Sex-based analysis of vascular alterations on optical coherence tomography angiography in patients with diabetes.

Abstract

Purpose : Epidemiological studies have found that males with diabetes have a higher incidence of diabetic retinopathy (DR) and higher risk for progression of DR than females. However, there have been limited investigations on vascular manifestations of sex-based differences in DR. We performed a retrospective case-control study using optical coherence tomography angiography (OCTA) to investigate microvascular differences between males and females with diabetes without DR or with mild non-proliferative diabetic retinopathy (NPDR).

Methods : We obtained 3x3mm macular OCTA scans of participants with diabetes without DR or with mild NPDR without other ocular comorbidities or prior DR treatments. Images with significant motion or shadow artifact or signal strength index (SSI) of <8 were excluded. One eye per patient was included in the analysis. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) parameters were analyzed to include parafoveal vessel density (VD), vessel length density (VLD)— a skeletonization of the VD to remove disproportionate influence of large vessels on VD—, and flow index (FI). Multivariable linear regression was used to adjust estimates for potential confounders of age, race, SSI, hypertension, duration of disease, and HbgA1c.

Results : 1548 participants with diabetes without DR and 332 participants with mild NPDR were included in the study with 50.7% male participants. In the multivariable analysis, male sex was associated with lower VD (P < 0.01, β = -0.004), lower VLD (P < 0.01, β = -0.196), and higher flow index (P < 0.001, β = -0.013) in the SCP and lower VD (P < 0.001, β = -1.348) and lower VLD (P < 0.001, β = -0.413) in the DCP.

Conclusions : In a large diabetic population with no or mild DR, OCTA demonstrated a significant association between male sex and multiple reduced vascular parameters. These findings suggest that diabetic males may exhibit more advanced microvascular alterations than females, with implications for further sex-based studies to better understand DR.

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