Expanded Field OCT Angiography Biomarkers for Predicting Clinically Significant Outcomes in Non-Proliferative Diabetic Retinopathy

Xinyi Ding; Francesco Romano; Itika Garg; Jenny Gan; Filippos Vingopoulos; Mauricio D Garcia; Katherine M Overbey; Ying Cui; Ying Zhu; Cade F Bennett; Isabella Stettler; Mridula Shan; Matthew J Finn; Demetrios G Vavvas; Deeba Husain; Nimesh A Patel; Leo A Kim; John B Miller

doi:10.1016/j.ajo.2024.10.016

Expanded Field OCT Angiography Biomarkers for Predicting Clinically Significant Outcomes in Non-Proliferative Diabetic Retinopathy

Am J Ophthalmol. 2024 Oct 28:270:216-226. doi: 10.1016/j.ajo.2024.10.016. Online ahead of print.

Authors

Xinyi Ding¹, Francesco Romano¹, Itika Garg², Jenny Gan², Filippos Vingopoulos², Mauricio D Garcia², Katherine M Overbey², Ying Cui², Ying Zhu², Cade F Bennett², Isabella Stettler², Mridula Shan², Matthew J Finn², Demetrios G Vavvas³, Deeba Husain³, Nimesh A Patel³, Leo A Kim³, John B Miller⁴

Affiliations

¹ From the Harvard Retinal Imaging Lab (X.D., F.R., I.G., J.G., F.V., M.D.G., K.M.O., Y.C., Y.Z., C.F.B., I.S., M.S., M.J.F., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Retina Service (X.D., F.R., D.G.V., D.H., N.A.P., L.A.K., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
² From the Harvard Retinal Imaging Lab (X.D., F.R., I.G., J.G., F.V., M.D.G., K.M.O., Y.C., Y.Z., C.F.B., I.S., M.S., M.J.F., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
³ Retina Service (X.D., F.R., D.G.V., D.H., N.A.P., L.A.K., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
⁴ From the Harvard Retinal Imaging Lab (X.D., F.R., I.G., J.G., F.V., M.D.G., K.M.O., Y.C., Y.Z., C.F.B., I.S., M.S., M.J.F., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Retina Service (X.D., F.R., D.G.V., D.H., N.A.P., L.A.K., J.B.M.), Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: [email protected].

PMID: 39490720
DOI: 10.1016/j.ajo.2024.10.016

Abstract

Purpose: To evaluate the utility of extended field swept-source Optical Coherence Tomography Angiography (SS-OCTA) imaging biomarkers in predicting the occurrence of clinically significant outcomes in eyes with Non-Proliferative Diabetic Retinopathy (NPDR).

Design: Retrospective clinical case-control study.

Methods: Single-center clinical study. Eighty-eight eyes with NPDR from 57 participants (median age: 64.0 years; mean duration of diabetes: 15.8 years) with at least 2 consecutive SS-OCTA scans over a follow-up period of at least 6 months were included. The presence of intraretinal microvascular abnormalities (IRMAs) at baseline and the stability of IRMAs during follow-up period on 12 × 12-mm angiograms were evaluated. Baseline nonperfusion ischemia index (ISI) and other SS-OCTA metrics were calculated on FIJI and ARI Network. Significant clinical outcomes were defined as occurrence of one or more of the following events at the last available clinical visit:1. significant DR progression (2-step DR progression or progression to proliferative DR (PDR)); 2) development of new center-involving diabetic macular edema (CI-DME); and 3) initiation of treatment with PRP or anti-VEGF injections during the follow-up period. Mixed-effects Cox regression models was used to explore these outcomes.

Results: Following a clinical follow-up period lasting 25.1 ± 10.8 months, we observed significant clinical outcomes in 17 eyes (19.3%). Among these, 7 eyes (8.0%) experienced significant progression and 4 eyes (4.5%) developed CI-DME. Anti-VEGF injections were initiated in 15 eyes (17.0%), while PRP was initiated in 2 eyes (2.3%). Upon adjusting for age, the duration of DM, and prior Anti-VEGF treatments, our analysis revealed that non-stable IRMAs during the follow-up periods and a higher ischemia index at baseline were significantly associated with the occurrence of significant clinical outcomes with HRs of 3.88 (95% CI: 1.56-9.64; p = .004) and 1.05 (95% CI: 1.02-1.09; p = .004), respectively.

Conclusions: In conclusion, NPDR eyes with non-stable IRMAs over time and more ischemia at baseline are in higher risk of developing significant clinical outcomes. Our findings suggest that expanded field SS-OCTA may offer additional prognostic benefits for clinical DR staging and predicting high-risk patients.