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Graefe's Archive for Clinical and Experimental Ophthalmology

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24-11-2023 | Diabetic Retinopathy | Retinal Disorders

Association between choroidopathy and photoreceptors during the early stage of diabetic retinopathy: a cross-sectional study

Authors: Ningxin Dou, Guangyang Li, Dong Fang, Shaochong Zhang, Xiaoling Liang, Shanshan Yu

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 4/2024

Abstract

Purpose

To explore the role of choroidopathy in diabetic retinopathy (DR) by investigating the correlation between alterations of choroidal vessel and photoreceptors during the early stage of DR.

Methods

We performed a cross-sectional comparison of diabetic patients without DR (NDR group; n=16) and those with mild nonproliferative diabetic retinopathy (NPDR group; n=39). Optical coherence tomography (OCT) images of choroidal vessel alterations and photoreceptor structures were evaluated using the choroidal vascularity index (CVI) and adjusted ellipsoid zone (EZ) reflectivity, respectively. To evaluate the function of cone photoreceptors, the fundamental, harmonic amplitudes, the parameters S and R_mp3 were calculated from the electroretinogram (ERG). These factors were compared between groups. The correlation between the CVI and parameters describing the function and structure of the photoreceptors was evaluated.

Results

The significant decrease was observed in the CVI in the NPDR group compared to the NDR group (0.67 ± 0.04 vs. 0.70 ± 0.06; p = 0.028), but not in the adjusted EZ reflectivity or ERG parameters. In NPDR group and merging the 2 groups, CVI was moderately positively correlated with the fundamental amplitude obtained by the flicker ERG (NPDR only: r = 0.506; p = 0.001; merge the 2 groups: r = 0.423; p = 0.001), which was regulated by the response of the cone photoreceptors. The CVI was positively and moderately correlated with the logS (NPDR only: r = 0.462; p = 0.003; merge the 2 groups: r = 0.355; p = 0.008), indicating the sensitivity of cone cell light transduction.

Conclusion

Compared to eyes without DR, CVI decreased representing choroidal vascular changes in eyes with mild NPDR. These changes may be related to the functional impairment of cone photoreceptors, especially phototransduction sensitivity, as the DR develops.

Assi L, Chamseddine F, Ibrahim P, Sabbagh H, Rosman L, Congdon N, Evans J, Ramke J, Kuper H, Burton MJ, Ehrlich JR, Swenor BK (2021) A global assessment of eye health and quality of life: a systematic review of systematic reviews. JAMA Ophthalmol 139:526–541. https://doi.org/10.1001/jamaophthalmol.2021.0146CrossRefPubMed

Cheung N, Mitchell P, Wong TY (2010) Diabetic retinopathy. Lancet (London, England) 376:124–136. https://doi.org/10.1016/s0140-6736(09)62124-3CrossRefPubMed

Cao J, McLeod S, Merges CA, Lutty GA (1998) Choriocapillaris degeneration and related pathologic changes in human diabetic eyes. Arch Ophthalmol 116:589–597. https://doi.org/10.1001/archopht.116.5.589CrossRefPubMed

Murakami T, Uji A, Suzuma K, Dodo Y, Yoshitake S, Ghashut R, Yoza R, Fujimoto M, Yoshimura N (2016) In vivo choroidal vascular lesions in diabetes on swept-source optical coherence tomography. PloS One 11:e0160317. https://doi.org/10.1371/journal.pone.0160317CrossRefPubMedPubMedCentral

Li L, Almansoob S, Zhang P, Zhou YD, Tan Y, Gao L (2019) Quantitative analysis of retinal and choroid capillary ischaemia using optical coherence tomography angiography in type 2 diabetes. Acta Ophthalmol 97:240–246. https://doi.org/10.1111/aos.14076CrossRefPubMed

Betzler BK, Ding J, Wei X, Lee JM, Grewal DS, Fekrat S, Sadda SR, Zarbin MA, Agarwal A, Gupta V, Schmetterer L, Agrawal R (2022) Choroidal vascularity index: a step towards software as a medical device. Br J Ophthalmol 106:149–155. https://doi.org/10.1136/bjophthalmol-2021-318782CrossRefPubMed

Gupta C, Tan R, Mishra C, Khandelwal N, Raman R, Kim R, Agrawal R, Sen P (2018) Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema-a novel OCT based imaging biomarker. PloS One 13:e0207435. https://doi.org/10.1371/journal.pone.0207435CrossRefPubMedPubMedCentral

Foo VHX, Gupta P, Nguyen QD, Chong CCY, Agrawal R, Cheng CY, Yanagi Y (2020) Decrease in choroidal vascularity index of Haller’s layer in diabetic eyes precedes retinopathy. BMJ Open Diabetes Res Care 8. https://doi.org/10.1136/bmjdrc-2020-001295

Hood DC, Birch DG (1995) Phototransduction in human cones measured using the alpha-wave of the ERG. Vision Res 35:2801–2810. https://doi.org/10.1016/0042-6989(95)00034-wCrossRefPubMed

10.

McAnany JJ, Chen YF, Liu K, Park JC (2019) Nonlinearities in the flicker electroretinogram: a tool for studying retinal dysfunction applied to early-stage diabetic retinopathy. Vision Res 161:1–11. https://doi.org/10.1016/j.visres.2019.05.005CrossRefPubMedPubMedCentral

11.

Alexander KR, Barnes CS, Fishman GA (2001) Origin of deficits in the flicker electroretinogram of the cone system in X-linked retinoschisis as derived from response nonlinearities. J Opt Soc Am A Opt Image Sci Vis 18:747–754. https://doi.org/10.1364/josaa.18.000747CrossRefPubMed

12.

Sonoda S, Sakamoto T, Yamashita T, Uchino E, Kawano H, Yoshihara N, Terasaki H, Shirasawa M, Tomita M, Ishibashi T (2015) Luminal and stromal areas of choroid determined by binarization method of optical coherence tomographic images. Am J Ophthalmol 159:1123–1131.e1121. https://doi.org/10.1016/j.ajo.2015.03.005CrossRefPubMed

13.

Zeng Y, Cao D, Yang D, Zhuang X, Yu H, Hu Y, Zhang Y, Yang C, He M, Zhang L (2020) Screening for diabetic retinopathy in diabetic patients with a mydriasis-free, full-field flicker electroretinogram recording device. Doc Ophthalmol 140:211–220. https://doi.org/10.1007/s10633-019-09734-2CrossRefPubMed

14.

Değirmenci MFK, Demirel S, Batıoğlu F, Özmert E (2018) Role of a mydriasis-free, full-field flicker ERG device in the detection of diabetic retinopathy. Doc Ophthalmol 137:131–141. https://doi.org/10.1007/s10633-018-9656-8CrossRefPubMed

15.

McAnany JJ, Park JC (2019) Cone photoreceptor dysfunction in early-stage diabetic retinopathy: association between the activation phase of cone phototransduction and the flicker electroretinogram. Invest Ophthalmol Vis Sci 60:64–72. https://doi.org/10.1167/iovs.18-25946CrossRefPubMedPubMedCentral

16.

Agrawal R, Gupta P, Tan KA, Cheung CM, Wong TY, Cheng CY (2016) Choroidal vascularity index as a measure of vascular status of the choroid: measurements in healthy eyes from a population-based study. Sci Rep 6:21090. https://doi.org/10.1038/srep21090CrossRefPubMedPubMedCentral

17.

Cuenca N, Ortuño-Lizarán I, Sánchez-Sáez X, Kutsyr O, Albertos-Arranz H, Fernández-Sánchez L, Martínez-Gil N, Noailles A, López-Garrido JA, López-Gálvez M, Lax P, Maneu V, Pinilla I (2020) Interpretation of OCT and OCTA images from a histological approach: clinical and experimental implications. Prog Retin Eye Res 77:100828. https://doi.org/10.1016/j.preteyeres.2019.100828CrossRefPubMed

18.

Flores M, Debellemanière G, Bully A, Meillat M, Tumahai P, Delbosc B, Saleh M (2015) Reflectivity of the outer retina on spectral-domain optical coherence tomography as a predictor of photoreceptor cone density. Am J Ophthalmol 160:588–595.e582. https://doi.org/10.1016/j.ajo.2015.06.008CrossRefPubMed

19.

Toprak I, Yildirim C, Yaylali V (2015) Impaired photoreceptor inner segment ellipsoid layer reflectivity in mild diabetic retinopathy. Can J Ophthalmol 50:438–441. https://doi.org/10.1016/j.jcjo.2015.07.009CrossRefPubMed

20.

Guyon B, Elphege E, Flores M, Gauthier AS, Delbosc B, Saleh M (2017) Retinal reflectivity measurement for cone impairment estimation and visual assessment after diabetic macular edema resolution (RECOVER-DME). Invest Ophthalmol Vis Sci 58:6241–6247. https://doi.org/10.1167/iovs.17-22380CrossRefPubMed

21.

Kessler LJ, Auffarth GU, Bagautdinov D, Khoramnia R (2021) Ellipsoid zone integrity and visual acuity changes during diabetic macular edema therapy: a longitudinal study. J Diabetes Res 2021:8117650. https://doi.org/10.1155/2021/8117650CrossRefPubMedPubMedCentral

22.

Ro-Mase T, Ishiko S, Omae T, Ishibazawa A, Shimouchi A, Yoshida A (2020) Association between alterations of the choriocapillaris microcirculation and visual function and cone photoreceptors in patients with diabetes. Invest Ophthalmol Vis Sci 61:1. https://doi.org/10.1167/iovs.61.6.1CrossRefPubMedPubMedCentral

23.

McAnany JJ, Park JC (2018) Temporal frequency abnormalities in early-stage diabetic retinopathy assessed by electroretinography. Invest Ophthalmol Vis Sci 59:4871–4879. https://doi.org/10.1167/iovs.18-25199CrossRefPubMedPubMedCentral

24.

Xu F, Li Z, Yang X, Gao Y, Li Z, Li G, Wang S, Ning X, Li J (2022) Assessment of choroidal structural changes in patients with pre- and early-stage clinical diabetic retinopathy using wide-field SS-OCTA. Front Endocrinol 13:1036625. https://doi.org/10.3389/fendo.2022.1036625CrossRef

Title: Association between choroidopathy and photoreceptors during the early stage of diabetic retinopathy: a cross-sectional study
Authors: Ningxin Dou
Guangyang Li
Dong Fang
Shaochong Zhang
Xiaoling Liang
Shanshan Yu
Publication date: 24-11-2023
Publisher: Springer Berlin Heidelberg
Keywords: Diabetic Retinopathy
Diabetic Retinopathy
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 4/2024
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06282-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between choroidopathy and photoreceptors during the early stage of diabetic retinopathy: a cross-sectional study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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