Abstract
Purpose :
This prospective, observational study aims to investigate the longitudinal changes of choriocapillaris flow deficits (CFDs) in type 2 diabetic patients with or without diabetic retinopathy (DR).
Methods :
Healthy individuals and patients with type 2 diabetes were enrolled and underwent SS-OCTA imaging annually for four years to measure CFDs. The rate of change in CFDs was estimated using a linear mixed model.
Results :
A total of 1025 subjects were included, involving 465 healthy controls (244 [52.47%] females), 454 diabetic patients without DR (243 [53.52%] females), and 106 with NPDR (53 [50%] females). After 4 years of follow-up, CFD increased by 0.319 (95%CI 0.225, 0.412) %/year (P < 0.001) in the non-DR group and 0.423 (95%CI 0.230, 0.616) %/year (P < 0.001) in the NPDR group, both significantly higher than the 0.173 (95%CI 0.079, 0.266) %/year in the control group (both P < 0.001). After adjusting for other factors, the rates of CFD change were 0.171 %/year faster in the NDR group (95%CI: 0.060, 0.283; P = 0.003) and 0.258 %/year faster in the NPDR group (95%CI: 0.068, 0.449; P = 0.008) compared with normal controls. In addition, higher serum creatinine, higher HbA1c, worse BCVA, lower OCTA image quality scores, and smaller baseline CFD were independently associated with faster longitudinal CFD rates (all P < 0.05). Rapid initial CFD progressors were more likely to have DR progression (hazard ratio = 2.26, 95%CI: 1.64, 3.32; P = 0.010).
Conclusions :
Both healthy individuals and type 2 diabetic patients, regardless of DR status, showed a progressive decline in choriocapillaris perfusion. This suggests that CFD alterations might precede DR-related microvascular abnormalities, offering insights for early DR detection and underlying pathophysiology.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.