations & Notes
  • Jennifer K Sun
    Beetham Eye Inst & Eye Rsch Sec, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Omar Abu-Qamar
    Internal Medicine, University of Missouri, Missouri, United States
  • Konstantina Sampani
    Beetham Eye Inst & Eye Rsch Sec, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Ward Fickweiler
    Beetham Eye Inst & Eye Rsch Sec, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Inst & Eye Rsch Sec, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Miguel Bernabeu
    The University of Edinburgh, United Kingdom
    University College London, United Kingdom
  • Footnotes
    Commercial Relationships   Jennifer Sun, Boston Micromachines (F), Optovue (F), Zeiss (F); Omar Abu-Qamar, None; Konstantina Sampani, None; Ward Fickweiler, None; Lloyd Aiello, None; Miguel Bernabeu, None
  • Footnotes
    Support  NEI 5R01EY024702-04, Research to Prevent Blindness, Massachusetts Lions Eye Research Fund.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4597. doi:
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      Jennifer K Sun, Omar Abu-Qamar, Konstantina Sampani, Ward Fickweiler, Lloyd P Aiello, Miguel Bernabeu; Blood Flow Parameters from Computational Fluid Dynamics Modeling Associated with Clotting and Local Neural Retinal Disorganization in Diabetic Microaneurysms. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4597.

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

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Abstract

Purpose : Microaneurysms are a common lesion in diabetic eye disease. It remains unclear, however, why some grow and leak fluid, causing local neural pathology, while others within the same region resolve without sequelae. We evaluated the relationship of blood flow parameters estimated by computational fluid dynamics (CFD) modeling of diabetic microaneurysms (MAs) with vascular and local neural retinal characteristics.

Methods : MAs in eyes of diabetic study participants were imaged with adaptive optics scanning laser ophthalmoscope (AOSLO) imaging and spectral domain optical coherence tomography (SDOCT). AOSLO and SDOCT images were registered and assessed for MA cross-sectional area and perfusion status. OCT images were graded for disorganization of the retinal inner layers (DRIL) within 500 microns of MAs. CFD modeling estimated shear rate and wall shear stress for the whole MA body and subregions within individual MAs.

Results : A total of 52 MAs were imaged (30 eyes) from 22 participants with mean±SD age 40.4±11.0 years, diabetes duration 23.1±8.1 years, hemoglobin A1c 8.1±1.1%, who were 82% with type 1 diabetes and 41% female. Mean shear rate drop between the MA feeding vessels and body was higher in larger MAs (p=0.0002) and MAs with decreased perfusion (p=0.003). MAs with greater differences in shear rate drop between subregions were significantly larger (p=0.009), less perfused (p=0.0005) and more likely to have visible clot within the MA (p<0.05). Mean wall shear stress drop was higher in larger (p=0.007) and less perfused MAs (p=0.002). Greater variability in either shear rate (p=0.008) or wall shear stress drop (p=0.0009) was associated with greater extent of local surrounding DRIL. In a small subgroup of 8 MAs imaged in follow-up (7.0±5.1 mo later), MA growth was associated with increasing variability of shear rate drop (r=0.80, p=0.02) and wall shear stress drop (r=0.86, p=0.007).

Conclusions : Estimation of shear rate and wall shear stress by CFD modeling can identify MAs that are likely to be larger, less perfused, and associated with local neural retinal pathology. Future studies will address whether longitudinal changes in these blood flow parameters predict future anatomic and functional outcomes of MAs in the diabetic eye.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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