Abstract
Objective
To present a fluorescein angiography (FA)‒based computer algorithm for quantifying retinal blood flow, perfusion, and permeability, in patients with diabetic retinopathy (DR). Secondary objectives were to quantitatively assess treatment efficacy following panretinal photocoagulation (PRP) and define thresholds for pathology based on a new retinovascular function (RVF) score for quantifying disease severity.
Methods
FA images of 65 subjects (58 patients and 7 healthy volunteers) were included. Dye intensity kinetics were derived using pixel-wise linear regression as a measure of retinal blood flow, perfusion, and permeability. Maps corresponding to each measure were then generated for each subject and segmented further using an ETDRS grid. Non-parametric statistical analyses were performed between all ETDRS subfields. For 16 patients, the effect of PRP was measured using the same parameters, and an amalgam of RVF was used to create an RVF index. For ten post-treatment patients, the change in FA-derived data was compared to the macular thickness measured using optical coherence tomography.
Results
Compared to healthy controls, patients had significantly lower retinal and regional perfusion and flow, as well as higher retinal permeability (p < 0.05). Moreover, retinal flow was inversely correlated with permeability (R = –0.41; p < 0.0001). PRP significantly reduced retinal permeability (p < 0.05). The earliest marker of DR was reduced retinal blood flow, followed by increased permeability. FA-based RVF index was a more sensitive indicator of treatment efficacy than macular thickness.
Conclusions
Our algorithm can be used to quantify retinovascular function, providing an earlier diagnosis and an objective characterisation of disease state, disease progression, and response to treatment.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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The authors’ responsibilities were as follows: AF and JL formulated the research question and designed the study; AW, AC, YS and JL obtained data; AA analysed the data; AA, OT-N, AL, YS and JL: interpreted the findings and wrote the article. All authors read and approved the final manuscript.
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AA and AF: Emagix, Inc., Halifax, Nova Scotia, Canada. The other authors declare no competing interests.
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Abbasnejad, A., Tomkins-Netzer, O., Winter, A. et al. A fluorescein angiography-based computer-aided algorithm for assessing the retinal vasculature in diabetic retinopathy. Eye 37, 1293–1301 (2023). https://doi.org/10.1038/s41433-022-02120-4
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DOI: https://doi.org/10.1038/s41433-022-02120-4