Association of Microaneurysms on Adaptive Optics Scanning Laser Ophthalmoscopy With Surrounding Neuroretinal Pathology and Visual Function in Diabetes

• Published in: Investigative ophthalmology & visual science Vol. 59; no. 13; pp. 5633 - 5640
• Main Authors: Lammer, Jan, Karst, Sonja G, Lin, Michael M, Cheney, Michael, Silva, Paolo S, Burns, Stephen A, Aiello, Lloyd Paul, Sun, Jennifer K
• Format: Journal Article
• Language: English
• Published: United States The Association for Research in Vision and Ophthalmology 01.11.2018
• Subjects: Adult; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - diagnostic imaging; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Retinopathy - diagnostic imaging; Diabetic Retinopathy - physiopathology; Female; Glycated Hemoglobin - metabolism; Humans; Male; Microaneurysm - diagnostic imaging; Middle Aged; Ophthalmoscopy - methods; Optics and Photonics; Retina; Retina - physiopathology; Retinal Vessels - diagnostic imaging; Tomography, Optical Coherence - methods; Visual Acuity - physiology
• ISSN: 1552-5783; 0146-0404; 1552-5783
• DOI: 10.1167/iovs.18-24386

We evaluate diabetic microaneurysm (MA) features on high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) and their correlations with visual acuity (VA) and local retinal pathology on spectral domain optical coherence tomography (SDOCT). Diabetic participants underwent VA testing and AOSLO and SDOCT imaging of MAs. AOSLO images were graded for MA dimension, wall hyperreflectivity (WH), intraluminal hyperreflectivity (IH), and perfusion pattern. SDOCTs centered on each MA were graded for disorganization of the retinal inner layers (DRIL) and other neuroretinal pathology. We imaged 109 MAs (30 eyes). Multivariate modeling, including statistically significant covariates from bivariate analyses, associated WH with greater MA size (P = 0.001) and DRIL (P = 0.04). IH was associated with perfusion (P = 0.003) and MA visibility on photographs (P = 0.0001), and larger MA size with partial perfusion (P = 0.03), MA ring signs (P = 0.0002), and photographic visibility (P = 0.01). Multivariate modeling revealed an association of WH and VA with DRIL. AOSLO imaging demonstrates associations of hyperreflective MA walls with MA size and adjacent DRIL, as well as the presence of DRIL with lower VA. This study identifies a correlation between vascular and neural pathology associated with VA decline. Further studies of MA structure and neuroretinal disorganization may enable novel approaches to assess anatomic and functional outcomes in the diabetic eye.