Diabetic macular ischemia on OCTA predicts DME formation, DR progression and acuity deterioration: JAMA

The appearance of diabetic macular ischemia (DMI) in optical coherence tomography angiography (OCTA) images is predictive of diabetic retinopathy (DR) progression, diabetic macular edema (DME) formation, and visual acuity (VA) deterioration, says an article published in JAMA Ophthalmology.

An OCTA-based DMI evaluation may help to further improve the management of diabetic retinopathy since the presence of diabetic macular ischemia on optical coherence tomography angiography pictures predicts the progression of diabetic retinal disease and impairment of visual acuity. In order to determine if an automated binary DMI method employing OCTA pictures gives predictive value on DR advancement, diabetic macular edema formation, and VA degradation in a cohort of patients with diabetes, Dawei Yang and colleagues conducted this study.

An earlier deep learning method was used in this cohort research to measure the DMI of superficial capillary plexus and deep capillary plexus OCTA pictures. The lack of DMI was defined as images showing an intact contour of the fovea avascular zone and a normal distribution of the vasculature. The presence of DMI was described as images showing disruption of the fovea avascular zone together with or without other regions of capillary loss. Starting in July 2015, diabetic patients were enrolled, and they underwent at least four years of follow-up. The relationship between the existence of DMI and the development of DR, DME, and VA was examined using Cox proportional hazards models. The study was conducted between June and December 2022.

The key findings of this study were:

178 patients' eyes, totaling 321, were included in the analysis. 

A median (IQR) follow-up of 50.41 (48.16-56.48) months revealed that 68 eyes (21.18%) had VA deterioration, 33 eyes (10.28%) had DME, and 105 eyes (32.71%) had DR advancement. 

After adjusting for age, diabetes duration, fasting glucose, glycated haemoglobin, mean arterial blood pressure, DR severity, ganglion cell-inner plexiform layer thickness, axial length, and smoking at baseline, presence of superficial capillary plexus-DMI and deep capillary plexus-DMI were significantly associated with DR progression, whereas presence of deep capillary plexus-DMI was also associated with DME development and VA deterioration.

Reference: 

Yang, D., Tang, Z., Ran, A., Nguyen, T. X., Szeto, S., Chan, J., Wong, C. Y. K., Hui, V., Tsang, K., Chan, C. K. M., Tham, C. C., Sivaprasad, S., Lai, T. Y. Y., & Cheung, C. Y. (2023). Assessment of Parafoveal Diabetic Macular Ischemia on Optical Coherence Tomography Angiography Images to Predict Diabetic Retinal Disease Progression and Visual Acuity Deterioration. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2023.1821