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- Title
Assessment of Parafoveal Diabetic Macular Ischemia on Optical Coherence Tomography Angiography Images to Predict Diabetic Retinal Disease Progression and Visual Acuity Deterioration.
- Authors
Yang, Dawei; Tang, Ziqi; Ran, Anran; Nguyen, Truong X.; Szeto, Simon; Chan, Jason; Wong, Cherie Y. K.; Hui, Vivian; Tsang, Ken; Chan, Carmen K. M.; Tham, Clement C.; Sivaprasad, Sobha; Lai, Timothy Y. Y.; Cheung, Carol Y.
- Abstract
This cohort study investigates the association of the deep learning–based diabetic macular ischemia with the subsequent risk of diabetic retinopathy progression, diabetic macular edema development, and visual acuity deterioration. Key Points: Question: Can an automated binary diabetic macular ischemia (DMI) algorithm using optical coherence tomography angiography (OCTA) images predict diabetic retinal disease progression and visual acuity (VA) deterioration? Findings: In this cohort study of 321 eyes from 178 patients, the presence of DMI on OCTA images demonstrated prognostic value for diabetic retinopathy progression, diabetic macular edema development, and VA deterioration. Meaning: These findings provide evidence that an OCTA-based DMI evaluation may improve the evaluation of risk of diabetic retinopathy progression, diabetic macular edema development, and VA deterioration beyond traditional risk factors and may provide insights for incorporating both OCTA and artificial intelligence to early detect DMI and further enhance diabetic retinopathy management. 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.
- Publication
JAMA Ophthalmology, 2023, Vol 141, Issue 7, p641
- ISSN
2168-6165
- Publication type
Article
- DOI
10.1001/jamaophthalmol.2023.1821