Purpose To determine the relationship of various systemic and ocular characteristics with perifoveal and macular vessel density in healthy African American eyes.
Design A population-based cross-sectional study of prospectively recruited African Americans ≥40 years of age. Participants underwent 3×3 mm and 6×6 mm macula scans using spectral-domain optical coherence tomography angiography (OCTA), clinical examinations and clinical questionnaires. Participants with glaucoma, severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular oedema were excluded. Custom MATLAB based software quantified vessel area density (VAD) and vessel skeleton density (VSD) in the superficial retinal layer of the macula. Multivariable regression analysis, controlling for inter-eye correlation, was performed to determine systemic and ocular determinants of macular vessel metrics using stepwise selection. Candidate variables included: age, gender, body mass index, history of smoking, history of diabetes, diabetes duration, history of stroke or brain haemorrhage, systolic blood pressure, diastolic blood pressure (DBP), pulse pressure, mean arterial pressure, central subfield thickness (CSFT), visual field mean deviation, intraocular pressure, axial length (AL), mean ocular perfusion pressure and signal strength (SS).
Results A total of 2221 OCTA imaged eyes from 1472 participants were included in this study. Reduced perifoveal and macular VAD and VSD were independently associated with longer AL, reduced SS, reduced CSFT and older age. Male gender and lower DBP were also associated with reduced perifoveal and macular VSD.
Conclusions When interpreting OCTA images in a clinical setting, it is important to consider the effects ocular and systemic characteristics may have on the macular microcirculation.
Data availability statement
Data are available upon reasonable request. All raw data and measurement results are de-identified participant data, and are available from the corresponding author on reasonable request.
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Contributors GMR and AHK conceptualised the study idea. GMR and AHK designed and funded the study. JCL, BH, NK and AV collected the data and contributed to image analysis. XZ, ZC and RW developed quantification software. JCL, BB, BH, NK and AV carried out the statistical analyses. GMR, BB, AHK and RV performed critical review of the data and analyses and results. GMR and JCL wrote the manuscript. GMR, JCL, BB, NK, AV, XZ, ZC, RW, AHK and RV contributed to critical revisions of the manuscript. RV and AHK are joint co-last authors.
Funding This work was supported by National Institutes of Health Grants (K23EY027855, GMR; SC-CTSI Grant, GMR; U10EY023575, RV; R01EY030564 AHK; R01EY028753 RW) and by Southern California Clinical and Translational Science Institute (no grant number).
Competing interests GMR: Carl Zeiss Meditec—research support. RW: Carl Zeiss Meditec—research support, consultant, patent. AHK: Carl Zeiss Meditec—research support, consultant. The remaining authors declare no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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