Kakihara Shinji, Busza Anna, Yamaguchi Taffeta Chingning, Fawzi Amani A
Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
Invest Ophthalmol Vis Sci. 2025 Jun 2;66(6):5. doi: 10.1167/iovs.66.6.5.
The purpose of this study was to investigate whether the topographic location of retinal non-perfusion influences visual function, specifically low luminance visual acuity (LLVA) and best-corrected visual acuity (BCVA), in individuals with diabetes.
In this cross-sectional observational study, individuals with diabetes across the spectrum of diabetic retinopathy (DR) severity were enrolled. LLVA and BCVA were measured according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, with a 2.0-log unit neutral density filter for LLVA. Retinal ischemia was evaluated using ultra-widefield fluorescein angiography (UWF-FA) to manually quantify non-perfusion within (posterior ischemia) and outside (peripheral ischemia) the ETDRS seven fields. Macular ischemia was assessed by optical coherence tomography angiography (OCTA) using geometric perfusion deficits (GPDs) in both the superficial and deep capillary plexus (DCP). Associations between visual acuity and various explanatory variables, focusing on retinal ischemic parameters were assessed with linear mixed models.
A total of 181 eyes from 126 patients without diabetic macular edema were analyzed. Increasing DR severity reduced both BCVA and LLVA. After adjusting other explanatory variables, age and posterior ischemia (estimate = -0.46, P = 0.046) were significant for LLVA. In contrast, age, sex, posterior ischemia (estimate = -0.50, P = 0.009), and GPD-DCP (estimate = -0.25, P = 0.049) were statistically significant for BCVA.
Retinal ischemia's topographic location differentially affects visual function in diabetes. Posterior ischemia predominantly impacts LLVA, whereas both macular and posterior ischemia contribute to BCVA decline. These results highlight the importance of assessing retinal ischemia beyond the macula to better understand visual function deficits in patients with diabetes.
本研究旨在调查视网膜无灌注的地形位置是否会影响糖尿病患者的视觉功能，特别是低亮度视力（LLVA）和最佳矫正视力（BCVA）。
在这项横断面观察性研究中，纳入了患有不同严重程度糖尿病视网膜病变（DR）的糖尿病患者。根据早期糖尿病视网膜病变治疗研究（ETDRS）方案测量LLVA和BCVA，测量LLVA时使用2.0对数单位中性密度滤光片。使用超广角荧光血管造影（UWF-FA）评估视网膜缺血情况，以手动量化ETDRS七个视野内（后部缺血）和视野外（周边缺血）的无灌注区域。通过光学相干断层扫描血管造影（OCTA）使用浅表和深层毛细血管丛（DCP）中的几何灌注缺损（GPD）来评估黄斑缺血。使用线性混合模型评估视力与各种解释变量之间的关联，重点关注视网膜缺血参数。
共分析了126例无糖尿病性黄斑水肿患者的181只眼。DR严重程度增加会降低BCVA和LLVA。在调整其他解释变量后，年龄和后部缺血（估计值=-0.46，P=0.046）对LLVA有显著影响。相比之下，年龄、性别、后部缺血（估计值=-0.50，P=0.009）和GPD-DCP（估计值=-0.25，P=0.049）对BCVA有统计学意义。
视网膜缺血的地形位置对糖尿病患者的视觉功能有不同影响。后部缺血主要影响LLVA，而黄斑和后部缺血均导致BCVA下降。这些结果强调了评估黄斑以外的视网膜缺血对于更好地理解糖尿病患者视觉功能缺陷的重要性。
