Clinical Scorecard: Imaging biomarkers associated with visual outcomes in diabetic macular oedema

At a Glance

Key Highlights

• In the 60-eye post hoc analysis, mean visual acuity increased from 62.9 letters at baseline to 75.4 letters at week 52.
• Baseline central subfield thickness (CSFT) independently predicted baseline visual acuity and week-52 visual acuity.
• A composite of superficial perfusion density and vessel length density was independently associated with week-52 visual acuity.
• Greater baseline volume of hyperreflective foci was independently associated with a smaller visual-acuity gain.
• The source identifies diabetic macular ischaemia assessed with OCTA as one of the strongest predictors of long-term visual outcomes.
• A meta-analysis of 27 studies and 75 candidate biomarkers found five associated with reduced visual acuity at two or more time points, with moderate certainty.

Guideline-Based Recommendations

Diagnosis

Management

Monitoring & Follow-up

• The source notes that CSFT explains only a limited fraction of variation in visual acuity; it discusses visual outcomes alongside imaging features.
• The source describes standardised OCTA acquisition and processing—including scan protocol, slab definitions, segmentation, projection-artefact removal, and binarisation thresholds—as prerequisites for comparable measurements.

Risks

• The featured analysis was limited by 60 eyes, discretionary OCTA acquisition, use of Heidelberg Spectralis scans, models accounting for 19%–32% of variance, and no adjustment for multiple comparisons.
• OCTA vascular measurements may vary by device and analysis pipeline; thresholds may not transfer between centres unless acquisition and processing are reproduced.
• The exclusion of deep vascular complex metrics from the models may reflect more consistent measurement of the superficial slab in oedematous eyes, rather than greater biological relevance.

Patient & Prescribing Data

Patients with DMO treated with anti-VEGF injections; the featured analysis used baseline imaging and week-52 visual-acuity data from 60 eyes.

The article reports associations between baseline imaging biomarkers and visual outcomes, but does not provide prescribing instructions or validated biomarker-based treatment thresholds.

Clinical Best Practices

• The source describes limited concordance between CSFT and visual acuity and discusses structural and vascular imaging features in relation to visual outcomes.
• The source notes that post hoc biomarker findings require validation and that evidential strength depends on the number of eyes included.
• The source identifies standardised imaging acquisition and analysis as prerequisites for comparable OCTA measurements.
• The source discusses prespecified imaging substudies as a way to develop exploratory signals into more reliable estimates.

Related Resources & Content

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