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The diagnostic efficacy of various measurements using optical coherence tomography angiography for detecting retinal microvascular changes in diabetic eyes without clinical features of diabetic retinopathy

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Posterboard#: A0366

Abstract Number: 3023 - A0366

AuthorBlock: Sawarin Laotaweerungsawat1,2, Catherine Psaras1, Chutiwan Amornrattanapan1,3, Hieu Tran1, Huizhen Li1, Armin R. Afshar1, Jay M. Stewart1
1Ophthalmology, UCSF, San Francisco, California, United States; 2Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand; 3Ophthalmology, Banphaeo Hospital, , Thailand;

DisclosureBlock: Sawarin Laotaweerungsawat, None; Catherine Psaras, None; Chutiwan Amornrattanapan, None; Hieu Tran, None; Huizhen Li, None; Armin R. Afshar, None; Jay M. Stewart, Genentech Code C (Consultant), Merck Code C (Consultant), Achaogen Code C (Consultant)

Purpose
Diabetic microvasculopathy can be detected in the retina via multiple optical coherence tomography angiography (OCTA) metrics. This study sought to identify the parameter that could reliably show the most prominent change in diabetic eyes without clinical retinopathy when compared with healthy, non-diabetic eyes.

Methods
We analyzed cross-sectional data of eyes from the diabetic retinopathy (DR) screening clinic and optometry clinic of Zuckerberg San Francisco General Hospital at the University of California, San Francisco, between April 2018 and October 2018. We divided participants into two groups: group 1, healthy eyes, and group 2, diabetes without DR. Subjects with glaucoma or any stage of DR based on clinical features detected on fundus photography were excluded. Both groups underwent OCTA using the Zeiss CIRRUS HD-OCT 5000. Automated OCTA data from CIRRUS 11.0 software consisted of superficial retinal vessel density (SVD), superficial retinal perfusion density (SPD), foveal avascular zone area (FAZ area), and foveal avascular zone circularity index (FAZ CI). We used Image J software to process the images and calculate the numeric data for deep retinal vessel density (DVD) and deep retinal perfusion density (DPD). All of the OCTA data were analyzed using receiver operating characteristic (ROC) curves.

Results
A total of 90 healthy subjects (150 eyes) and 166 diabetic patients without DR (261 eyes) were included. DVD represented the highest area under the receiver operating characteristic curve (AUC) (0.590, p=0.002 [95% CI, 0.531- 0.649]). DPD had the second highest AUC (0.586, p=0.004 [95% CI, 0.527-0.646]) followed by FAZ area (0.573, p=0.013 [95% CI, 0.515-0.631]) and FAZ CI (0.570, p=0.018 [95% CI, 0.514-0.626]). On the other hand SVD and SPD did not show a statistically significant AUC, 0.547 (p=0.110) and 0.541 (p=0.169), respectively.

Conclusions
Deep retinal vessel density provided the greatest diagnostic efficacy among OCTA parameters in distinguishing healthy eyes from those with diabetes without DR. OCTA may be a useful tool in detecting the first signs of microvascular change in diabetes even before the development of clinically detectable diabetic retinopathy.

Layman Abstract (optional): Provide a 50-200 word description of your work that non-scientists can understand. Describe the big picture and the implications of your findings, not the study itself and the associated details.