Imaging Modalities for Assessing the Vascular Component of Diabetic Retinal Disease: Review and Consensus for an Updated Staging System
Year: 2023
Type: article
Abstract: Purpose: To review the evidence for imaging modalities in assessing the vascular component of diabetic retinal disease (DRD), to inform updates to the DRD staging system. Design: Standardized narrative review of the literature by an international expert workgroup, as part of the DRD Staging System Update Effort, a project of the Mary Tyler Moore Vision Initiative. Overall, there were 6 workgroups: Vascular Retina, Neural Retina, Systemic Health, Basic and Cellular Mechanisms, Visual Function, and Quality of Life. Participants: The Vascular Retina workgroup, including 16 participants from 4 countries. Methods: Literature review was conducted using standardized evidence grids for 5 modalities: standard color fundus photography (CFP), widefield color photography (WFCP), standard fluorescein angiography (FA), widefield FA (WFFA), and OCT angiography (OCTA). Summary levels of evidence were determined on a validated scale from I (highest) to V (lowest). Five virtual workshops were held for discussion and consensus. Main Outcome Measures: Level of evidence for each modality. Results: Levels of evidence for standard CFP, WFCP, standard FA, WFFA, and OCTA were I, II, I, I, and II respectively. Traditional vascular lesions on standard CFP should continue to be included in an updated staging system, but more studies are required before they can be used in posttreatment eyes. Widefield color photographs can be used for severity grading within the area covered by standard CFPs, although these gradings may not be directly interchangeable with each other. Evaluation of the peripheral retina on WFCP can be considered, but the method of grading needs to be clarified and validated. Standard FA and WFFA provide independent prognostic value, but the need for dye administration should be considered. OCT angiography has significant potential for inclusion in the DRD staging system, but various barriers need to be addressed first. Conclusions: This study provides evidence-based recommendations on the utility of various imaging modalities for assessment of the vascular component of DRD, which can inform future updates to the DRD staging system. Although new imaging modalities offer a wealth of information, there are still major gaps and unmet research needs that need to be addressed before this potential can be realized. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Source: Ophthalmology Science
Institutions: National University of Singapore, Singapore National Eye Center, Singapore Eye Research Institute, Duke-NUS Medical School, Northwestern University, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière, Fondation Ophtalmologique Adolphe de Rothschild, University of California, Los Angeles, Doheny Eye Institute, University College London, University of Wisconsin–Madison, Johns Hopkins University, Johns Hopkins Medicine, University of Alabama at Birmingham, UAB Medicine, University of Michigan, Michigan Medicine, Breakthrough T1D, Joslin Diabetes Center, Harvard University, Tsinghua University
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
Funders: American Diabetes Association, Research to Prevent Blindness, University of Michigan, A. Alfred Taubman Medical Research Institute, American Academy of Ophthalmology, Apellis Pharmaceuticals, Novo Nordisk, Novo Nordisk Fonden, Genentech, National Heart, Lung, and Blood Institute, National Eye Institute, National Institute of Diabetes and Digestive and Kidney Diseases
Awards: Inflammatory Resolution and Vascular Restoration in Diabetic Retinopathy, G7278242751, Mechanisms of Retinal Vascular Permeability in Diabetes, Michigan Center for Diabetes Translational Research, Michigan Diabetes Research Center (MDRC), Unraveling the role of tPA in the neurovascular unit, DRCR Retina Network
OpenAlex ID: W4389515648