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Resistive Index of Ophthalmic Artery as a Bioimaging Biomarker for the Severity of Diabetic Retinopathy

Objective: To assess the resistive index (RI) of ophthalmic artery (OA) and central retinal artery (CRA) as a bioimaging biomarker for the severity of diabetic retinopathy, for the first time.

Design: Tertiary care center based cross sectional study.

Setting: RI in OA and CRA was studied using color Doppler and gray scale sonography. Central Subfield Thickness (CST), Cube Average Thickness (CAT), retinal photoreceptor ellipsoid zone (EZ) disruption, and Retinal Nerve Fiber Layer (RNFL) thickness were studied using SD-OCT.

Participants: Sample size was calculated using 95% confidence interval. 69 consecutive cases of type 2 diabetes mellitus between the ages of 40 and 70 years were included after informed consent. According to Early Treatment Diabetic Retinopathy Study (ETDRS) classification cases were grouped as: diabetes mellitus with no retinopathy (No DR) (n=22); non-proliferative diabetic retinopathy (NPDR) (n=25); and Proliferative Diabetic Retinopathy (PDR) (n=22). Healthy control subjects of similar age were included (n=22).

Main outcome measures: RI in OA and CRA.

Results: A significant increase in RI of OA and CRA was observed with increased severity of DR. A significant positive correlation of RI of OA and CRA with CST, CAT and grades of EZ disruption and a negative correlation with RNFL thickness was observed. RI of OA was found to be a significant independent predictor of severity of DR [multivariate analysis OR=0.00, p<0.001; area under receiver operating characteristic curve analysis=0.941-1.000, p<0.001].

Conclusions: Resistive index of OA is a bio imaging biomarker for the severity of DR.


Manila Khatri, Sandeep Saxena, Manoj Kumar, Apjit Kaur Chabbra, Shashi K Bhasker, Ankita, Hang Pham, Levent Akduman1 and Ece Isin Akduman

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