Choriocapillaris flow deficit may predict risk of retinopathy and macular edema in diabetics

A study was conducted to investigate the relationship between choriocapillaris flow deficit percentage (CC FD%) by swept-source optical coherence tomography angiography (SS-OCTA) and 3-year risk of diabetic retinopathy (DR) progression and diabetic macular edema (DME) development.

A total of 903 participants with type 2 diabetes mellitus (T2DM) without DR or with mild non-proliferative DR (NPDR) free of DME at baseline were followed up annually for 3 years. All participants underwent standard 7-field fundus photography and spectral-domain OCT. SS-OCTA was used for retinal and choriocapillaris imaging and 3 × 3 mm2 macular CC FD% was quantified. Univariate and multivariate logistic models were used to evaluate the association between CC FD% and two or more steps of DR progression and DME development. The additional predictive value of CC FD% for outcome events was assessed using C-statistic, net reclassification index (NRI), and integrated discrimination improvement index (IDI).

Results

• Over 3 years, 295 of 1805 eyes (16.34%) developed DR progression, and 118 eyes developed DME.

• A higher average CC FD% was correlated with DR progression and DME development after adjusting for confounders.

• In the ETDRS regions, increased CC FD% in all fields was associated with DR progression; however, increased CC FD% in the inferior field was associated with DME development.

• Compared with the models based on established risk factors, the addition of average CC FD% significantly improved the C-statistics for DR progression and DME occurrence

• The estimated NRIs and IDIs (all >0) indicated that the addition of CC FD% led to a significant improvement in the discriminative performance for endpoints.

CC FD% is independently associated with DR progression and DME development in the Chinese T2DM population and provides incremental predictive value beyond traditional risk factors and retinal microvascular parameters. Further inclusion of CC FD% in DR prediction models helps guide population-based screening and personalized management.

Reference:

Yanping Chen, Zhuoting Zhu,Weijing Cheng, Mingguang He,Wei Wang. Choriocapillaris flow deficit as a biomarker for diabetic retinopathy and diabetic macular edema: 3-year longitudinal cohort. American Journal of Ophthalmology

Published:November 23, 2022DOI:https://doi.org/10.1016/j.ajo.2022.11.018

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