Optical coherence tomography angiography (OCT-A) is an innovative and noninvasive imaging modality that enables visualization of the retinal microvasculature. The present study aimed to utilize OCT-A to determine the systemic risk factors for retinal microvascular impairment in type 2 diabetic patients without clinical diabetic retinopathy (DR).


We retrospectively reviewed, based on the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria, the medical records of type 2 diabetic patients without clinically evident DR. OCT-A parameters were measured to determine vascular density (VD) and the foveal avascular zone (FAZ) area in the superficial and deep capillary plexuses (SCP/DCP) of the retina. Clinical data were collected on sex, age, diabetes duration, hemoglobin A1c (HbA1c), hypertension, dyslipidemia, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR), and lipid-lowering treatment. Multiple linear regression analyses were performed to determine the retinal microvascular impairment risk factors.


Seventy-four Korean patients were enrolled. Mean age was 56.6 ± 12.8 years, and 44 patients (59.5%) were male. Median duration of diabetes and HbA1c were 3.1 years and 8.0%, respectively. Mean VD in the SCP and DCP were 35.3 ± 0.88% and 34.8 ± 0.79%. Mean FAZ area in the SCP and DCP were 0.377 ± 0.131 mm2 and 0.67 ± 0.199 mm2. In age- and sex-adjusted multiple regression analyses, dyslipidemia and hypertension were negatively associated with SCP-VD (β = -0.357, P = 0.002; β = -0.239, P = 0.039, respectively). The use of fibrates was correlated with increased DCP-VD (β = 0.307, P = 0.007). Enlargement of SCP-FAZ area was associated with dyslipidemia and greater LDL-C (β = 0.254, P = 0.013; β = 0.232, P = 0.029, respectively), and of DCP-FAZ area, with lower eGFR and greater LDL-C (β = -0.355, P = 0.004; β = 0.235, P = 0.037, respectively).


Dyslipidemia and/or high LDL-C were important risk factors for retinal microvascular impairment in type 2 diabetic patients without clinical DR. The use of fibrates was a protective factor, in particularly, for VD in the DCP. Hypertension and lower eGFR also contributed to microvascular impairment, at least in part.


So Hyun Bae


So Hyun BAE*, Gi Hyun BAE, Hakyoung KIM
Kangnam Sacred Heart Hospital, Hallym University
South Korea
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