Association of Intravenous Fluorescein Angiography and Adaptive Optics Imaging in Diabetic Retinopathy: A Prospective Case Series

Abstract

Purpose: To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy (DR). Methods: Consecutive patients with DR over the age of 18 years presenting to a single centre in Toronto, Canada from 2020-2021 were recruited. AO was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. IVFA was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson’s correlation coefficient. Results: Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r=0.303, p=0.027), as well as perfusion (r=0.272, p=0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r=0.770, p=0.043; r=0.846, p=0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r=-0.819, p=0.046). Conclusion: Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with DR. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.