title: Association of pathomorphology, photoreceptor status, and retinal thickness with visual acuity in diabetic retinopathy.
abstract: OBJECTIVE
  To evaluate whether visual acuity (VA) is associated with pathologic changes in morphology (pathomorphology), macular thickness, and the status of external limiting membrane (ELM) in diabetic retinopathy (DR).
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  One hundred twenty-five consecutive eyes of 73 patients with DR were analyzed retrospectively. No patients had been treated for diabetic macular edema, and all had Spectralis optical coherence tomography (OCT) images. We evaluated the pathomorphology, qualitatively evaluated the status of ELM and cystic changes, and measured the retinal thickness. The correlation with logarithm of the minimal angle of resolution (logMAR) was investigated.
  
  
  RESULTS
  We classified 3 types of pathomorphology at the presumed fovea: cystoid macular edema (CME type, n = 20), serous retinal detachment (SRD type, n = 21), and the absence of either cystoid macular edema or serous retinal detachment (diffuse type, n = 84). The mean logMAR VA with the CME type (0.460 ± 0.301) was significantly worse than with the SRD type (0.222 ± 0.178; P = .004) or diffuse type (0.149 ± 0.260; P < .001). With CME type and diffuse type, a disrupted ELM or parafoveal thickening was significantly correlated with poor VA; these correlations were not found with the SRD type. Seventy-nine of 104 eyes with CME type or diffuse type presented intact ELM and showed the significant correlation between logMAR and the parafoveal thickness or cystic changes, although these parameters were not associated with logMAR VA in 25 eyes with disrupted ELM.
  
  
  CONCLUSIONS
  The pathomorphology and photoreceptor status at the fovea and retinal edema in the parafovea are correlated with the VA in DR.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan. mutomo@kuhp.kyoto-u.ac.jp
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nishijima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ota
authors.forename: Takahiro
authors.initials: T
authors.lastname: Horii
authors.forename: Nagahisa
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008269:Macular Edema / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D012163:Retinal Detachment / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*