Characterization of the Structural and Functional Alteration in Eyes with Diabetic Macular Ischemia

Wei Shan Tsai; Sridevi Thottarath; Sarega Gurudas; Elizabeth Pearce; Andrea Giani; Victor Chong; Chui Ming Gemmy Cheung; Sobha Sivaprasad

doi:10.1016/j.oret.2022.07.010

Characterization of the Structural and Functional Alteration in Eyes with Diabetic Macular Ischemia

Wei Shan Tsai, Sridevi Thottarath, Sarega Gurudas, Elizabeth Pearce, Andrea Giani, Victor Chong, Chui Ming Gemmy Cheung, Sobha Sivaprasad

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Abstract

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.

Original language	English
Pages (from-to)	142-152
Number of pages	11
Journal	Ophthalmology Retina
Volume	7
Issue number	2
Early online date	7 Aug 2022
DOIs	https://doi.org/10.1016/j.oret.2022.07.010
Publication status	Published - 2 Feb 2023
Externally published	Yes

Bibliographical note

This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

You are not required to obtain permission to reuse this article.

Funder

The 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.).

Publisher Copyright:
© 2022 American Academy of Ophthalmology

Keywords

Diabetic macular ischemia
Disorganization of the retinal inner layers
Ellipsoid zone loss
Optical coherence tomography
Optical coherence tomography angiography

ASJC Scopus subject areas

Ophthalmology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.oret.2022.07.010Licence: CC BY

PublishedFinal published version, 727 KBLicence: CC BY

Cite this

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title = "Characterization of the Structural and Functional Alteration in Eyes with Diabetic Macular Ischemia",

abstract = "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.",

keywords = "Diabetic macular ischemia, Disorganization of the retinal inner layers, Ellipsoid zone loss, Optical coherence tomography, Optical coherence tomography angiography",

author = "Tsai, {Wei Shan} and Sridevi Thottarath and Sarega Gurudas and Elizabeth Pearce and Andrea Giani and Victor Chong and {Gemmy Cheung}, {Chui Ming} and Sobha Sivaprasad",

note = "This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article. ",

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doi = "10.1016/j.oret.2022.07.010",

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AU - Tsai, Wei Shan

AU - Thottarath, Sridevi

AU - Gurudas, Sarega

AU - Pearce, Elizabeth

AU - Giani, Andrea

AU - Chong, Victor

AU - Gemmy Cheung, Chui Ming

AU - Sivaprasad, Sobha

N1 - This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.

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Y1 - 2023/2/2

N2 - 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.

AB - 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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KW - Ellipsoid zone loss

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Characterization of the Structural and Functional Alteration in Eyes with Diabetic Macular Ischemia

Abstract

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UN SDGs

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