Article Text

Download PDFPDF
Multimodal imaging analysis for the impact of retinal peripheral lesions on central neurovascular structure and retinal function in type 2 diabetes with diabetic retinopathy
  1. Xuenan Zhuang1,2,
  2. Ruoyu Chen1,3,
  3. Anyi Liang1,
  4. Jie Yao1,4,
  5. Zicheng Wang1,5,
  6. Yesheng Chen1,6,
  7. Kangyan Zheng1,4,
  8. Peiyao Lu1,6,
  9. Liang Zhang1,3,6,
  10. Dan Cao1,3,6
  1. 1 Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  2. 2 Key Laboratory of Ophthalmology, Zhongshan Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
  3. 3 The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
  4. 4 Shantou University Medical College, Shantou, China
  5. 5 School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
  6. 6 Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
  1. Correspondence to Dr Dan Cao; dancao5413{at}; Dr Liang Zhang; zhangliang5413{at}


Objectives To explore the possible role of peripheral lesions (PLs) detected by ultrawide field (UWF) imaging system on central neurovascular structure and retinal function.

Methods Ninety-seven diabetic patients were included in this cross-sectional study using UWF pseudocolour colour imaging with Optos Daytona (Optos, PLC). UWF images were graded as with predominantly peripheral lesions (PPLs) and without PPL. Macular neurovascular alterations and retinal function were measured by optical coherence tomography angiography (OCTA) and RETeval device, respectively. Central microcirculation and retinal function were compared between eyes with and without PPL.

Results The study evaluated 186 eyes (97 patients; 43 females (44.3%)), including 92 eyes without PPL and 94 eyes with PPL. Central retinal vessel density was comparable between eyes with and without PPL. Delayed implicit time and decreased pupil area ratio were found in the PPL group compared with eyes without PPL, and this difference remained unchanged after adjusting for systemic factors (all p<0.01).

Conclusions Our study suggests that retinal function is worse in diabetic eyes with PPL. These findings challenged the conventional ETDRS protocols which ignored peripheral retina in determining DR severity. Furthermore, combining UWF imaging with RETeval system to detect more retinal abnormalities may be helpful in DR management.

  • retina
  • imaging

Data availability statement

Data are available on reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request.

View Full Text


  • XZ and RC are joint first authors.

  • XZ and RC contributed equally.

  • LZ and DC contributed equally.

  • Contributors LZ, DC, XZ and RC contributed to the conception and design of the study. AL, JY, ZW, YC, KZ and PL contributed to data collection, analysis and/or interpretation. XZ and RC wrote the article. DC and LZ revised the manuscript. DC is the guarantor.

  • Funding This study was supported by Guangzhou Science and Technology Program (Grant Number 201904010092) and Bethune Merck Diabetes Research Foundation (Grant Number 2018-133).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.