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Abstract
Introduction The study aimed to evaluate Choroidal Vascularity Index (CVI) of Haller’s and Sattler’s layers and their relationships with choroidal and retinal thickness, volumes measured on enhanced depth imaging–optical coherence tomography (OCT) scans in the eyes of patients without diabetes, patients with diabetes with no diabetic retinopathy (DR) and patients with diabetes and DR.
Research design and methods Retrospective analysis of 165 eyes from 84 Singapore Indian Eye Study-2 study participants (group 1: no diabetes, group 2: diabetes with no DR and group 3: with DR). Groups 1 and 2 were matched by age and gender from group 3.
Results In the eyes of patients with diabetes without DR, the macular CVI of Haller’s but not Sattler’s layer was significantly reduced compared with eyes of patients without diabetes. Eyes with >5 years of diabetes have significantly decreased CVI of Sattler’s layers (mean difference=0.06 ± 0.10, p=0.04) and also decreased subfoveal choroidal volume (mean difference=0.89 ± 0.16 mm3, p=0.02), compared with those with ≤5 years of diabetes.
Conclusion Diabetic eyes without DR had significantly lower CVI of macular Haller’s layer than those of healthy controls. With a longer duration of diabetes, CVI of subfoveal Sattler’s layer and choroidal volume continue to decrease, irrespective of diabetic control, suggesting that early diabetic choroidopathy mainly affects larger choroidal veins initially before medium-sized arterioles. The CVI of macular Haller’s layer could potentially be used as a marker on spectral domain OCT imaging in newly diagnosed patients with diabetes for the onset of DR and as a possible prognostication tool in diabetic eyes. Future prospective longitudinal studies in diabetic eyes would be useful in establishing the relationship between CVIs of Haller’s and Sattler’s layer with visual acuity as a marker of photoreceptor health and visual prognosis.
- retinopathy
- A1C
- pathophysiological processes
- acute and late complications
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Footnotes
Contributors VHXF, PG, RA, C-YC and YY helped to conceptualize and design the study. QDN and CCYC contributed to the statistical analysis and discussion of the manuscript. VHXF, PG, RA, C-YC and YY analyzed, interpreted the data, and wrote the manuscript. YY is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This project was supported by TAAP (NMRC/OFLCG/004/2018).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The research adhered to the tenets of the Declaration of Helsinki and ethics approval was obtained (Singhealth Centralised Institutional Review Board approval number R1107/9/2014) from the institutional review board of Singhealth and Singapore Eye Research Institute.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. YY is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He can be contacted at yasuo.yanagi@snec.com.sg.