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Intersession repeatability of visual function and OCTA metrics in eyes with diabetic macular ischaemia

Eye volume 39, pages 906–912 (2025)Cite this article

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Abstract

Objective

To estimate inter-session coefficient of repeatability (CR) of visual function and OCTA metrics over 3 months in diabetic macular ischaemia (DMI) in stable laser-treated proliferative diabetic retinopathy (PDR) patients.

Methods

This prospective study recruited patients with stable PDR for at least 6 months following pan-retinal photocoagulation with visual acuity of at least 54 ETDRS letters. DMI was confirmed on OCTA as FAZ area of at least 0.5 mm2 or parafoveal capillary dropout in at least one quadrant if the FAZ area was less than 0.5 mm2. Repeatability was assessed at baseline and 3 months by calculating the coefficients of repeatability (CR) and intraclass correlation coefficient (ICC). The Bland Altman (BA) plots including 95% CI bands for the bias (mean difference) and upper and lower limits of agreement (LOA) were used to visualise the agreement of the measurements.

Results

88 eligible eyes of 63 participants were included in the analysis. The CR for best corrected visual acuity (BCVA) was 10.1 ETDRS letters (95% CI 8.5–11.7 ETDRS letters), and for low luminance visual acuity (LLVA) was 12.4 letters (95% CI 10.4–14.4). The ICC for BCVA and LLVA was 0.81 and 0.75 respectively. For Square Root of Foveal Avascular Zone (SQRT-FAZ) area, CR and ICC was 0.043 mm and 1.00 respectively. The Bland-Altman plots suggest that the level of agreement is wider for vascular density (VD) metrics compared to FAZ parameters.

Conclusion

We recommend using the FAZ metrics for quantitative measurements of DMI outcomes due to the excellent repeatability of manually corrected FAZ area.

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Fig. 1: Bland-Altman plots assessing agreement between baseline and 3-month follow-up visits for VA measures.
Fig. 2: Bland-Altman plots assessing agreement between baseline and 3-month follow-up visits for FAZ metrics.
Fig. 3: Bland-Altman plots assessing agreement between baseline and 3-month follow-up visits for vessel density metrics.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request

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Funding

The investigator-initiated study was funded by Boehringer Ingelheim International GmbH (Grant number: SIVS1048). This study was also supported by the NIHR Biomedical Research Centre and Clinical Research Facility at the Moorfields Eye Hospital National Health Service Foundation Trust and the University College London Institute of Ophthalmology.

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Authors and Affiliations

  1. National Institute of Health Research Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital, London, UK

    Sridevi Thottarath, Wei-Shan Tsai, Sarega Gurudas & Sobha Sivaprasad

  2. Institute of Ophthalmology, University College London, London, UK

    Sarega Gurudas, Elizabeth Pearce & Sobha Sivaprasad

  3. Singapore National Eye Centre, Singapore, Singapore

    Chui Ming Gemmy Chueng

  4. Boehringer Ingelheim International GmbH, Binger Straße 173 | 55216 Ingelheim am Rhein, Germany

    Taffeta Ching Ning Yamaguchi

Authors
  1. Sridevi Thottarath
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  2. Wei-Shan Tsai
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  3. Sarega Gurudas
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  4. Elizabeth Pearce
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  5. Chui Ming Gemmy Chueng
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  7. Sobha Sivaprasad
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Contributions

Conceptualization: S.T. and S.S.; Data curation: S.T, and W-S.T.; Formal analysis: S.G.; Funding acquisition: S.S.; Methodology: S.T, S.G. and S.S; Project administration: S.S.; Resources: S.T., W-S.T. and S.S.; Supervision: T.Y, G.C, E.P, S.S; Visualization: S.G. and S.T.; Writing – original draft: S.T, S.G. and S.S.; Writing - review & editing: S.S. Review and approval of final manuscript: S.T., W-S.T., S.G., G.C., T.Y., E.P., S.S,

Corresponding author

Correspondence to Sobha Sivaprasad.

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Competing interests

The authors declare no competing interests. Sridevi Thottarath and Wei-Shan Tsai has received travel support from Boehringer Ingelheim. Dr. Sivaprasad reported receiving financial support from AbbVie, Amgen, Apellis, Bayer, Biogen, Boehringer Ingelheim, Novartis, Eyebiotech, Eyepoint Pharmaceuticals, Janssen Pharmaceuticals, Nova Nordisk, Optos, Ocular Therapeutix, Kriya Therapeutics, OcuTerra, Roche, Stealth Biotherapeutics and Sanofi. Sobha Sivaprasad is the Editor-in-Chief of EYE. Dr Cheung is a consultant for Topcon, Novartis, Bayer, Allergan, Roche, Boehringher-Ingelheim, and Samsung. Dr Cheung is a member of the editorial board of EYE. Taffeta Ching Ning Yamaguchi is an employee of Boehringer-Ingelheim.

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Thottarath, S., Tsai, WS., Gurudas, S. et al. Intersession repeatability of visual function and OCTA metrics in eyes with diabetic macular ischaemia. Eye 39, 906–912 (2025). https://doi.org/10.1038/s41433-024-03505-3

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