Race/Ethnicity Analysis of Vascular Alterations in Optical Coherence Tomography Angiography in Diabetic Patients

ABSTRACT

Purpose

Racial and ethnic minorities have a higher prevalence of diabetic retinopathy (DR) and present at advanced stages of disease. In an urban hospital population, we investigated microvascular differences in optical coherence tomography angiography (OCTA) between racial/ethnic groups while adjusting for socioeconomic status (SES).

Methods

3 × 3 mm² macular OCTA scans were obtained for analysis of foveal avascular zone (FAZ) area, FAZ perimeter as well as superficial (SCP) and deep capillary plexus (DCP) vessel density (VD), vessel length density (VLD), and adjusted flow index (AFI). SES was measured using the Area Deprivation Index. Multivariable regression models were used to adjust estimates for relevant confounders.

Results

217 non-diabetic and 1,809 diabetic patients were included in the study, consisting of 42.2% Hispanic, 24.9% non-Hispanic (NH) Asian, 6.8% NH Black, 9.7% NH White and 16.3% Other patients. NH White was used as the reference group. Hispanic, NH Asian, and NH Black patients had significantly greater FAZ areas and FAZ perimeters, and lower DCP VD and VLD, among both non-diabetic and diabetic patients (Benjamini-Hochberg adjusted P-values <0.05). The addition of SES scores in the models did not modify any regressions significantly.

Conclusions

In patients with and without diabetes, racial and ethnic minorities have significant retinal microvasculature differences when compared to NH White patients, regardless of SES. These differences are pronounced in DCP and may predispose racial/ethnic minorities to worse outcomes in DR, thus widening disparities in ophthalmic care.

KEYWORDS:

• Optical coherence tomography angiography
• race
• ethnicity
• diabetic retinopathy
• socioeconomic status

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2024.2348050

Acknowledgments

The authors would like to thank Daphne Yang and the staff of 4 M clinic at ZSFG for their assistance in collecting patient data as well as Samuel A. Vydro for refining previous versions of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Research to Prevent Blindness Unrestricted Grant to the UCSF Department of Ophthalmology, and All May See Foundation, San Francisco, CA. In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that I am a consultant for the following companies: Zeiss, Valitor, Long Bridge, and Twenty Twenty. I have a personal financial interest in Long Bridge. These companies may be affected by the research reported in the enclosed paper. I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from my involvement in these companies.