Abstract
Purpose :
Prior epidemiology studies have found that males with diabetes have a higher incidence of diabetic retinopathy (DR) and higher risk for progression of DR than females with diabetes. However, whether these findings translate to retinal microvascular differences between the sexes is unknown. In this retrospective case-control study, we investigate the sex-based microvascular and structural differences between males and females on OCT Angiography (OCTA) in an urban population with and without diabetes.
Methods :
We obtained 3x3mm OCTA macula scans of non-diabetic and diabetic participants. Diabetics of varying DR severity from no DR to proliferative DR (PDR) were included. Images with significant artifact or signal strength (SS) of <8 were excluded. One eye per patient was included. Vascular parameters included parafoveal vessel density (VD), vessel length density (VLD), and flow index (FI) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) as well as foveal avascular zone (FAZ) area and perimeter. Parafoveal ganglion cell complex (GCC) thickness was also measured from the OCTA structural scans. Multivariable linear regression was used to adjust estimates for potential confounders of age, race, SS, hypertension, duration of disease, and HbgA1c. P value of <0.001 was considered significant.
Results :
1993 diabetic and 227 non-diabetic participants were included in the study. Of the diabetics, 1496 had no DR, 452 had mild or moderate non-proliferative DR (NPDR), and 45 had severe NPDR or PDR. 46.3% of the diabetics and 50.4% of the non-diabetics were male. Male sex was significantly associated with smaller FAZ area in both non-diabetic controls (β = -0.056) and diabetics (β = -0.048). In the diabetic groups, male sex was also associated with lower FAZ perimeter (β = -0.115), SCP VD (β = -0.435), SCP VLD (β = -0.303), DCP VD (β = -1.432), DCP VLD (β = -0.454). Male sex was associated with higher superficial FI (β = 0.014) and thicker GCC P < 0.001 (β = 1.006).
Conclusions :
In a diverse diabetic population mostly with no or mild disease, OCTA demonstrates a significant association between the male sex and multiple reduced vascular parameters without structural retinal thinning. These findings suggest that diabetic males may exhibit more advanced microvascular damage than females, with implications for further sex-based studies to better understand DR.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.