研究目的
To evaluate the microvascular and neural differences of the optic nerve head (ONH) between type 2 diabetes mellitus (T2DM) subjects and controls, and to provide evidence on whether microvascular changes or neural impairment occurs first in early-stage diabetic retinopathy.
研究成果
OCTA findings suggest that microvascular changes in the optic nerve head area may precede neural impairment in early-stage diabetic retinopathy. Reduced ONH perfusion inside the optic disc is a crucial biomarker for early detection and a predictor of visual acuity. OCTA with ONH mode is a promising tool for DR screening, but more research is required to confirm these findings.
研究不足
The study was a cross-sectional observational study, limiting causal inferences. Assessments of retinal neurodysfunction such as multifocal electroretinograms (mfERG) were not performed. The sample size was relatively small. Automatic segmentation was used for density calculations, which may have errors. Further longitudinal studies with neurodysfunction assessments are needed.
1：Experimental Design and Method Selection:
This was a cross-sectional observational study using optical coherence tomography angiography (OCTA) to assess microvascular and neural parameters in the optic nerve head (ONH) area. The study adhered to the tenets of the Declaration of Helsinki and was approved by the research ethics committee.
2：Sample Selection and Data Sources:
One hundred and eight eyes of 108 T2DM subjects (54 preclinical diabetic retinopathy and 54 mild-to-moderate non-proliferative diabetic retinopathy) and 52 eyes of 52 healthy subjects as controls were recruited from the ophthalmology department of the DM centre between January 2018 and October
3：Inclusion criteria included diagnosis of T2DM with no DR or mild-to-moderate NPDR, T2DM duration more than 1 year, age not less than 40 years. Exclusion criteria included moderate or high myopia, glaucoma, optic neuropathy, other retinal diseases, dioptric media opacity, history of intraocular surgery, and macular edema. List of Experimental Equipment and Materials:
20 OCTA device (RTVue XR Avanti with AngioVue
4：0 software, Optovue Inc.), FFA device (Microclear, Inc.), 7 standard 35-mm colour fundus photographs (7F-ETDRS, Canon, Inc.), LogMAR best-corrected visual acuity (BCVA) measurement, intraocular pressure (IOP) measurement, dilated fundus examination. Experimental Procedures and Operational Workflow:
OCTA images were obtained using the
5：5-mm Angio Disc scan mode and the ganglion cell complex (GCC) scan mode. All examinations were performed by experienced ophthalmic examiners. Images with scan quality less than 6 were excluded. Radial peripapillary capillary (RPC) density in different sections and peripapillary thicknesses were automatically calculated by the software. Data Analysis Methods:
Statistical analyses were performed using SPSS 24.0. One-way ANOVA with Bonferroni's post hoc analysis for numerical variables, chi-squared test for categorical variables. Multivariable binary logistic regression and multiple linear regression were used for further analysis. Receiver operating characteristic (ROC) curves were generated.
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