Optic Nerve Head Capillary Network Quantified by Optical Coherence Tomography Angiography and Decline of Renal Function in Type 2 Diabetes: A Three-Year Prospective Study

PURPOSE: To assess the association of optic capillary perfusion with decline in the estimated glomerular filtra-tion rate (eGFR) and to clarify its added value.& BULL; DESIGN: Prospective, observational cohort study.& BULL; METHODS: Patients with type 2 diabetes mellitus with-out diabetic retinopathy (non-DR) underwent standard-ized examinations annually during a 3-year follow-up pe-riod. The superficial capillary plexus (SCP), deep capil-lary plexus (DCP), and radial peripapillary plexus (RPC) of optic nerve head (ONH) were visualized using opti-cal coherence tomography angiography (OCTA), and the perfusion density (PD) and vascular density were quan-tified for the whole image and circumpapillary regions of the ONH. The lowest tercile of annual eGFR slope was defined as the rapidly progressive group, and the highest tercile was considered the stable group.& BULL; RESULTS: A total of 906 patients were included for 3 -mm x 3-mm OCTA analysis. After adjusting for other confounders, each 1% decrease in baseline whole en face PD in SCP and RPC was associated with accelerated rates of decline in eGFR by-0.53 mL/min/1.73/m2 per year (95% confidence interval [CI]-0.17 to-0.90; P = .004) and-0.60 mL/min/1.73/m2 per year (95% CI 0.28-0.91), respectively. Adding both whole-image PD in SCP and whole-image PD in RPC to the conventional model increased the area under the curve from 0.696 (95% CI 0.654-0.737) to 0.725 (95% CI 0.685-0.765; P = .031). Another cohort of 400 eligible patients with 6-mm x 6 mm OCTA imaging validated the significant associations between ONH perfusion and rate of eGFR decline ( P < .05).& BULL; CONCLUSIONS: Reduced capillary perfusion of ONH in patients with type 2 diabetes mellitus is associ-ated with a greater eGFR decline, and it has addi-tional predictive value for detecting an early stage and progression. (Am J Ophthalmol 2023;253: 96-105. & COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))