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Original Investigation
May 10, 2018

Association Between Vessel Density and Visual Acuity in Patients With Diabetic Retinopathy and Poorly Controlled Type 1 Diabetes

Author Affiliations
  • 1Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
JAMA Ophthalmol. Published online May 10, 2018. doi:10.1001/jamaophthalmol.2018.1319
Key Points

Question  What is the association between macular vessel density as measured by optical coherence tomography angiography and visual acuity in patients with diabetic retinopathy and poorly controlled type 1 diabetes?

Findings  In a cohort study of 22 eyes of 22 patients with type 1 diabetes and diabetic retinopathy without macular edema, 41% had decreased vision. Vessel density was lower in eyes with diabetic retinopathy and decreased vision than in eyes with diabetic retinopathy and normal vision; loss of vessel density was greater in the deep capillary complex, particularly the deep capillary plexus, than in the superficial vascular plexus.

Meaning  These findings suggest that decreased vision in patients with diabetic retinopathy may be associated with the degree of capillary loss in the deep capillary complex.

Abstract

Importance  Capillary dropout is a hallmark of diabetic retinopathy, but its role in visual loss remains unclear.

Objective  To examine how macular vessel density is correlated with visual acuity (VA) in patients younger than 40 years who have type 1 diabetes without macular edema but who have diabetic retinopathy requiring panretinal photocoagulation.

Design, Settings, and Participants  Retrospective cohort study of VA and optical coherence tomography angiography data collected from consecutive patients during a single visit to Lariboisière Hospital, a tertiary referral center in Paris, France. The cohort included 22 eyes of 22 patients with type 1 diabetes without macular edema but with bilateral rapidly progressive diabetic retinopathy that was treated with panretinal photocoagulation between August 15, 2015, and December 30, 2016. Eyes were classified into 2 groups by VA: normal (logMAR, 0; Snellen equivalent, 20/20) and decreased (logMAR, >0; Snellen equivalent, <20/20). The control group included 12 eyes from age-matched healthy participants with normal vision.

Main Outcomes and Measures  Visual acuity and mean vessel density in 4 retinal vascular plexuses: the superficial vascular plexus and the deep capillary complex, which comprises the intermediate capillary plexus and the deep capillary plexus.

Results  Of the 22 participants, 11 (50%) were men, mean (SD) age was 30 (6) years, and mean (SD) hemoglobin A1c level was 8.9% (1.6%). Of the 22 eyes with diabetic retinopathy, 13 (59%) had normal VA and 9 (41%) had decreased VA (mean [SD]: logMAR, 0.12 [0.04]; Snellen equivalent, 20/25). Mean [SE] vessel density was lower for eyes with diabetic retinopathy and normal VA compared with the control group in the superficial vascular plexus (44.1% [0.9%] vs 49.1% [0.9%]; difference, −5.0% [1.3%]; 95% CI, −7.5% to −2.4%; P < .001), in the deep capillary complex (44.3% [1.2%] vs 50.6% [1.3%]; difference, −6.3% [1.8%]; 95% CI, −9.9% to −2.7%; P = .001), in the intermediate capillary plexus (43.8% [1.2%] vs 49.3% [1.2%]; difference, −5.5% [1.7%]; 95% CI, −9.0% to −2.0%; P = .003), and in the deep capillary plexus (24.5% [1.0%] vs 30.5% [1.0%]; difference, −6.1% [1.4%]; 95% CI, −8.9% to −3.2%; P < .001). Mean vessel density was lower in eyes with diabetic retinopathy and decreased VA compared with eyes with diabetic retinopathy and normal VA; the mean (SE) loss was more pronounced in the deep capillary complex (34.6% [1.5%] vs 44.3% [1.2%]; difference, −9.6% [1.9%]; 95% CI, −13.6% to −5.7%; P < .001), especially in the deep capillary plexus (15.2% [1.2%] vs 24.5% [1.0%]; difference, −9.3% [1.5%]; 95% CI, −12.4% to −6.1%; P < .001), than in the superficial vascular plexus (39.6% [1.1%] vs 44.1% [0.9%]; difference, −4.5% [1.4%]; 95% CI, −7.3% to −1.7%; P = .002).

Conclusions and Relevance  These data suggest that in patients with type 1 diabetes without macular edema but with severe nonproliferative or proliferative diabetic retinopathy, decreased VA may be associated with the degree of capillary loss in the deep capillary complex.

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