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The effects of macular ischemia on visual acuity in diabetic retinopathy.

Abstract：

PURPOSE:To investigate the impact of diabetic macular ischemia (DMI) on visual acuity (VA), through the analysis of novel fluorescein angiography (FA) parameters. METHODS:Data were retrospectively collected over a 6-month period. DMI severity was graded using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols. Custom software was used to quantify areas of the foveal avascular zone (FAZ), and of capillary nonperfusion over the papillo-macular nerve fiber layer bundle, and temporal macula, and associations tested with VA. RESULTS:A total of 488 patients with type 2 diabetes mellitus and FAs of sufficient quality to allow detailed quantitative analyses were included. ETDRS-DMI SEVerity was graded as: none, 39.7%; questionable, 18.4%; mild, 25.2%; moderate, 11.0%; and severe, 5.6%. Median FAZ areas were 0.19 mm(2) (interquartile range [IQR], 0.13-0.25); 0.25 mm(2) (IQR, 0.18-0.32); 0.27 mm(2) (IQR, 0.19-0.38); 0.32 mm(2) (IQR, 0.25-0.54); and 0.78 mm(2) (IQR, 0.60-1.32), respectively, and were significantly different between all grades (P < 0.002), apart from "questionable" versus "mild" grades. Significant association of VA to FAZ area was observed only in the moderate (β = 0.406, SE = 0.101, P = 0.001) and severe (β = 0.299, SE = 0.108, P = 0.006) subgroups, but not in milder ETDRS-DMI grades. A strong association with VA was observed in cases with papillomacular ischemia (β = 1.123, SE = 0.355, P = 0.005), independent of FAZ size or the presence of macular edema. CONCLUSIONS:Diabetic macular ischemia is associated with reduced VA in eyes with moderate to severe ETDRS-DMI grades of ischemia but preserved in milder grades. In addition, we describe the independent association of papillomacular nerve fiber bundle ischemia with reduced VA.

journal_name

Invest Ophthalmol Vis Sci

journal_title

Investigative ophthalmology & visual science

authors

Sim DA,Keane PA,Zarranz-Ventura J,Fung S,Powner MB,Platteau E,Bunce CV,Fruttiger M,Patel PJ,Tufail A,Egan CA

doi

10.1167/iovs.12-11103

subject

Has Abstract

pub_date

2013-03-28 00:00:00

pages

2353-60

issue

3

eissn

0146-0404

issn

1552-5783

pii

iovs.12-11103

journal_volume

54

pub_type

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