title: Neural Retinal Disorganization as a Robust Marker of Visual Acuity in Current and Resolved Diabetic Macular Edema.
abstract: Despite treatment advances, diabetic eye disease remains a leading cause of visual acuity (VA) loss worldwide. No methods to prospectively determine which patients will gain or lose vision exist, limiting individualized risk assessment and management. We investigated whether noninvasive, readily obtainable spectral domain optical coherence tomography parameters were correlated with VA in eyes with current or resolved center-involved diabetic macular edema (DME). Images were evaluated for disorganization of the retinal inner layers (DRIL), cysts, epiretinal membranes, microaneurysms, subretinal fluid, and outer layer disruption/reflectivity. DRIL affecting ≥50% of the 1-mm central retinal zone was associated with worse VA in all eyes, eyes with current edema, and eyes with resolved edema. Furthermore, early 4-month change in DRIL extent predicted VA change from baseline to 1 year. These data suggest that DRIL is a robust predictor of VA in eyes with present or previous DME and more highly correlated with VA than other widely used measures, such as retinal thickness. If further studies confirm DRIL as a predictive biomarker of future VA, physicians would gain a new tool of substantial clinical and investigative importance that could significantly change the approach to ophthalmic counseling and therapeutic management in patients with diabetes.
authors: Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA jennifer.sun@joslin.harvard.edu.
authors: Jennifer K
authors: JK
authors: Sun
authors: Department of Ophthalmology, University of Minnesota, Minneapolis, MN Department of Ophthalmology, Cairo University, Cairo, Egypt.
authors: Salma H
authors: SH
authors: Radwan
authors: Department of Ophthalmology, University of Minnesota, Minneapolis, MN Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ahmed Z
authors: AZ
authors: Soliman
authors: Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria.
authors: Jan
authors: J
authors: Lammer
authors: Harvard Medical School, Boston, MA.
authors: Michael M
authors: MM
authors: Lin
authors: Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria.
authors: Sonja G
authors: SG
authors: Prager
authors: Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA.
authors: Paolo S
authors: PS
authors: Silva
authors: Beetham Eye Institute, Joslin Diabetes Center, Boston, MA.
authors: Lloyd Bryce
authors: LB
authors: Aiello
authors: Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA.
authors: Lloyd Paul
authors: LP
authors: Aiello
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D015415:Biomarkers
references: Ophthalmology. 1984 Dec;91(12):1464-74
references: 6521986
references: Am J Ophthalmol. 1961 May;51:1123-41
references: 13786453
references: Diabetes. 1962 Jan-Feb;11:1-22
references: 13870120
references: Ophthalmology. 2007 Mar;114(3):525-36
references: 17123615
references: Acta Ophthalmol. 2008 May;86(3):284-91
references: 18005220
references: Ophthalmology. 2009 May;116(5):914-20
references: 19410950
references: Retina. 2010 Jan;30(1):63-70
references: 19952996
references: Ophthalmology. 2010 Apr;117(4):773-9
references: 20079541
references: Am J Ophthalmol. 2010 Jul;150(1):63-67.e1
references: 20451897
references: Am J Ophthalmol. 2010 Dec;150(6):840-8
references: 20855054
references: Invest Ophthalmol Vis Sci. 2010 Dec;51(12):6710-4
references: 20484587
references: Ophthalmology. 2010 Dec;117(12):2379-86
references: 20561684
references: Invest Ophthalmol Vis Sci. 2011 Feb;52(2):772-7
references: 20926810
references: Am J Ophthalmol. 2011 Feb;151(2):310-7
references: 21145531
references: Invest Ophthalmol Vis Sci. 2011 Apr;52(5):2741-8
references: 20538987
references: Am J Ophthalmol. 2012 Apr;153(4):710-7, 717.e1
references: 22137207
references: Br J Ophthalmol. 2012 May;96(5):699-703
references: 22174096
references: Invest Ophthalmol Vis Sci. 2012 Aug;53(9):5814-8
references: 22836760
references: Ophthalmology. 2012 Dec;119(12):2643.e1
references: 23207021
references: Invest Ophthalmol Vis Sci. 2012 Dec;53(13):8154-61
references: 23132803
references: Br J Ophthalmol. 2013 Feb;97(2):228-32
references: 23172879
references: JAMA Ophthalmol. 2014 Nov;132(11):1309-16
references: 25058813