Optical coherence tomography biomarkers and their association with baseline visual acuity in diabetic macular edema. A cross-sectional observational study.

Dr Kaneez  Fatima; Dr G Sowmya  Sri; Dr Adiba  Fatima

doi:10.51168/sjhrafrica.v6i12.2393

Authors

Dr Kaneez Fatima Associate Professor, Department of Ophthalmology, Osmania Medical College, Hyderabad, Telangana, India
Dr G Sowmya Sri Assistant Professor, Department of Ophthalmology, Osmania Medical College, Hyderabad, Telangana, India
Dr Adiba Fatima Assistant Professor, Department of Ophthalmology, Osmania Medical College, Hyderabad, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2393

Keywords:

Diabetic macular edema, Optical coherence tomography, Visual acuity, Ellipsoid zone, DRIL.

Abstract

Background

Diabetic macular edema is a major cause of visual impairment in individuals with diabetes mellitus and remains a significant contributor to functional vision loss.

Objectives

To determine the frequency of key optical coherence tomography biomarkers in diabetic macular edema and to evaluate their association with baseline best-corrected visual acuity.

Methods

This cross-sectional observational study included 100 eyes of 100 consecutive patients with diabetic macular edema attending a tertiary care teaching hospital in South India. All participants underwent comprehensive ophthalmic examination, including best-corrected visual acuity assessment using Snellen charts, subsequently converted to logMAR units for statistical analysis. Spectral-domain optical coherence tomography was performed to document central macular thickness and qualitative biomarkers, including intraretinal cystoid spaces, subretinal fluid, ellipsoid zone disruption, disorganization of retinal inner layers, and hyperreflective foci. Associations between biomarkers and baseline visual acuity were analyzed using appropriate statistical tests, with p<0.05 considered significant.

Results

Participants were predominantly aged 41–60 years (48%) and >60 years (38%), with male predominance (62%). Diabetes duration exceeded five years in 78% of patients, and diffuse edema was observed in 71%. Moderate visual impairment (6/18–6/60) occurred in 62%. Increased central macular thickness was present in 82%, intraretinal cysts in 76%, hyperreflective foci in 57%, ellipsoid zone disruption in 44%, and disorganization of retinal inner layers in 41%. Visual acuity was significantly worse in eyes with ellipsoid zone disruption (0.92 ± 0.21 logMAR; p<0.001) and disorganization of retinal inner layers (0.95 ± 0.22 logMAR; p<0.001). Subretinal fluid showed no significant association (p=0.087).

Conclusion

Microstructural retinal disruption demonstrates strong association with poorer baseline visual acuity in diabetic macular edema.

Recommendations

Routine evaluation of prognostically relevant optical coherence tomography biomarkers should be integrated into baseline assessment to enhance risk stratification and individualized clinical decision-making.

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