Baseline OCT Biomarkers Associated with Visual Acuity in Diabetic Macular Edema: A Systematic Review and...

Area of Science:

• Ophthalmology
• Medical Imaging
• Diabetic Retinopathy

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Optical coherence tomography (OCT) provides detailed retinal imaging, identifying potential biomarkers.
• Predictive biomarkers are crucial for tailoring treatment strategies in DME.

Purpose of the Study:

• To determine the association between baseline OCT biomarkers and visual acuity (VA) in DME patients.
• To assess the predictive value of OCT biomarkers for VA changes over 24 months.
• To evaluate the certainty of evidence for these associations using GRADE guidelines.

Main Methods:

• Systematic review and meta-analysis of studies evaluating OCT biomarkers in DME.
• Searched Ovid MEDLINE, EMBASE, and CENTRAL databases.
• Assessed risk of bias using QUIPS and certainty of evidence using GRADE.

Main Results:

• Twenty-seven studies included 75 biomarkers; none predicted improved VA with moderate certainty.
• Five biomarkers (hyper-reflective foci, disrupted inner retinal layers, ellipsoid zone, external limiting membrane, and COST line) were associated with worse VA at multiple time points.
• Specific OCT findings like hyper-reflective choroidal foci (HCF) and disorganization of retinal inner layers (DRIL) showed significant negative associations with VA.

Conclusions:

• Baseline OCT biomarkers, including HRF, HCF, DRIL, disrupted EZ/ELM, and disrupted COST lines, are associated with poorer visual outcomes in DME.
• These findings highlight the prognostic value of specific OCT biomarkers for disease activity.
• Standardization of biomarker classification and control of confounding factors are necessary for future research.