Objective: To investigate the relative effect of disorganization of the retinal inner layers (DRIL) and ellipsoid zone (EZ) loss on visual function in diabetic macular ischemia (DMI). Design: Prospective cross-sectional observational study. Participants: Patients with stable treated proliferative diabetic retinopathy (PDR) without center-involved diabetic macular edema were recruited at the Moorfields Eye Hospital from December 2019 to November 2021. The main inclusion criteria were best-corrected visual acuity (BCVA) of ≥ 40 ETDRS letters (Snellen equivalent 20/160) with OCT angiography (OCTA) evidence of DMI in ≥ 1 eye. Methods: Each eligible eye of the recruited patients was assessed for BCVA, OCT, and OCTA metrics. The prespecified OCT parameters were DRIL and subfoveal EZ loss. Generalized estimating equations were used. Main Outcomes Measures: The frequency of DRIL and EZ loss, their relative contributions to vision loss, and their associations with microvascular alterations were evaluated. Results: A total of 125 eyes of 86 patients with PDR were enrolled; 104 (83%) eyes had a BCVA of ≥ 70 letters. Disorganization of the retinal inner layers was more prevalent than EZ loss (46% [58 eyes] vs. 19% [24 eyes]). On average, the presence of DRIL had a more pronounced impact on vision, retinal thickness, and microvascular parameters than EZ loss. After multivariable adjustment, the odds of coexisting DRIL increased by 12% with every letter decrease in BCVA; however, there was no statistically significant association of subfoveal EZ loss with BCVA. In eyes with DRIL in the absence of EZ loss, the BCVA declined significantly by 6.67 letters compared with eyes with no DRIL nor EZ loss (95% confidence interval [CI], −9.92 to −3.41; P < 0.001). However, if DRIL and EZ loss coexisted, the resultant BCVA was 13.22 letters less than eyes without these structural abnormalities (95% CI, −18.85 to −7.59; P < 0.001). Conclusions: In patients with DMI with a Snellen visual acuity of 20/160 or better, eyes with DRIL were associated with more visual function loss and retinal blood circulation alterations than those with subfoveal EZ loss only.
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FunderThe authors have made the following disclosures: S.S.: Consulting fees – Allergan, Apellis, Bayer, Boehringer Ingelheim, Novartis, Oxurion, Oculis, Roche; Grants – Bayer; Payment or honoraria for lectures – Allergan; Support for attending meetings and/or travel – Bayer; Leadership or fiduciary role – Macular Society Trustee; receipt of medical writing service – Boehringer Ingelheim.C.M.G.C.: Financial support to institution – Allergan, Bayer, Boehringer Ingelheim, Novartis, Roche, Topcon, Zeiss; Stock – Avirmax.Funded by Boehringer Ingelheim, Germany. Supported by the NIHR Biomedical Research Centre at the Moorfields Eye Hospital National Health Service Trust and the University College London Institute of Ophthalmology. Funded by the ORNATE-India research project grant (Ref: GCRF UKRI [MR/P027881/1]) (W.-S.T., S.T., S.G., S.S.). Obtained funding: Cheung, Sivaprasad
Funded by Boehringer Ingelheim , Germany. Supported by the NIHR Biomedical Research Centre at the Moorfields Eye Hospital National Health Service Trust and the University College London Institute of Ophthalmology. Funded by the ORNATE-India research project grant (Ref: GCRF UKRI [MR/P027881/1]) (W.-S.T., S.T., S.G., S.S.).
© 2022 American Academy of Ophthalmology
- Diabetic macular ischemia
- Disorganization of the retinal inner layers
- Ellipsoid zone loss
- Optical coherence tomography
- Optical coherence tomography angiography
ASJC Scopus subject areas