Clinical Ophthalmology (Jul 2024)
Quantitative Biomarkers of Diabetic Retinopathy Using Ultra-Widefield Fluorescein Angiography
Abstract
Salma Fleifil,1 Lyna Azzouz,1 Gina Yu,1 Corey Powell,2 Nikhil Bommakanti,1 Yannis M Paulus1,3 1Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Statistics, University of Michigan, Ann Arbor, MI, USA; 3Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USACorrespondence: Yannis M Paulus, Department of Ophthalmology and Visual Sciences, Department of Biomedical Engineering, University of Michigan, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +734 764-4182, Fax +734 936-3815, Email [email protected]: Diabetic retinopathy (DR) is a leading cause of blindness. Retinal imaging is an important tool to monitor the progression of DR. While seven-standard retinal fields are the traditional method for evaluating DR, ultra-widefield (UWF) imaging allows for improved visualization of peripheral areas of nonperfusion (NP) and neovascularization (NV), which could be used as biomarkers to monitor and predict progression of DR.Methods: A retrospective, cross-sectional study was conducted on 651 eyes from 363 patients diagnosed with type 1 or type 2 diabetes who received UWF-FA over 10 years. Fluorescein Angiography (FA) images were segmented, and surface areas of NP and NV were analyzed using multivariate regression to determine if biomarkers of DR and DR severity are associated with increasing areas of NP and NV.Results: Each additional year with a diagnosis of DR was associated with a 10.75 mm2 increase in the total NP (95% CI, 1.94— 19.56; P = 0.02) and 7.87 mm2 increase in NP far-periphery (95% CI, 1.62— 14.13; P = 0.01). A one-unit change in severity as defined by the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification was associated with a 25.75 mm2 increase in total NP (95% CI, 11.16— 40.33; P = 0.001), a 13.15 mm2 increase in mid-periphery NP (95% CI, 6.93— 19.38; P < 0.0001), and a 12.29 mm2 increase in far-periphery NP (95% CI, 3.62— 20.97; P = 0.01).Discussion: Biomarkers identified through UWF imaging such as total and regional areas of NP can be used to monitor and predict the progression of DR. This may provide a quantitative method for prognostication in patients with DR.keywords: diabetic retinopathy, ultra-widefield fluorescein angiography, nonperfusion, neovascularization
