Research progress of choroidal vascular index in diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Xiaokun ^1,2 , Wu Chao ^1,2 , Cui Yanyan ³ , Chang Weiwei ⁴ ,  Zhao Bojun ^1,2

1. Cheeloo College of Medicine, Shandong University, Jinan 250012, China;
2. Department of Ophthalmology, Shandong Provincial Hospital, Jinan 250021, China;
3. Department of Ophthalmology, The Second Hospital of Shandong University, Jinan 250033, China;
4. Graduate School, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan 250117, China;

Corresponding?author：

Zhao Bojun, Email: 15168860708@163.com

Keywords：

Choroidal vascular index; Diabetic retinopathy; Optical coherence tomography; Review

DOI：

10.3760/cma.j.cn511434-20220902-00487

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic retinopathy (DR) is the main cause of blindness in diabetic patients. Early diagnosis and intervention are essential to improve the quality of life of patients with DR. Choroidal vascularity index (CVI) is the ratio of choroidal luminal area to total area, which can reflect the structure and blood flow of the choroid, and has been used to evaluate the choroidal condition in various eye diseases. CVI has shown great potential in the prediction, early intervention, disease assessment, and prognosis of DR. The relationship between CVI and photoreceptors needs more research, and CVI may be used as a predictive indicator of photoreceptor health and visual prognosis. In addition, the study of CVI at different layers of the choroid is limited by the accuracy of stratification and the repeatability of measurement. Artificial intelligence and other technologies may provide solutions for this. In the future, through more comprehensive study and the help of artificial intelligence, the value of CVI will be further enriched, which is of great significance for the elucidation of the pathogenesis of DR and serving the clinic.

Citation： Wang Xiaokun, Wu Chao, Cui Yanyan, Chang Weiwei, Zhao Bojun. Research progress of choroidal vascular index in diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(12): 1016-1021. doi: 10.3760/cma.j.cn511434-20220902-00487 Copy

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3. Lin KY, Hsih WH, Lin YB, et al. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy[J]. J Diabetes Investig, 2021, 12(8): 1322-1325. DOI: 10.1111/jdi.13480.
4. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy[J]. N Engl J Med, 2012, 366(13): 1227-1239. DOI: 10.1056/NEJMra1005073.
5. Delaey C, Van De Voorde J. Regulatory mechanisms in the retinal and choroidal circulation[J]. Ophthalmic Res, 2000, 32(6): 249-256. DOI: 10.1159/000055622.
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7. Tan KA, Gupta P, Agarwal A, et al. State of science: choroidal thickness and systemic health[J]. Surv Ophthalmol, 2016, 61(5): 566-581. DOI: 10.1016/j.survophthal.2016.02.007.
8. Campos A, Campos EJ, Martins J, et al. Viewing the choroid: where we stand, challenges and contradictions in diabetic retinopathy and diabetic macular oedema[J]. Acta Ophthalmol, 2017, 95(5): 446-459. DOI: 10.1111/aos.13210.
9. Foo VHX, Gupta P, Nguyen QD, et al. Decrease in choroidal vascularity index of Haller's layer in diabetic eyes precedes retinopathy[J/OL]. BMJ Open Diabetes Res Care, 2020, 8(1): e001295[2020-09-01]. https://pubmed.ncbi.nlm.nih.gov/32912848/. DOI: 10.1136/bmjdrc-2020-001295.
10. Muir ER, Rentería RC, Duong TQ. Reduced ocular blood flow as an early indicator of diabetic retinopathy in a mouse model of diabetes[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6488-6494. DOI: 10.1167/iovs.12-9758.
11. Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imaging spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2008, 146(4): 496-500. DOI: 10.1016/j.ajo.2008.05.032.
12. Wei X, Ting DSW, Ng WY, et al. Choroidal vascularity index: a novel optical coherence tomography based parameter in patients with exudative age-related macular degeneration[J]. Retina, 2017, 37(6): 1120-1125. DOI: 10.1097/IAE.0000000000001312.
13. Lee SW, Yu SY, Seo KH, et al. Diurnal variation in choroidal thickness in relation to sex, axial length, and baseline choroidal thickness in healthy Korean subjects[J]. Retina, 2014, 34(2): 385-393. DOI: 10.1097/IAE.0b013e3182993f29.
14. Iovino C, Pellegrini M, Bernabei F, et al. Choroidal vascularity index: an in-depth analysis of this novel optical coherence tomography parameter[J]. J Clin Med, 2020, 9(2): 595. DOI: 10.3390/jcm9020595.
15. Branchini LA, Adhi M, Regatieri CV, et al. Analysis of choroidal morphologic features and vasculature in healthy eyes using spectral-domain optical coherence tomography[J]. Ophthalmology, 2013, 120(9): 1901-1908. DOI: 10.1016/j.ophtha.2013.01.066.
16. Sonoda S, Sakamoto T, Yamashita T, et al. Choroidal structure in normal eyes and after photodynamic therapy determined by binarization of optical coherence tomographic images[J]. Invest Ophthalmol Vis Sci, 2014, 55(6): 3893-3899. DOI: 10.1167/iovs.14-14447.
17. Agrawal R, Salman M, Tan KA, et al. Choroidal vascularity index (CVI)--a novel optical coherence tomography parameter for monitoring patients with panuveitis?[J/OL]. PLoS One, 2016, 11(1): e0146344[2016-01-11]. https://pubmed.ncbi.nlm.nih.gov/26751702/. DOI: 10.1371/journal.pone.0146344.
18. Liu G, Li Y, Hu Y, et al. Influence of lifestyle on incident cardiovascular disease and mortality in patients with diabetes mellitus[J]. J Am Coll Cardiol, 2018, 71(25): 2867-2876. DOI: 10.1016/j.jacc.2018.04.027.
19. Sinclair SH, Schwartz SS. Diabetic retinopathy-an underdiagnosed and undertreated inflammatory, neuro-vascular complication of diabetes[J]. Front Endocrinol (Lausanne), 2019, 10: 843. DOI: 10.3389/fendo.2019.00843.
20. Kim M, Ha MJ, Choi SY, et al. Choroidal vascularity index in type-2 diabetes analyzed by swept-source optical coherence tomography[J/OL]. Sci Rep, 2018, 8(1): 70[2018-01-08]. https://pubmed.ncbi.nlm.nih.gov/29311618/. DOI: 10.1038/s41598-017-18511-7.
21. Temel E, ?zcan G, Yan?k ?, et al. Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy[J]. Int Ophthalmol, 2022, 42(12): 3661-3672. DOI: 10.1007/s10792-022-02363-w.
22. Endo H, Kase S, Ito Y, et al. Relationship between choroidal structure and duration of diabetes[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(6): 1133-1140. DOI: 10.1007/s00417-019-04295-1.
23. Romero-Aroca P, Navarro-Gil R, Valls-Mateu A, et al. Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study[J]. Br J Ophthalmol, 2017, 101(10): 1346-1351. DOI: 10.1136/bjophthalmol-2016-310063.
24. Aksoy M, Simsek M, Apayd?n M. Choroidal vascularity index in patients with type-1 diabetes mellitus without diabetic retinopathy[J]. Curr Eye Res, 2021, 46(6): 865-870. DOI: 10.1080/02713683.2020.1846755.
25. Giblin MJ, Ontko CD, Penn JS. Effect of cytokine-induced alterations in extracellular matrix composition on diabetic retinopathy-relevant endothelial cell behaviors[J/OL]. Sci Rep, 2022, 12(1): 12955[2022-07-28]. https://pubmed.ncbi.nlm.nih.gov/35902594/. DOI: 10.1038/s41598-022-12683-7.
26. Sinha B, Ghosal S. A target HbA1c between 7 and 7.7% reduces microvascular and macrovascular events in T2D regardless of duration of diabetes: a meta-analysis of randomized controlled trials[J]. Diabetes Ther, 2021, 12(6): 1661-1676. DOI: 10.1007/s13300-021-01062-6.
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