July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Association of Ultrawide Field (UWF) Retinal Vessel Caliber with Diabetic Retinopathy (DR) Severity, Predominantly Peripheral Lesions (PPL) and Retinal Nonperfusion (NP)
Author Affiliations & Notes
  • Siamak Shokrollahi
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Mohamed Ashraf Elmasry
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Konstantina Sampani
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Alex Umali Pisig
    Ophthalmology, Cardinal Santos Medical Center, San Juan, Philippines
  • Omar Abdelal
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Gavin Robertson
    Optos PLC, United Kingdom
  • Alan Fleming
    Optos PLC, United Kingdom
  • Cloyd M Pitoc
    Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Siamak Shokrollahi, None; Mohamed Elmasry, None; Konstantina Sampani, None; Alex Pisig, None; Omar Abdelal, None; Gavin Robertson, Optos PLC (E); Alan Fleming, Optos PLC (E); Cloyd Pitoc, None; Jennifer Sun, None; Paolo Silva, Optos PLC (F), Welch Allyn, Inc (F); Lloyd Aiello, Kalvista Pharmaceuticals (I), Kalvista Pharmaceuticals (C), Mingsight (C), Novo Nordisk (C), Optos (R), Retinal Solutions (C)
  • Footnotes
    Support  Massachusetts Lions’ Eye Research Fund, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4771. doi:
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      Siamak Shokrollahi, Mohamed Ashraf Elmasry, Konstantina Sampani, Alex Umali Pisig, Omar Abdelal, Gavin Robertson, Alan Fleming, Cloyd M Pitoc, Jennifer K Sun, Paolo Sandico Silva, Lloyd P Aiello; Association of Ultrawide Field (UWF) Retinal Vessel Caliber with Diabetic Retinopathy (DR) Severity, Predominantly Peripheral Lesions (PPL) and Retinal Nonperfusion (NP). Invest. Ophthalmol. Vis. Sci. 2019;60(9):4771.

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

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Abstract

Purpose : To evaluate the association of retinal vessel diameter with NP, DR severity and PPL in diabetic (DM) eyes.

Methods : Same day UWF color and fluorescein angiography images from eyes without PRP or non-DR vascular retinal disease were graded for DR severity and presence of PPL. Arteriolar (AD) and venular (VD) calibers and AD:VD ratio (AVR) at 1 DD (inner) and 3.5 DD (outer) from the optic nerve were obtained from UWF color images using a customized semi-automated program. NP area (NPA) and NP index (NPI) were determined for the entire image and the posterior pole (PP), midperiphery (MP) and far periphery (FP).

Results : 178 eyes from 109 patients with mean age 52.2±13.9 yrs, DM duration 21.8±12.3 yrs, Hba1c 8.3±1.6%, 52.3% male and 47.7% type1 DM were evaluated. DR severity distribution: 16.9% mild nonproliferative DR (NPDR); 25.3% moderate; 43.8% severe and 14% proliferative DR (PDR). Total, PP, MP and FP NPA and NPI all increased with worsening DR severity (p<0.0001). Outer and inner AVR decreased with increasing DR severity (Outer/Inner: mild 0.92±0.11/0.87±0.12; moderate 0.87±0.09/0.85±0.14; severe 0.85±0.10/0.79 ±0.11; PDR 0.80±0.11/0.79±0.13; p<0.001/p=0.005) while outer VD increased (mild 111.3±11.9µm; moderate 117.3±10.3µm, severe 116.9±14.3µm and PDR 124.7±16.2µm; p<0.001). Outer and inner AD and inner VD showed no significant correlation with DR severity. In eyes with PPL (N=68), as DR severity increased outer AVR decreased (p=0.005), outer AD decreased (p=0.021) and outer VD increased (p=0.003). Pairwise comparisons after adjusting for multiple analysis showed that outer AVR in eyes with PPL was significantly different between eyes with mild vs moderate (p=0.002), mild vs severe (p=0.018) and mild vs PDR (p=0.002). In eyes without PPL (N=110), only outer AVR decreased with increasing DR severity (p=0.048) with no pairwise comparison differences between DR severity levels.

Conclusions : Non-invasively measured retinal vessel caliber changes are correlated with retinal NP and DR severity. Eyes with PPL have increased venous dilation and arterial narrowing, which become greater with increasing DR severity - a finding not observed in eyes without PPL. These data suggest that PPL are associated with greater vascular pathology, thus possibly contributing to accelerated DR progression.

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

 

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