Quantification of diabetic retinopathy-associated non-perfusion on ultra-wide-field fluorescein angiography and assessment of the impact of age, sex, race, and type of diabetes mellitus

Abstract

Purpose : This study evaluates the association between diabetic retinopathy (DR) related non-perfusion (NP) observed using ultra-wide-field (UWF) fluorescein angiography (FA) and variables including age, sex, race, and type of diabetes mellitus (DM).

Methods : A retrospective chart review of patients who had previously been diagnosed with DM, evaluated at the University of Michigan Kellogg Eye Center, Ann Arbor, and undergone Optos UWF FA imaging between January 2009 and May 2018 was conducted after approval from the IRB. Demographic and clinical data were acquired for each patient. Trained, masked graders segmented regions of NP within each presenting image. Eyes with severe media opacities or panretinal laser photocoagulation were excluded. Optos research software was used to determine the surface area (SA) of the segmented regions for a nominal eye diameter of 24mm. A linear mixed model was used to evaluate univariate associations and to account for inter-eye correlation.

Results : 573 eyes from 349 patients were included. The mean age of the cohort was 57.7 years, and 42.4% of patients were female. 65.0% of patients were white, 24.4% were African American, 4.6% were Asian, and 6.0% were unknown/other. 81.7% of patients were diagnosed with type II DM, 17.8% had type I DM, and 0.6% were unknown. Men had significantly greater NP SA than women, 74.57 mm² vs. 60.02 mm² respectively (p=0.01). The NP SA of patients over age 65 (56.41 mm²) was significantly less than that of younger age groups: 18-44 years (75.92 mm²; p=0.02), 45-54 years (71.44 mm²; p=0.04), and 55-64 years (72.57 mm²; p=0.02). African American patients had a significantly greater NP SA (77.59 mm²) than white patients (64.38 mm²) (p=0.03). Type I and II DM did not significantly differ in NP SA.

Conclusions : Age, race, and sex had significant impacts on the quantified extent of NP on univariate analysis. Multivariable linear mixed model results will be presented to better understand how these variables collectively associate with the clinical status of DR in these patients.

This abstract was presented at the 2019 ARVO Imaging in the Eye Conference, held in Vancouver, Canada, April 26-27, 2019.

 

Example segmentation of an Optos UWF FA image. Red, green, and blue indicate NP, foveal avascular zone, and neovascularization, respectively.

 

Average NP observed within distinct population subsets. Yellow indicates the reference group and asterisks denote statistical significance (p<0.05).