Widerfield Swept-Source Optical Coherence Tomography Angiography (WF SS-OCTA) Reveals Retinal Vascular Differences Among Eyes with Concomitant Age-Related Macular Degeneration (AMD) and Diabetic Retinopathy (DR)

Abstract

Purpose : We evaluated the WF SS-OCTA vascular metrics associated with concomitant AMD and DR, a rarer disease entity, compared with AMD or DR alone.

Methods : This cross-sectional observational study included 279 eyes of 181 patients. The three study groups included 71 eyes with both non-exudative AMD and DR, 60 eyes with non-exudative AMD alone, and 148 eyes with DR alone. All eyes were imaged with WF SS-OCTA (PLEX® Elite 9000, Carl Zeiss Meditec) from December 2018 to August 2022. The ARI Network (Zeiss Portal v5.4) was used to quantify foveal avascular zone (FAZ) area, circularity, and perimeter and vessel density (VD) and vessel skeleton density (VSD) in the superficial (SCP) and deep (DCP) capillary plexus and whole retina (WR) on 3x3, 6x6, and 12x12 mm images. Mixed effects multivariable regression analyses, controlling for age, were performed for the whole cohort and by subgroups based on DR and AMD stages.

Results : Regression results revealed significantly reduced vascular metrics in eyes with concomitant AMD and DR compared to eyes with AMD or DR alone on all image sizes. For example, when compared to eyes with AMD alone, eyes with AMD and DR had significantly reduced VD (β= -0.03, p= 0.014) and VSD (β= -1.17, p= 0.018) in the DCP on 12x12 mm images, increased FAZ perimeter (β= 0.60, p= 0.012) and FAZ area (β= 0.12, p= 0.008) on 6x6 mm images, and reductions in all VD and VSD metrics on 3x3 and 6x6 mm images. While both the main group and subgroup analyses revealed significant differences, having the additional diagnosis of DR among eyes with AMD, was associated with more numerous significantly different vascular metrics compared to having the additional diagnosis of AMD among eyes with DR.

Conclusions : Our results demonstrate further microvascular damage occurred in eyes with concomitant AMD and DR than with the presence of AMD alone, where the damage was most prevalent, or DR alone. Future work further characterizing the WF SS-OCTA changes associated with AMD and DR, may elucidate unique pathophysiology and impact clinical management as OCTA becomes more integrated in treatment paradigms.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1. Results from mixed effects multivariate regression analysis evaluating diagnosis type and vascular metrics, while controlling for age. Significant p-values are bolded.