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Thomas S Hwang, Qisheng You, Jie Wang, Yukun Guo, Christina J Flaxel, Steven T Bailey, David Huang, Yali Jia; Optical coherence tomography angiography-quantified avascular area is associated with diabetic retinopathy severity and predicts one-year treatment requirement and disease progression.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4774. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the association between optical coherence tomography angiography (OCTA) quantified avascular areas (AA) in diabetic eyes at baseline and diabetic retinopathy (DR) severity, disease progression, vision loss and treatment requirement in the following year.
We obtained 3x3 mm2 OCTA scans with AngioVue system (Optovue Inc., CA) and 7-field color photographs in eyes with DR and followed them prospectively for 1 year for disease progression, loss of greater than 5 Early Treatment of Diabetic Retinopathy (ETDRS) letters and treatment requirement. A masked grader determined the DR severity from the color photographs using the ETDRS scheme. A custom deep-learning algorithm detected extrafoveal AA (EAA) excluding the central 1mm circle in projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Student’s t test compared the EAA in different groups. The association between DR severity and EAA at baseline was analyzed using Spearman correlation. Logistic regression analyzed the association between baseline EAA and the retinopathy progression, treatment for DME or DR, and vision loss during the 1-year follow up.
Sixty-four patients with diabetes (29 males, age 28-84, mean 60.2), including 5 without DR, 35 mild to moderate NPDR, 13 severe NPDR, and 22 with PDR were followed for one year. At baseline, EAA for individual plexuses (Figure 1) were significantly correlated with DR severity after Bonferroni corrections (all p<0.0167). The DCP EAA was significantly associated with worse visual acuity (p=0.01), but the SVC and ICP EAA were not.At one year, 8 eyes progressed in severity by at least one step. The progression was significantly associated with DCP EAA detected at baseline (p=0.008), but not with other metrics.During the follow up, 25 eyes underwent treatment, with intravitreal anti-VEGF agents (22), steroids (1), focal laser (1) and panretinal photocoagulation(4). The DCP EAA (p=0.01) was significantly associated with treatment requirement during the one-year follow-up visits (Table 1). No metric was associated with vision loss at one year.
Avascular areas detected by OCTA in diabetic eyes are significantly associated with baseline DR severity, disease progression, and treatment requirement over one year.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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