June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Relationship Between Macular Vessel Density Metrics and Lesion Distribution in Diabetic Retinopathy
Author Affiliations & Notes
  • Navid Manafi
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Deniz Oncel
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Aditya Verma
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Ahmed Roshdy Alagorie
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, Tanta University Faculty of Medicine, Tanta, Egypt
  • Kim Ramasamy
    Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
  • Jano van Hemert
    Optos plc, Dunfermline, Fife, United Kingdom
  • Naresh Yadav
    Narayana Nethralaya, Bangalore, Karnataka, India
  • Rajeev R Pappuru
    Smt. Kanuri Santhamma Vitreoretina Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Adnan Tufail
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Houri Esmaeilkhanian
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Muneeswar Gupta nittala
    Doheny Eye Institute, Los Angeles, California, United States
  • Rajiv Raman
    Sankara Nethralaya, Chennai, Tamil Nadu, India
    Medical Research Foundation, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Nungambakkam, India
  • Srinivas R Sadda
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Navid Manafi None; Deniz Oncel None; Aditya Verma None; Ahmed Roshdy Alagorie None; Kim Ramasamy None; Jano van Hemert Optos Plc, Dunfermline, Dunfermline, UK , Code E (Employment); Naresh Yadav None; Rajeev Pappuru None; Adnan Tufail None; Houri Esmaeilkhanian None; Muneeswar nittala None; Rajiv Raman None; Srinivas Sadda Amgen, Allergan, Genentech/Roche, Iveric, Oxurion, Novartis, Regeneron, Bayer, 4DMT, Centervue, Heidelberg, Optos, Merck, Apellis, Astellas, Code C (Consultant/Contractor), Carl Zeiss Meditec, Nidek, Code R (Recipient), Nidek, Topcon, Heidelberg, Carl Zeiss Meditec, Optos, Centervue, Code R (Recipient)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2181 – F0244. doi:
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    • Get Citation

      Navid Manafi, Deniz Oncel, Aditya Verma, Ahmed Roshdy Alagorie, Kim Ramasamy, Jano van Hemert, Naresh Yadav, Rajeev R Pappuru, Adnan Tufail, Houri Esmaeilkhanian, Muneeswar Gupta nittala, Rajiv Raman, Srinivas R Sadda; Relationship Between Macular Vessel Density Metrics and Lesion Distribution in Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2181 – F0244.

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

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Abstract

Purpose : Diabetic eyes with predominantly peripheral lesions (PPL) have been suggested to be at higher risk for progression to proliferative diabetic retinopathy (PDR). Retinal nonperfusion is known to increase with increasing severity of diabetic retinopathy. We sought to evaluate the relationship between macula vessel density metrics on optical coherence tomography angiography (OCTA) with lesion distribution in eyes with DR.

Methods : Patients with DR presenting to three tertiary care centers (Aravind Eye Hospital (326 eyes), LV Prasad Eye Institute (86 eyes), Sankara Nethralaya (86 eyes)) who underwent both Optos ultrawidefield (UWF) pseudocolor imaging and macular OCTA (Cirrus Angioplex, 6x6 mm) were included in this retrospective analysis. The distribution of DR lesions was assessed by comparing each of the peripheral ETDRS extended fields (3-7) against their corresponding ETDRS field. An eye was determined to have predominantly peripheral lesions (PPL) if any peripheral field had a greater severity or extent of lesions compared to its corresponding central ETDRS field; otherwise, it was classified as predominantly central lesions (PCL). After correction for segmentation errors, en face OCTA images from the superficial and deep capillary plexuses (SCP and DCP) were exported and analyzed using Image J. Perfusion density (PD) and vessel length density (VLD) were calculated following binarization (PD) and skeletonization (VLD). PD and VLD of the SCP and DCP were compared between eyes with PPL and PCL DR lesion distribution.

Results : Total of 404 eyes were included in this study (62.1% PCL and 37.9% PPL). There was no significant difference, however in mean SCP PD (30.45 in PPL eyes and 30.95 in PCL eyes; p=0.415) or in DCP PD (34.13 in PPL and 34.22 in PCL; p=0.480). There was also no significant difference in SCP VLD (11.53 in PPL and 11.73 in PCL; p=0.394) or DCP VLD (14.49 in PPL and 14.47 in PCL; p=0.307).

Conclusions : Though predominantly peripheral lesions are thought to be associated with a higher risk of progression, eyes with PPL do not have worse macular perfusion. OCTA analysis of the retinal periphery will be necessary to determine whether eyes with PPL have more severe peripheral nonperfusion.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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