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Olivieri C, Salato M, Campanella A, Marolo P, Parisi G, Neri G, Toro MD, Scarmozzino A, Broglio F, Borrelli E, Reibaldi M. Comparison of diabetic retinopathy screening between hospital-based multidisciplinary and general practice-based settings: insights from a regional study in Italy. Acta Diabetol 2024:10.1007/s00592-024-02354-6. [PMID: 39160371 DOI: 10.1007/s00592-024-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/04/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To compare diabetic retinopathy screening among patients with type 1 or type 2 diabetes under care in two distinct setups: hospital-based multidisciplinary and general practice-based. MATERIALS AND METHODS In this retrospective observational case series, we collected data from a total of 133 diabetic patients: subjects from the hospital-based multidisciplinary setting were referred by the diabetologist and screened by an ophthalmologist using the Optomed Aurora IQ fundus camera. These patients were compared with those who underwent DR screening arranged through a general practice-based setting. RESULTS The proportion of patients treated with insulin was higher in the hospital-based multidisciplinary group, both considering the totality patients and those affected by type 2 diabetes (71.6% vs. 32.2%; p < 0.001, and 58.8% vs. 31.0%; p = 0.004 respectively). Patients from the hospital-based multidisciplinary group had a longer mean diabetes duration (19.6 vs 14.9 years, p < 0.001), underwent DR screening more frequently in the previous three years (2.9 vs 1.4, p < 0.001), the mean time between two DR screenings was shorter (14.6 vs 77.9 weeks, p < 0.001), and DR was detected more frequently (32,4% vs 13.5%; p = 0.011). CONCLUSION We were able to demonstrate that patients screened in the multidisciplinary center, which had characteristics predisposing to a higher risk of DR, were more likely to be diagnosed with DR on time, with a higher mean number of DR screenings and a shorted interval between diabetic and ophthalmological assessments.
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Affiliation(s)
- Chiara Olivieri
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | | | | | - Paola Marolo
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Giovanni Neri
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Mario Damiano Toro
- Public Health Department, Eye Clinic, University of Naples Federico II, 80138, Naples, Italy
| | - Antonio Scarmozzino
- Department of Quality and Cure Safety, Città Della Salute E Della Scienza, Turin, Italy
| | - Fabio Broglio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Turin, Italy.
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy.
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
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Tombolini B, Crincoli E, Sacconi R, Battista M, Fantaguzzi F, Servillo A, Bandello F, Querques G. Optical Coherence Tomography Angiography: A 2023 Focused Update on Age-Related Macular Degeneration. Ophthalmol Ther 2024; 13:449-467. [PMID: 38180632 PMCID: PMC10787708 DOI: 10.1007/s40123-023-00870-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Optical coherence tomography angiography (OCTA) has extensively enhanced our comprehension of eye microcirculation and of its associated diseases. In this narrative review, we explored the key concepts behind OCTA, as well as the most recent evidence in the pathophysiology of age-related macular degeneration (AMD) made possible by OCTA. These recommendations were updated since the publication in 2020, and are targeted for 2023. Importantly, as a future perspective in OCTA technology, we will discuss how artificial intelligence has been applied to OCTA, with a particular emphasis on its application to AMD study.
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Affiliation(s)
- Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Emanuele Crincoli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Srinivasan S, Sivaprasad S, Rajalakshmi R, Anjana RM, Malik RA, Kulothungan V, Raman R, Bhende M. Association of OCT and OCT angiography measures with the development and worsening of diabetic retinopathy in type 2 diabetes. Eye (Lond) 2023; 37:3781-3786. [PMID: 37280352 PMCID: PMC10698183 DOI: 10.1038/s41433-023-02605-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE To assess if optical coherence tomography (OCT) and OCT angiography (OCTA) measures are associated with the development and worsening of diabetic retinopathy (DR) over four years. METHODS 280 participants with type 2 diabetes underwent ultra-wide field fundus photography, OCT and OCTA. OCT-derived macular thickness measures, retinal nerve fibre layer and ganglion cell-inner plexiform layer thickness and OCTA-derived foveal avascular zone area, perimeter, circularity, vessel density (VD) and macular perfusion (MP) were examined in relation to the development and worsening of DR over four years. RESULTS After four years, 206 eyes of 219 participants were eligible for analysis. 27 of the 161 eyes (16.7%) with no DR at baseline developed new DR, which was associated with a higher baseline HbA1c and longer diabetes duration. Of the 45 eyes with non-proliferative DR (NPDR) at baseline, 17 (37.7%) showed DR progression. Baseline VD (12.90 vs. 14.90 mm/mm2, p = 0.032) and MP (31.79% vs. 36.96%, p = 0.043) were significantly lower in progressors compared to non-progressors. Progression of DR was inversely related to VD ((hazard ratio [HR] = 0.825) and to MP (HR = 0.936). The area under the receiver operating characteristic curves for VD was AUC = 0.643, with 77.4% sensitivity and 41.8% specificity for a cut-off of 15.85 mm/mm2 and for MP it was AUC = 0.635, with 77.4% sensitivity and 25.5% specificity for a cut-off of 40.8%. CONCLUSIONS OCTA metrics have utility in predicting progression rather than the development of DR in individuals with type 2 diabetes.
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Affiliation(s)
| | | | | | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar & Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Vaitheeswaran Kulothungan
- National Centre for Disease Informatics and Research (NCDIR) & Indian Council of Medical Research (ICMR), Bangalore, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
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Bandello F, Borrelli E, Trevisi M, Lattanzio R, Sacconi R, Querques G. Imaging Biomarkers of Mesopic and Dark-Adapted Macular Functions in Eyes With Treatment-Naïve Mild Diabetic Retinopathy. Am J Ophthalmol 2023; 253:56-64. [PMID: 37059317 DOI: 10.1016/j.ajo.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To investigate the relationship between imaging biomarkers and mesopic and dark-adapted (ie, scotopic) functions in patients with treatment-naïve mild diabetic retinopathy (DR) and normal visual acuity. DESIGN Prospective cross-sectional study. METHODS In this study, 60 patients with treatment-naïve mild DR (Early Treatment of Diabetic Retinopathy Study levels 20-35) and 30 healthy control subjects underwent microperimetry, structural optical coherence tomography (OCT), and OCT angiography (OCTA). RESULTS The foveal mesopic (22.4 ± 4.5 dB and 25.8 ± 2.0 dB, P = .005), parafoveal mesopic (23.2 ± 3.8 and 25.8 ± 1.9, P < .0001), and parafoveal dark-adapted (21.1 ± 2.8 dB and 23.2 ± 1.9 dB, P = .003) sensitivities were reduced in DR eyes. For foveal mesopic sensitivity, the regression analysis showed a significant topographic association with choriocapillaris flow deficits percentage (CC FD%; β = -0.234, P = .046) and ellipsoid zone (EZ) normalized reflectivity (β = 0.282, P = .048). Parafoveal mesopic sensitivity was significantly topographically associated with inner retinal thickness (β = 0.253, P = .035), deep capillary plexus (DCP) vessel length density (VLD; β = 0.542, P = .016), CC FD% (β = -0.312, P = .032), and EZ normalized reflectivity (β = 0.328, P = .031). Similarly, parafoveal dark-adapted sensitivity was topographically associated with inner retinal thickness (β = 0.453, P = .021), DCP VLD (β = 0.370, P = .030), CC FD% (β = -0.282, P = .048), and EZ normalized reflectivity (β = 0.295, P = .042). CONCLUSIONS In treatment-naïve mild DR eyes, both rod and cone functions are affected and they are associated with both DCP and CC flow impairment, which suggests that a macular hypoperfusion at these levels might implicate a reduction in photoreceptor function. Normalized EZ reflectivity may be a valuable structural biomarker for assessing photoreceptor function in DR. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Francesco Bandello
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Enrico Borrelli
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Trevisi
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosangela Lattanzio
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
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Yang D, Tang Z, Ran A, Nguyen TX, Szeto S, Chan J, Wong CYK, Hui V, Tsang K, Chan CKM, Tham CC, Sivaprasad S, Lai TYY, Cheung CY. Assessment of Parafoveal Diabetic Macular Ischemia on Optical Coherence Tomography Angiography Images to Predict Diabetic Retinal Disease Progression and Visual Acuity Deterioration. JAMA Ophthalmol 2023; 141:641-649. [PMID: 37227703 PMCID: PMC10214181 DOI: 10.1001/jamaophthalmol.2023.1821] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/31/2023] [Indexed: 05/26/2023]
Abstract
Importance The presence of diabetic macular ischemia (DMI) on optical coherence tomography angiography (OCTA) images predicts diabetic retinal disease progression and visual acuity (VA) deterioration, suggesting an OCTA-based DMI evaluation can further enhance diabetic retinopathy (DR) management. Objective To investigate whether an automated binary DMI algorithm using OCTA images provides prognostic value on DR progression, diabetic macular edema (DME) development, and VA deterioration in a cohort of patients with diabetes. Design, Setting, and Participants In this cohort study, DMI assessment of superficial capillary plexus and deep capillary plexus OCTA images was performed by a previously developed deep learning algorithm. The presence of DMI was defined as images exhibiting disruption of fovea avascular zone with or without additional areas of capillary loss, while absence of DMI was defined as images presented with intact fovea avascular zone outline and normal distribution of vasculature. Patients with diabetes were recruited starting in July 2015 and were followed up for at least 4 years. Cox proportional hazards models were used to evaluate the association of the presence of DMI with DR progression, DME development, and VA deterioration. Analysis took place between June and December 2022. Main Outcomes and Measures DR progression, DME development, and VA deterioration. Results A total of 321 eyes from 178 patients were included for analysis (85 [47.75%] female; mean [SD] age, 63.39 [11.04] years). Over a median (IQR) follow-up of 50.41 (48.16-56.48) months, 105 eyes (32.71%) had DR progression, 33 eyes (10.28%) developed DME, and 68 eyes (21.18%) had VA deterioration. Presence of superficial capillary plexus-DMI (hazard ratio [HR], 2.69; 95% CI, 1.64-4.43; P < .001) and deep capillary plexus-DMI (HR, 3.21; 95% CI, 1.94-5.30; P < .001) at baseline were significantly associated with DR progression, whereas presence of deep capillary plexus-DMI was also associated with DME development (HR, 4.60; 95% CI, 1.15-8.20; P = .003) and VA deterioration (HR, 2.12; 95% CI, 1.01-5.22; P = .04) after adjusting for age, duration of diabetes, fasting glucose, glycated hemoglobin, mean arterial blood pressure, DR severity, ganglion cell-inner plexiform layer thickness, axial length, and smoking at baseline. Conclusions and Relevance In this study, the presence of DMI on OCTA images demonstrates prognostic value for DR progression, DME development, and VA deterioration.
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Affiliation(s)
- Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Truong X. Nguyen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Cherie Y. K. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Vivian Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Ken Tsang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Timothy Y. Y. Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- 2010 Eye & Cataract Centre, Hong Kong Special Administrative Region, China
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Iyer SS, Radhakrishnan NS, Roohipourmoallai R, Guerin CM, Maylath JS, Garson N. Chronic ocular small vessel disease: An overview of diabetic retinopathy and its relationship with cardiovascular health. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 29:100270. [PMID: 38510674 PMCID: PMC10945896 DOI: 10.1016/j.ahjo.2023.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/22/2024]
Abstract
Diabetic retinopathy (DR) is a potentially blinding disease originating from small vessel damage in the retina in chronic hyperglycemic states. DR has a complex multi-pathway driven pathogenesis resulting in diabetic macular edema and retinal ischemia, the former being the most common cause of vision impairment in DR. Hypoxia induced cytokines stimulate vascular endothelial growth factor (VEGF) production and subsequent angiogenesis with resultant mechanical retinal damage over time. Anti-VEGF therapy is effective for the treatment of center-involving diabetic macular edema. There is evolving evidence showing the effectiveness of anti-VEGF as both adjuvant and monotherapy in the treatment of proliferative DR, however laser photocoagulation continues to remain the standard of care. DR in large cohort studies has been shown to be an independent risk factor for the development of cardiovascular disease and mortality. In addition, changes in retinal vascular caliber ratios may have implications for risk of macrovascular events with a gender discrepancy towards women.
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Affiliation(s)
- Siva S.R. Iyer
- Vitreoretinal Associates, Gainesville, FL, United States of America
| | - Nila S. Radhakrishnan
- University of Florida College of Medicine, Department of Medicine, United States of America
| | - Ramak Roohipourmoallai
- University of South Florida College of Medicine, Department of Ophthalmology, United States of America
| | - Cynthia M. Guerin
- Texas Tech Department of Ophthalmology and Visual Sciences, United States of America
| | - Jeremy S. Maylath
- Texas Tech Department of Ophthalmology and Visual Sciences, United States of America
| | - Nickolas Garson
- University of Florida College of Medicine, Department of Ophthalmology, United States of America
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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Sener H, Gulmez Sevim D, Erkilic K, Oner A, Gunay Sener AB. Evaluation of Ring Amplitude and Factors Affecting Ring Amplitude in Multifocal Electroretinography in Diabetic Eyes. Semin Ophthalmol 2022; 37:895-901. [PMID: 35834721 DOI: 10.1080/08820538.2022.2100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this paper was to evaluate the ring amplitudes in diabetic patients and to evaluate the effect of the risk factors for diabetic retinopathy on the ring amplitudes. We also aimed to investigate the success of ring amplitudes in classifying diabetic retinopathy. METHODS The study included 32 eyes of 32 diabetic patients without retinopathy (DM), 34 eyes of 34 patients with mild non-proliferative diabetic retinopathy (NPDR) without macular edema, and 62 eyes of 62 age- and sex-matched controls (CG). All subjects were evaluated using mfERG. The relationship between age, diabetes duration, HbA1c and ring amplitudes and the effect of diabetes and hypertension on ring amplitudes were evaluated. Three-way ROC analysis was performed to evaluate the discrimination power of the ring amplitudes. RESULTS In the comparison of the ring amplitudes, the amplitudes of the DM and NPDR groups were statistically significantly decreased compared to the CG (p < .05). A moderate to strong correlation was found between the duration of diabetes, HbA1c and ring amplitudes (p < .05). The effect of diabetes decreased towards the peripheral rings and hypertension did not affect ring amplitudes. Volume under the ROC surface of R1 = 0.65 had p < .05 and 95% CI [0.50-0.72], and the best cut-off point pair to differentiate the three classes was found to be c1 = 217.3, c2 = 151.2 in three-way ROC analysis. CONCLUSION In conclusion, the effects of diabetes are unevenly distributed on the retina topographically. Diabetes affects the central rings more than peripheral rings in multifocal ERG. Both ring densities and ring ratios are effective ways to identify early changes in retinal function.
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Affiliation(s)
- Hidayet Sener
- Department of Ophthalmology, Cukurca State Hospital, Hakkari, Turkey
| | - Duygu Gulmez Sevim
- Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Kuddusi Erkilic
- Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ayse Oner
- Department of Ophthalmology, Acibadem Hospital, Kayseri, Turkey
| | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
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