Optical Coherence Tomography-angiography: Comparison of the Foveal Avascular Zone between Diabetic Retinopathy and Normal Subjects

MD In Geun Kim,; MD Joo Eun Lee,

doi:10.3341/jkos.2017.58.8.952

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In Geun Kim, and Joo Eun Lee,: Optical Coherence Tomography-angiography: Comparison of the Foveal Avascular Zone between Diabetic Retinopathy and Normal Subjects

Original Article

J Korean Ophthalmol Soc 2017;58(8):952-959.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.8.952

Optical Coherence Tomography-angiography: Comparison of the Foveal Avascular Zone between Diabetic Retinopathy and Normal Subjects

MD In Geun Kim,, PhD¹, MD Joo Eun Lee,, PhD^2,

¹J Eye Center

²Busan, Korea Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Joo Eun Lee, MD, PhD Department of Ophthalmology, Inje University Haeundae Paik Hospital, # 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea Tel: 82-51-797-2310, Fax: 82-51-797-3534 E-mail: jooeun2@paik.ac.kr

* This work was supported by Grant from Inje University, 2011.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 2 May 201710 July 2017 Accepted 28 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effectiveness of optical coherence tomography angiography (OCTA) in investigating changes in the area of the foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) and normal subjects.

Methods

Eighty-five eyes of 50 DR patients and 50 eyes of 25 normal subjects were included. OCTA images of the FAZ were acquired using the split-spectrum amplitude decorrelation angiography algorithm of Optovue Avanti RTVue XR OCT. Patients were divided into three groups according to DR severity: mild-to-moderate non-proliferative diabetic retinopathy (NPDR) group, severe NPDR group, and proliferative DR group. The area of the FAZ was measured using built-in software and was compared between the patients and normal subjects and among the three groups.

Results

The area of the FAZ in patients with diabetic retinopathy (0.46 mm²) was significantly larger than that in normal subjects (0.30 mm², p = 0.001). A significant difference was observed depending on DR severity: 0.40 mm² in the mild-to-moderate NPDR group, 0.45 mm² in the severe NPDR group, and 0.53 mm² in the PDR group (p = 0.03). Correlation between area of the foveal avascular zone and visual acuity showed a tendency toward reduction in visual acuity (p = 0.002).

Conclusions

OCTA effectively detected changes in the FAZ area in DR patients. OCTA has the potential to be used for non-invasive quantification and monitoring of the FAZ.

Keywords: Diabetic retinopathy, Foveal avascular zone, Optical coherence tomography angiography

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Figure 1.

Foveal avascular zone (FAZ) measured by optical coherence tomography angiography. Optical coherence tomog-raphy angiography clearly shows the area of the FAZ of the su-perficial retinal capillary plexus around the fovea. The margin of the FAZ was automatically demarcated and the area was measured by the built-in software.

Figure 2.

Optical coherence tomography angiography images of normal individuals and patients with diabetic retinopathy. (A) The foveal avascular zone (FAZ) in healthy individuals was round in shape and had regular borders (arrow). (B) The FAZ in patients with diabetic retinopathy had irregular borders (arrow). The pathologic capillary nonperfusion area was also frequently found outside the FAZ (arrowhead). The area of the FAZ in patients with diabetic retinopathy (B) was significantly larger than that in normal subjects.

Figure 3.

Comparison of the size of the foveal avascular zone (FAZ) according to diabetic retinopathy severity. Representative pho-tographs of the mild-to-moderate non-proliferative diabetic retinopathy (NPDR) (A), severe NPDR (B) and proliferative diabetic retinopathy (C) groups. A significant difference in the size of the FAZ was seen among the three groups.

Figure 4.

Correlation between the foveal avascular zone and visual acuity. It showed a tendency towards reduction in visual acuity (Pearson correlation coefficient = 0.392, p = 0.002). BCVA = best corrected visual acuity; FAZ = foveal avascular zone; logMAR = logarithm of minimum angle of resolution.

Table 1.

Comparison of the mean area of the foveal avascular zone between patients with diabetic retinopathy and normal subjects

	Normal subjects (n= 50 eyes)	Eyes with DR (n= 85 eyes)	p-value^*
Age (years)	33.4 ± 9.8	57.2 ± 12.4
Sex (male:female)	5:20	37:13
Area of FAZ (mm²)	0.30 ± 0.10	0.46 ± 0.16	0.001^*

Values are presented as mean ± SD unless otherwise indicated.

DR = diabetic retinopathy; FAZ = foveal avascular zone.

^* Mann-Whitney U-test.

Table 2.

Comparison of the foveal avascular zone among diabetic retinopathy patients

	Mild-moderate NPDR (n= 19 eyes)	Severe NPDR (n= 43 eyes)	PDR (n= 15 eyes)	p-value^*
Age (years)	55.3 ± 11.2	58.7 ± 12.9	57.3 ± 11.7
Sex (male:female)	11:8	32:11	9:6
Area of FAZ (mm²)	0.40 ± 0.12	0.45 ± 0.16	0.53 ± 0.14	0.03^*

Values are presented as mean ± SD unless otherwise indicated.

NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; FAZ = foveal avascular zone.

^* Kruskal-Wallis test.

Table 3.

Comparison of the mild-moderate NPDR group, severe NPDR group and PDR group

	Mild-moderate NPDR vs. Severe NPDR	Severe NPDR vs. PDR	Mild-moderate NPDR vs. PDR
p-value^*	0.030	0.046	0.001

NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

^* Mann-Whitney U-test.

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