Potential Imaging Biomarkers in the Development and Progression of Diabetic Retinopathy

Diabetic retinopathy is one of the major microvascular complications of diabetes mellitus. The most common causes of vision loss in diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy. Recent developments in ocular imaging have played a significant role in early diagnosis and management of these complications. Color fundus photography is an imaging modality, which is helpful for screening patients with diabetic eye disease and monitoring its progression as well as response to treatment. Fundus fluorescein angiography (FFA) is a dye-based invasive test to detect subtle neovascularization, look for areas of capillary non-perfusion, diagnose macular ischemia, and differentiate between focal and diffuse capillary bed leak in cases of macular edema. Recent advances in retinal imaging like the introduction of spectral-domain and swept source-based optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography, and ultrawide field imaging and FFA have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in diabetic macular edema. This article will summarize the role of different imaging biomarkers in characterizing diabetic retinopathy and their potential contribution in its management.

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Spectropathology-corroborated multimodal quantitative imaging biomarkers for neuroretinal degeneration in diabetic retinopathy

Clinical Ophthalmology ◽

10.2147/opth.s140110 ◽

2017 ◽

Vol Volume 11 ◽

pp. 2073-2089 ◽

Cited By ~ 4

Author(s):

Arpan Guha Mazumder ◽

Swarnadip Chatterjee ◽

Saunak Chatterjee ◽

Juan Jose Gonzalez ◽

Swarnendu Bag ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Quantitative Imaging ◽

Imaging Biomarkers ◽

Quantitative Imaging Biomarkers

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Spectral domain optical coherence tomography based imaging biomarkers for diabetic retinopathy

Endocrine ◽

10.1007/s12020-019-02093-7 ◽

2019 ◽

Vol 66 (3) ◽

pp. 509-516 ◽

Cited By ~ 1

Author(s):

Sandeep Saxena ◽

Martin Caprnda ◽

Surabhi Ruia ◽

Senthamizh Prasad ◽

Ankita ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Diabetic Retinopathy ◽

Spectral Domain ◽

Imaging Biomarkers ◽

Optical Coherence

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Real-Time Diabetic Retinopathy Severity Score Level versus Ultra-Widefield Leakage Index-Guided Management of Diabetic Retinopathy: Two-Year Outcomes from the Randomized PRIME Trial

Journal of Personalized Medicine ◽

10.3390/jpm11090885 ◽

2021 ◽

Vol 11 (9) ◽

pp. 885

Author(s):

Hannah J. Yu ◽

Justis P. Ehlers ◽

Duriye Damla Sevgi ◽

Margaret O’Connell ◽

Jamie L. Reese ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Real Time ◽

Severity Score ◽

Imaging Biomarkers ◽

Prime Trial ◽

Severity Scale ◽

Intravitreal Aflibercept ◽

Level Versus ◽

Pro Re Nata

The prospective PRIME trial applied real-time, objective imaging biomarkers to determine individualized retreatment needs with intravitreal aflibercept injections (IAI) among eyes with diabetic retinopathy (DR). 40 eyes with nonproliferative or proliferative DR without diabetic macular edema received monthly IAI until a DR severity scale (DRSS) level improvement of ≥2 steps was achieved. Eyes were randomized 1:1 to DRSS- or PLI- guided management. At the final 2-year visit, DRSS level was stable or improved compared to baseline in all eyes, and mean PLI decreased by 11% (p = 0.73) and 23.6% (p = 0.25) in the DRSS- and PLI-guided arms. In both arms, the percent of pro re nata (PRN) visits requiring IAI was significantly higher in year 2 versus 1 (p < 0.0001). The percent of PRN visits receiving IAI during year 1 was significantly correlated with the percent of PRN visits with IAI during year 2 (p < 0.0001). Through week 104, 77.4% of instances of DRSS level worsening in the DRSS-guided arm were preceded by or occurred alongside an increase of PLI. Overall, consistent IAI re-treatment interval requirements were observed longitudinally among individual patients. Additionally, PLI increases appeared to precede DRSS level worsening, highlighting PLI as a valuable biomarker in the management of DR.

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Imaging Biomarkers in Diabetic Retinopathy and Diabetic Macular Edema

International Ophthalmology Clinics ◽

10.1097/iio.0000000000000249 ◽

2019 ◽

Vol 59 (1) ◽

pp. 241-262 ◽

Cited By ~ 2

Author(s):

Nitish Mehta ◽

Edmund Tsui ◽

Gregory D. Lee ◽

Vaidehi Dedania ◽

Yasha Modi

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Imaging Biomarkers

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Magnetic Resonance Imaging-Visible Perivascular Spaces in the Basal Ganglia Are Associated With the Diabetic Retinopathy Stage and Cognitive Decline in Patients With Type 2 Diabetes

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.666495 ◽

2021 ◽

Vol 13 ◽

Author(s):

Eun Young Choi ◽

Yae Won Park ◽

Minyoung Lee ◽

Min Kim ◽

Christopher Seungkyu Lee ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Basal Ganglia ◽

Cognitive Decline ◽

Small Vessel Disease ◽

Cognitive Status ◽

White Matter Hyperintensity ◽

Imaging Biomarkers ◽

Diabetic Patients ◽

Perivascular Spaces ◽

Cross Sectional

Purpose: The aim of this study was to evaluate whether perivascular space (PVS) severity and retinal ganglion cell layer (GCL) thickness differed based on the stage of diabetic retinopathy (DR) and the cognitive status in patients with DR.Methods: A total of 81 patients with DR (51 in the non-proliferative group and 30 in the proliferative group) were included in this retrospective, cross-sectional study. PVS severity was assessed in the basal ganglia (BG) and centrum semiovale using MRI. The total cerebral small vessel disease (SVD) score was determined based on the numbers of lacunes and microbleeds and the severity of white matter hyperintensity. Optical coherence tomography was used to measure foveal and perifoveal GCL thicknesses. Cerebral SVD markers and cognitive function were compared between the groups, and correlations between the BG-PVS severity and the Mini-Mental Status Examination (MMSE) scores and GCL parameters were evaluated.Results: Patients with proliferative DR had higher BG-PVS severity (P = 0.012), higher total cerebral SVD scores (P = 0.035), reduced GCL thicknesses in the inferior (P = 0.027), superior (P = 0.046), and temporal (P = 0.038) subfields compared to patients with non-proliferative DR. In addition, the BG-PVS severity was negatively correlated with the MMSE score (P = 0.007), and the GCL thickness was negatively correlated with the BG-PVS severity (P-values < 0.05 for inferior, superior, and temporal subfields).Conclusion: BG-PVS severity and retinal GCL thickness may represent novel imaging biomarkers reflecting the stage of DR and cognitive decline in diabetic patients. Furthermore, these results suggest a possible link between cerebral and retinal neurodegeneration at the clinical level.

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2D alpha-shapes to quantify retinal microvasculature morphology and their application to proliferative diabetic retinopathy characterisation in fundus photographs

Scientific Reports ◽

10.1038/s41598-021-02329-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Emma Pead ◽

Ylenia Giarratano ◽

Andrew J. Tatham ◽

Miguel O. Bernabeu ◽

Baljean Dhillon ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Imaging Biomarkers ◽

Cross Sectional ◽

Vascular Abnormalities ◽

Small Vessels ◽

Alpha Shapes ◽

Retinal Microvasculature ◽

Fundus Photographs ◽

Sectional Analysis

AbstractThe use of 2D alpha-shapes (α-shapes) to quantify morphological features of the retinal microvasculature could lead to imaging biomarkers for proliferative diabetic retinopathy (PDR). We tested our approach using the MESSIDOR dataset that consists of colour fundus photographs from 547 healthy individuals, 149 with mild diabetic retinopathy (DR), 239 with moderate DR, 199 pre-PDR and 53 PDR. The skeleton (centrelines) of the automatically segmented retinal vasculature was represented as an α-shape and the proposed parameters, complexity ($${Op\alpha }_{min}$$ O p α min ), spread (OpA), global shape (VS) and presence of abnormal angiogenesis (Gradα) were computed. In cross-sectional analysis, individuals with PDR had a lower $${Op\alpha }_{min}$$ O p α min , OpA and Gradα indicating a vasculature that is more complex, less spread (i.e. dense) and the presence of numerous small vessels. The results show that α-shape parameters characterise vascular abnormalities predictive of PDR (AUC 0.73; 95% CI [0.73 0.74]) and have therefore potential to reveal changes in retinal microvascular morphology.

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