June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Retinal Ischemia Rather than Neovascularization is Associated with Neovascular Glaucoma in Patients with Proliferative Diabetic Retinopathy Using Widefield Swept-Source Optical Coherence Tomography Angiography (WF SS-OCTA)
Author Affiliations & Notes
  • Edward S Lu
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Ying Cui
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Rongrong Le
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Ying Zhu
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Jay C Wang
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Ines Lains
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Raviv Katz
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Yifan Lu
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Rebecca Zeng
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Itika Garg
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • David M Wu
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Deeba Husain
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Leo A Kim
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • John B Miller
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Edward Lu None; Ying Cui None; Rongrong Le None; Ying Zhu None; Jay Wang None; Ines Lains None; Raviv Katz None; Yifan Lu None; Rebecca Zeng None; Itika Garg None; David Wu Massachusetts Eye and Ear, Code P (Patent); Deeba Husain Allergan, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor), Omeicos Therapeutics, Code C (Consultant/Contractor), Commonwealth Grant, Code F (Financial Support), Lions Vision Gift, Code F (Financial Support), Macular Society, Code F (Financial Support), National Eye Institute, Code F (Financial Support), Syneos LLC, Code F (Financial Support); Leo Kim CureVac AG, Code F (Financial Support), National Eye Institute, Code F (Financial Support), Pykus Therapeutics, Code I (Personal Financial Interest), Pykus Therapeutics, Code S (non-remunerative); John Miller Alcon, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor), Sunovion, Code C (Consultant/Contractor), Zeiss, Code C (Consultant/Contractor)
  • Footnotes
    Support  Lions International Fund (Grant 530125 and 530869)
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2952 – F0105. doi:
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      Edward S Lu, Ying Cui, Rongrong Le, Ying Zhu, Jay C Wang, Ines Lains, Raviv Katz, Yifan Lu, Rebecca Zeng, Itika Garg, David M Wu, Deeba Husain, Leo A Kim, John B Miller; Retinal Ischemia Rather than Neovascularization is Associated with Neovascular Glaucoma in Patients with Proliferative Diabetic Retinopathy Using Widefield Swept-Source Optical Coherence Tomography Angiography (WF SS-OCTA). Invest. Ophthalmol. Vis. Sci. 2022;63(7):2952 – F0105.

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

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Abstract

Purpose : To investigate WF SS-OCTA metrics, including nonperfusion area (NPA) and neovascularization (NV), in proliferative diabetic retinopathy (PDR) patients with and without neovascular glaucoma (NVG).

Methods : This prospective, observational, single-center study was conducted from November 2018 to February 2020. A total of 85 eyes of 60 PDR patients without NVG and 9 eyes of 8 PDR patients with NVG were imaged using WF SS-OCTA. Retinal ischemic parameters (NPA; ischemia index [NPA/total retinal area]) and neovascularization features (NV number; NV area; NV vessel density) were evaluated. Foveal avascular zone (FAZ), macular thickness/volume and choroidal thickness/volume were obtained using the Zeiss ARI Network. WF SS-OCTA retinal and choroidal metrics, systemic, and ocular parameters were screened using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression for variable selection. Firth’s Bias-Reduced logistic regression model (outcome: presence of NVG) was subsequently used to identify parameters associated with NVG.

Results : Ischemia index (cutoff 0.406; odds ratio [OR]=77.1, 95% confidence interval [CI]:9.1-1402.4, P<0.001) and BCVA (cutoff 0.185; OR=25.2, 95%CI:1.7-4138.2, P=0.015) were associated with the presence of NVG, and ischemia index remained significantly associated with NVG after exclusion of fellow eyes of NVG and adjustment for sex, age, and diabetes duration. NV metrics, FAZ, and choroidal parameters were not related to NVG.

Conclusions : Retinal ischemia but not neovascularization was associated with the presence of NVG in patients with PDR using WF SS-OCTA. Larger, longitudinal studies are needed to validate imaging biomarkers associated with diabetic NVG.

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

 

Quantitative analysis of nonperfusion areas (NPAs) and neovascularization (NV). (A) Montage 15x15mm whole retina image. (B) Manual selection of NPAs. (C) Montage vitreoretinal interface image. (D) Manual selection of NV with subsequent background subtraction, noise removal, and binarization to calculate NV area and vessel density

Quantitative analysis of nonperfusion areas (NPAs) and neovascularization (NV). (A) Montage 15x15mm whole retina image. (B) Manual selection of NPAs. (C) Montage vitreoretinal interface image. (D) Manual selection of NV with subsequent background subtraction, noise removal, and binarization to calculate NV area and vessel density

 

Whole retina (A) and retina depth-encoded (B) images of a PDR eye with NVG demonstrate large areas of nonperfusion. Whole retina (C) and retina depth-encoded (d) images of a PDR eye without NVG show more neovascularization and less nonperfusion area.

Whole retina (A) and retina depth-encoded (B) images of a PDR eye with NVG demonstrate large areas of nonperfusion. Whole retina (C) and retina depth-encoded (d) images of a PDR eye without NVG show more neovascularization and less nonperfusion area.

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